New HIV cases continue to decline in San Francisco. Last year, 166 people were diagnosed with HIV in the city, marking a 19% decrease from 2018, when 204 people were diagnosed. This is the lowest level the city has seen.
What’s more, according to The Bay Area Reporter, new cases dropped across population groups, including Black and Latino men, a cohort that had seen upticks in HIV rates. The good news was tempered, however, by concerns that COVID-19 and related disruptions (including health care and HIV prevention efforts) could threaten the encouraging drop in diagnoses.
“We think the decline in new infections is likely a result of improved linkage of people living with HIV into care and getting them virally suppressed. Once someone is fully virally suppressed, they cannot transmit HIV to their sexual partners,” Susan Buchbinder, MD, director of Bridge HIV at SFDPH, told the newspaper, referring to what’s generally known as U=U, or Undetectable Equals Untransmittable.
“Pre-exposure prophylaxis [PrEP] is also likely playing a role in driving down new infections,” Buchbinder added.
As the Bay Area Reporter noted, 95% of people newly diagnosed with HIV were connected to care within a month, and 81% of them were undetectable within a year. Thus, San Francisco moves closer to meeting the goals of its “Getting to Zero” initiative: zero new cases of HIV, zero HIV-related deaths and zero HIV stigma.
Although HIV rates are falling among various populations, disparities persist. African-American men and women are disproportionately affected, as are people who are homeless and those who inject drugs.
Below are the main takeaways from the SFDPH annual HIV report:
Trends and Disparities in New HIV Diagnoses
- New HIV diagnoses declined 19% from 204 diagnoses in 2018 to 166 diagnoses in 2019. This compares with a 13% decline between 2017 and 2018.
- Rates of new diagnoses for both African-American and Latino men declined in 2019 after annual increases between 2016 and 2018.
- African-American men and women had the highest HIV diagnosis rates by race, with rates of 79 per 100,000 people and 22 per 100,000, respectively, followed by Latino men and women.
- The number and proportion of diagnoses among people who inject drugs declined in 2019 after annual increases between 2015 and 2018.
- The number and proportion of diagnoses among people experiencing homelessness declined in 2019 after annual increases between 2016 and 2018.
- HIV diagnosis rates were higher among people who live in areas with a higher percentage of residents living below the federal poverty level, a higher percentage with less than a high school education and a lower median household income.
Trends and Disparities in HIV Care Outcomes
- 95% of new diagnoses in 2019 were linked to care within one month of diagnosis, compared with 90% in 2018.
- 81% of new diagnoses in 2018 were virally suppressed within 12 months after diagnosis, and the vast majority were virally suppressed within six months of diagnosis.
- Median time from diagnosis to first care visit declined from seven days in 2015 to two days in 2018.
- Median time from diagnosis to viral suppression declined from 79 days in 2015 to 46 days in 2018.
- Compared with the overall proportion of viral suppression among people living with HIV (75%), viral suppression was lower for women (71%), African Americans (70%), people who inject drugs (66%), men who have sex with men and who also inject drugs (69%) and trans women who have sex with men and who also inject drugs (67%) and was particularly low among people experiencing homelessness (39%).
- Three-year survival following an AIDS diagnosis was lowest among African Americans (82%) compared with other races and among people who inject drugs (79%) compared with other transmission categories.
- The proportion of HIV-related deaths declined from 44% in 2014 to 29% in 2018.