SF Reports Latinx Majority in New HIV Diagnoses Despite Overall Drop

San Francisco’s wide embrace of HIV prevention has led to a staggering decrease in new cases of the virus, which attacks the body’s immune system. But research released Tuesday by the San Francisco Department of Public Health shows the Latinx community is bearing the brunt of new diagnoses.

Testing for HIV has slightly recovered after a sharp decline in 2020 during the COVID-19 pandemic. As the city works to maintain its decades-long progress on HIV, public health officials are noticing slight demographic shifts among populations that are most at risk — and adapting their response as a result.

“We are seeing an increase in new infections in the Latinx community,” Dr. Susan Buchbinder told KQED in an interview. Buchbinder is the co-chair of the Getting to Zero Steering Committee, an effort launched in 2013 to prevent any new HIV infections in San Francisco. “We are trying to understand ‘why’ as much as we can, and who within the Latinx community is most affected. It does seem to be men.”

The report found there were 157 new HIV diagnoses in San Francisco in 2022, a slight decrease from 2021 when there was a modest uptick. Overall, today’s new case rate for HIV infections is staggeringly lower than years and decades prior and has been largely on a downward trend.

Annual HIV diagnoses among Latinx people started to exceed all other racial groups in 2018. But in 2022, the year data for the recent study was gathered, Latino cis men in particular had more new diagnoses than any other group for the first time.

It’s not easy to attribute the shift to any one cause, Buchbinder said, but factors include access to housing and health care, as well as place of origin and whether prevention was available before arriving in San Francisco.

Claudia Cabrera-Lara, program director for HIV services at Instituto Familiar de la Raza, said that concerns around sharing one’s immigration status are another barrier for many undocumented immigrants who could benefit from HIV preventative care.

“Many of the clients we work with are undocumented, and even though San Francisco is a sanctuary city, there is a fear that their information could be disclosed,” Cabrera-Lara told KQED. “That’s why so many people aren’t getting access to prep in the Latinx community.”

Other marginalized social groups that experienced disproportionate rates of new HIV diagnoses include people who are homeless, which accounted for one in every five new cases in 2022.

“We will not be satisfied until we get to zero new infections, and more must be done,” said SFDPH Director of Health Dr. Grant Colfax, in a press release about the new report. “Breaking down barriers to provide stigma-free care that reaches the community is key, and working together across San Francisco’s robust HIV care and prevention infrastructure, we will do just that.”

In July, the Department of Public Health opened seven sites, called Health Access Points, focusing on increasing HIV prevention and treatment services for the Latinx community, African Americans, and other priority populations including people who use drugs, trans women and people who are homeless.

At the sites, people can get free testing for HIV and other sexually transmitted diseases, as well as treatment services and support with overdose prevention in a low-barrier setting, meaning they don’t need to prove any insurance or residence. The access points are located within community-based nonprofits, such as the Rafiki Coalition, the San Francisco AIDS Foundation and the Instituto Familiar de la Raza.

“We are excited to see the recent launch of the HAPs, which provide equitable access to HIV prevention, care and treatment services,” said Health Officer Dr. Susan Philip in the press announcement. “Providing comprehensive, whole-person care delivered by expert community service providers to those who have traditionally experienced barriers will help us address disparities and reduce new HIV diagnoses.”

The total number of people living with HIV who died in 2022 increased from 279 in 2021 to 312 in 2022, the report shows. Many of those deaths, however, were from causes not directly tied to HIV, and the number of late-stage HIV-related deaths has decreased.

That is, in part, because San Francisco’s population of people living with HIV is getting older and dying of other causes. They might also be at a higher risk of cardiovascular disease or rectal cancer, Buchbinder said.

“HIV prevention is not just using condoms or prep but also the many psycho-social issues affecting this population, like housing, employment, immigration and so on,” said Cabrera-Lara. “In order for people to take care of themselves, they need to take care of these other needs. That’s sometimes forgotten in the prevention effort.”

About 73% of people living with HIV in San Francisco are 50 or older, according to the report, and about 25% are 65 and older. Diagnoses among people aged 50 and older have also increased in recent years.

“We need to improve the quality of life for people living with HIV,” Buchbinder said. “They have health and psycho-social needs. It’s a large population in San Francisco, and we see deaths go up as the population ages. But we need to get rid of preventable causes of death to help them live as healthy of a life as possible.”