With Federal Help, Alameda County and SF Hope to Cut Rate of HIV Infections

Alameda County is one of 48 counties handpicked by federal public health officials to receive extra resources to end the spread of HIV over the next decade — and getting that done will take creative, grassroots approaches, local AIDS activists said Friday at a meeting with national leaders.

Under a federal strategy announced by President Trump earlier this year, the U.S. Health and Human Services department has promised to pour money and other resources into communities that continue to be hardest hit by HIV. The counties chosen for the first round of funding — which has not yet been determined — account for more than half of all new HIV diagnoses in the United States.

Eight of those counties are in California, including Alameda and San Francisco counties. San Francisco since the earliest days of the AIDS epidemic has been among the hardest hit areas in the country, and its rate of new diagnoses remains relatively high compared with other cities and counties.

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But San Francisco has made dramatic progress in slowing down transmission of HIV — the number of diagnoses plummeted from 532 in 2006 to 221 in 2017, dropping every year since 2007. Meanwhile, Alameda County has struggled: The county had 283 new HIV diagnoses in 2006 and 207 in 2017, and the numbers have hopped up and down over the past decade. Alameda County has roughly twice the population of San Francisco.

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Still, Rep. Barbara Lee, D-Oakland, told community leaders on Friday that Oakland is no “shadow city” to San Francisco, and she commended the work being done by local nonprofits to reach the most vulnerable corners of the city and county.

“We’re not comparing ourselves to San Francisco,” Lee said. “You all have done phenomenal work with minimal resources. We have this new initiative in 48 counties to end transmission by 2030, and Alameda County is going to be the first one to get there.”

Lee joined Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, to ask HIV patient advocates and activists in Oakland what tools they need to end the epidemic in Alameda County.SUBSCRIBER BENEFITDid you know you have 10% off at San Francisco Wine School?

Their answers mostly focused on educational campaigns and clinical programs that are specific to the people most at risk of contracting HIV in Alameda County, which is a somewhat different demographic than San Francisco.

In Alameda County, black men make up the single largest group of people newly diagnosed with HIV.

Redfield seemed particularly interested in why more people in Alameda County aren’t using drugs that can protect them from HIV. The drugs, known as pre-exposure prophylaxis, or PrEP, have been widely embraced in San Francisco and are considered a major part of the city’s plan to end the spread of HIV.

But uptake has been much slower in Alameda County, along with many other parts of the country, Redfield noted. To end transmission, more people are going to need to take PrEP, but it’s going to require community-based campaigns to make that happen, local leaders told him.

“We need to reevaluate our community approaches,” said Carla Dillard Smith, executive director of Women Organized to Respond to Life-Threatening Diseases, an HIV-focused nonprofit that hosted Redfield and Lee at its offices in Oakland on Friday.

She told Redfield and Lee that most of the federal campaigns designed to push PrEP focus on men who have sex with men, a group that has traditionally been most at risk of contracting HIV. But those campaigns don’t necessarily work for women or for men who don’t consider themselves gay.

Federal programs also don’t take into account the immense effort it can take to reach people with HIV, or those at risk of infection, who may also be homeless or facing other hardships. That’s a problem in both Alameda and San Francisco counties, where homeless people are not only more likely to contract HIV but to suffer serious health problems once they’re infected.

HIV cannot be cured, but with drug therapy it can be well managed. In fact, with treatment the level of virus in the blood can be so low that there is no risk of spreading HIV to others. But getting people into care can be challenging, especially if they’re homeless or otherwise disadvantaged.

“Our community is dealing with homelessness and housing insecurity and financial instability. Our community is also touched by homophobia and stigma and racism,” said Nicholas Moss, director of the HIV and STD section with the Alameda County Public Health Department. “We need to find better ways to help people get the help they need.”