Cautious optimism in San Francisco as new HIV cases among Latinos decline

For years, Latinos accounted for the majority of new HIV cases in this city, but testing data suggests the tide may be turning.

According to a preliminary report released in July by the San Francisco Department of Public Health, the number of Latinos testing positive for HIV fell by 46% from 2022 to 2023.

The decline could mark the first time in five years that Latinos don’t account for the largest number of new cases, leading to cautious optimism that the millions of dollars the city has spent to address the troubling disparity are working. But outreach workers and health care providers say there’s still work to be done to increase HIV prevention and testing, especially among new immigrants.

“I have great confidence in it, but that doesn’t mean we’re going to give up our efforts in any way,” said Stephanie Cohen, who leads the city’s HIV program.

Public health experts said the city’s latest report may be encouraging, but that more data is needed to know whether San Francisco has addressed disparities in its HIV services. For example, it’s still unclear how many Latinos have been tested or whether the number of Latinos exposed to the virus has also declined — key health metrics that the public health department declined to provide to KFF Health News. The city also said testing rates are below pre-pandemic levels.

“If we see fewer Latinos being reached with testing when it is needed, that points to a serious challenge in responding to HIV,” said Lindsey Dawson, associate director of HIV policy and director of LGBTQ health policy at KFF, a nonprofit health information organization that includes KFF Health News.

San Francisco, like the rest of the country, struggles with stark disparities in diagnosis rates for Latinos and people of color. Outreach workers say recent immigrants are more vulnerable to infectious diseases because they don’t know where to get tested or because they have trouble navigating the health care system.

In 2022, Latinos accounted for 44% of new HIV cases in San Francisco, despite making up just 15% of the population. Latinos’ share of new cases dropped to 30% last year, while whites accounted for the largest share of new cases at 36%, the new report found.

Cohen acknowledged that a one-year decline isn’t enough to show a trend, but she said targeted funding for community organizations may have helped lower HIV rates among Latinos. A final report is expected in the fall.

Most cities rely primarily on federal dollars to pay for HIV services, but San Francisco has an ambitious goal of becoming the first U.S. city to eliminate HIV, and about half of its $44 million HIV/AIDS budget last year came from city coffers. By comparison, New Orleans, which has similar HIV rates, provided just $22,000 of its $13 million HIV/AIDS budget, according to that city’s health department.

As part of an effort to address HIV disparities among LGBTQ+ communities and people of color, San Francisco last year donated $2.1 million to three nonprofits: Instituto Familiar de la Raza, Mission Neighborhood Health Center and San Francisco AIDS Foundation. The organizations aim to improve HIV education, testing and treatment for Latinos, according to the city’s 2023 budget.

At Instituto Familiar de la Raza, which manages the contract, the funding has helped pay for HIV testing, prevention, treatment, outreach events, counseling and immigration legal services, said Claudia Cabrera-Lara, director of the HIV program at Sí a la Vida. But continued funding is not guaranteed.

“We live with the fear of not knowing what will happen,” she said.

The Department of Public Health has launched a $150,000 project with Instituto Familiar de la Raza to determine how Latinos contract HIV, who is most at risk and what health disparities remain. Results are expected in September.

“It can help us shape, adapt and grow our programs to be as effective as possible,” Cohen said.

San Francisco was at the center of the HIV epidemic in the mid-1980s and set a national model for dealing with the disease. The city built a network of HIV services where residents could receive free or low-cost HIV testing and treatment, regardless of their health insurance or immigration status.

While the city’s testing data showed new cases among Latinos declined last year, outreach workers are seeing the opposite. They say they’re seeing more Latinos diagnosed with HIV while struggling to get information about testing and prevention, such as taking preventive medications like PrEP, especially among the city’s young and gay immigrant communities.

San Francisco epidemiological data from 2022 shows that 95 of the 213 people diagnosed with late-stage cases of the virus were foreign-born. And the diagnosis rate among Hispanic men was four times higher than the rate among white men, and 1.2 times higher than that of Black men.

“It’s a tragedy,” said Carina Marquez, an associate professor of medicine in the division of HIV, infectious diseases and global medicine at Zuckerberg San Francisco General Hospital, the city’s largest provider of HIV care. “We have such great tools to prevent and treat HIV, but we’re seeing this stark disparity.”

Because Latinos are the least likely ethnic group to receive care in San Francisco, health care providers want the city to increase funding to further reduce HIV disparities.

The San Francisco AIDS Foundation, for example, would like to have more bilingual sexual health workers. The foundation currently has four, to cover areas where Latinos have recently settled, said Jorge Zepeda, director of Latine Health Services.

At Mission Neighborhood Health Center, which operates Clinica Esperanza, one of the largest providers of HIV care for Latinos and immigrants, the number of patients seeking help has increased from about two per month to about 16 per month.

Connecting patients with bilingual mental health and substance abuse services is key to keeping them in HIV care, said Luis Carlos Ruiz Perez, the clinic’s HIV medical case manager. The clinic wants to do more advertising for its testing and treatment services, but doesn’t have the money to do so.

“A lot of people don’t know what resources are available. Period,” said Liz Oates, a health systems navigator for the Glide Foundation who works on HIV prevention and testing. “So where do you start if no one is engaging you?”

2024 KFF Health News. Distributed by Tribune Content Agency, LLC.