Speaking on behalf of the Getting to Zero Consortium, Oliver Bacon, of the University of California, echoed Michael Kharfan’s comments about the importance of framing. “We’re not trying to ‘end AIDS’ in San Francisco,” he said. “We’ve gotten quite a fair amount of push-back from the community on that.” Instead, the consortium has set goals for zero new infections, zero deaths and zero stigma and discrimination – or a 90% reduction in those things – by 2020.
As in Washington DC, the treatment cascade in San Francisco was improving before the plan was announced. There have been fewer new diagnoses and deaths since 2006, and the city has already implemented many evidence-based interventions. After CDC released new testing recommendations in 2006, HIV testing became “essentially opt-out.” The city also abandoned CD4-guided ARV initiation and began providing ART at diagnosis in 2010, after data from the SMART study and others were released. The 2011 LINKS program enhanced linkage to care city-wide and, in 2012, San Francisco participated as one of three cities in a PrEP demonstration project that created a groundswell of support for preventative medication. In 2013, the RAPID program, which attempts to link newly-diagnosed patients to HIV care within 48 hours, was tested and is now being rolled out city-wide.
The story of Getting to Zero in San Francisco is the story of collective impact.
Getting to Zero was formed as a multisector independent consortium after epidemiological data was revealed on World AIDS Day in 2013. It represents the long-term commitment of many groups across sectors to work toward a common goal: improve life for people living with and at risk of HIV without cannibalizing existing resources. Its focus is on signature initiatives, such as the RAPID program. Bacon noted that both the city and private sector have been generous in their support.
Successes of Getting to Zero include: a robust HIV surveillance branch, tracking patterns in access to services across demographic groups; access to testing and clean drug injection equipment; the fact that 94% of people living with HIV now know their serostatus; and strong linkages to public and private health care providers.
Future goals of the project include: Increased knowledge, especially among youth, people of colour, people who use injection drugs and newcomers; increased peer support; improved access to mental health, housing and substance use services, as well as immediate ART; and reduction of stigma.
Speaking as part of the same panel, Austin Padilla, one of the founding members of the consortium, explained that research projects are currently underway in San Francisco to determine who endorses stigmatizing beliefs and how people living with HIV perceive interactions with service providers, as well as to gather community feedback on experiences with and strategies for coping with or showing resilience to stigma.