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Getting to Zero in San Francisco

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AIDS Conference

Scott Wiener, Supervisor of District 8, talks about what the HIV epidemic looks like today in San Francisco

Photo: Jeffrey Chen

 

By Jeffrey Chen, MS1

In 1981, the world’s first inpatient AIDS unit opened at San Francisco General Hospital (SFGH). At the time, Ward 86 was infamously a place where emaciated, young gay men would go to die. Nobody knew what caused this mysterious new disease, let alone how to treat it.

Fast-forward to December 2, 2013. Commemorating World AIDS Day, HIV experts and educators gathered at the San Francisco LGBT Community Center to give an update on the fight against the once-menacing virus. The theme of the forum, “Getting to Zero in San Francisco”, illustrated just how far the picture had shifted.

“We’re moving towards the end of the HIV epidemic,” said Diane Havlir, MD, chief of the HIV/AIDS division and Positive Health Program at San Francisco General Hospital, in her opening remarks. “Ending AIDS is a bold aspiration, but we can be the first community that gets to zero.”

The forum gave community members a chance to learn from UC San Francisco (UCSF) physicians and from representatives from the San Francisco AIDS Foundation, Project Inform, and the Department of Public Health, about the history of the epidemic in the city and current initiatives aimed at stopping it.

Today, nearly 16,000 San Franciscans are living with HIV, and public health officials still count over 400 new cases each year. However, with the numerous testing centers and clinics the government has set up throughout the city, the disease is consistently detected at earlier stages here than in the rest of the country, which makes it more treatable.

San Francisco leads the country in treatment and prevention of AIDS and HIV. Up until four years ago, physicians waited for weeks, sometimes months after detecting the virus before starting a patient on drugs. Anti-HIV medications had significant side effects, so doctors would only start treatment if the patient’s immune system had deteriorated to a certain point. Nowadays, thanks to studies done at UCSF, physicians are realizing the benefits of starting treatment as soon as possible.

Vivek Jain, MD and Hiroyu Hatano, MD, MHS, both faculty in UCSF’s Positive Health program, consider this “test and treat” paradigm key to curbing the HIV epidemic. As part of a new initiative, they carry around pagers that light up when somebody tests positive for HIV at one of the many testing centers throughout the city.

Previously, patients would have to wait days and contact their primary care providers—if they even had one—before starting treatment. “Now, when we’re on call, we can get a patient history, run some basic labs, and then hand them a cup of water and a few pills all on the same day as the positive test,” explained Hatano.

Such early treatment has been proven to avoid complications that can result from infection. How well it will prevent the spread of HIV and curb the epidemic in San Francisco remains to be seen.

What is clear is that these efforts, combined with continued community-building, advocacy, and stigma reduction, will maintain UCSF’s and SFGH’s central role in leading the national and international fight against AIDS. Working with the community and with government organizations, we can help move the city, which in the 1980’s was the epicenter of the HIV epidemic, closer and closer to zero.