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How San Francisco Plans to Reduce New HIV Cases to Zero

The city is turning in part to a controversial drug to eliminate the spread of the disease.




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Three hundred and fifty-nine. That’s the number of new HIV/AIDS cases reported in San Francisco in 2013.

Zero. That’s the number of new cases that San Francisco is aiming for. The city that was the epicenter of the modern AIDS crisis wants to be the first to entirely eliminate its spread. It’s a potent and poignant goal, but new cases of HIV/AIDS continue, disproportionately affecting minorities, the poor, and those with other diseases or substance abuse issues. So how do we get from the first number to the second?

Part of the answer lies in prevention—promoting safe sex and regular STD testing. Part of it lies in halting the spread of disease by responding rapidly to new cases: For example, on the very day of a positive diagnosis, a San Francisco patient can be tucked into a taxi and ferried to Ward 86, UCSF’s pioneering division of HIV/AIDS treatment. 

The third element of the strategy—called a pre-exposure prophylaxis (PrEP) regimen—is a daily pill for uninfected people at risk for HIV that all but eliminates their chance of contracting the disease. Critics of the controversial pill, called Truvada, point out that it could become a party drug, warning that it doesn’t work unless taken daily and that people using it might abandon condoms. But San Francisco begs to differ: With support from supervisors David Campos and Scott Wiener (who himself takes the pill), the city has allocated $300,000 to make Truvada more affordable (the pills are covered by Medi-Cal and many health plans, but their cost—up to $1,000 a month—is prohibitive for many).

A recent study by the San Francisco Department of Public Health found 533 San Franciscans at high risk for HIV (men who have sex with men and transgender women) who qualified for a PrEP regimen of Truvada. Of those, 300 have enrolled in a nearly yearlong course of Truvada treatment, the results of which are not yet available.


Originally published in the June issue of San Francisco

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