Will We Get to Zero HIV Stigma in San Francisco?

Cities worldwide are striving to get to zero HIV stigma as a condition to get to zero new infections. We tracked an indicator of perceived HIV stigma across surveys of men who have sex with men (MSM) in San Francisco from 2011 to 2017. Little improvement in perceived HIV stigma was observed, from 22.3% (95% CI 18.7-26.3) of MSM agreeing with the statement "Most people would discriminate against someone with HIV" in 2011 to 21.0% (95% CI 17.5-24.9) in 2017 (χ2 test for trend 0.252, p = 0.616). Success in ending the epidemic may flag without addressing the causes of HIV stigma.

High and Stable Human Immunodeficiency Virus Prevalence Among Transwomen With Low Income Recruited With Respondent-driven Sampling, San Francisco, 2010-2016.

BACKGROUND: Studies have documented high human immunodeficiency virus (HIV) prevalence among transwomen in the United States; however, to our knowledge, no studies have documented trends in HIV prevalence in this population. METHODS: We used respondent-driven sampling to sample transwomen in San Francisco for 3 HIV prevalence and behavioral surveys in 2010, 2013, and 2016. Our analysis of point estimates and trends were weighted for the sampling method. RESULTS: Human immunodeficiency virus prevalence by serological testing in the survey was 38.8% (95% confidence interval [CI], 32.4-45.2), 33.7% (95% CI, 25.9-41.5), and 31.6% (95% CI, 12.2-38.1) in 2010, 2013, and 2016, respectively. Disparities in higher HIV prevalence by black, Latino, and Asian race/ethnicity and lower education level persisted through 2016. CONCLUSIONS: Based on a statistical test for trend, HIV prevalence among transwomen has remained high and stable from 2010 to 2016. Human immunodeficiency virus infection is still highest at 31.6% compared to any other group in San Francisco. We also observed that older transwomen had significantly higher odds of living with HIV than younger women over the last 2 waves of data collection. Taken together, these trends suggest that there is declining incidence of new HIV infections among low-income transwomen in San Francisco. Moreover, among transwomen, HIV disproportionately affects transwomen of color.

Efforts to Find Heterosexual HIV in San Francisco, 2007-2013.

Nationally heterosexuals are an HIV prevention priority. In addition to case based HIV surveillance, behavioral surveillance surveys are conducted among heterosexuals living in high AIDS morbidity neighborhoods. We report on risk behaviors and HIV prevalence among "high-risk" heterosexuals in San Francisco. National HIV Behavioral Surveillance System is coordinated by the CDC and implemented in 21 health jurisdictions. The studies were conducted in 2006, 2010 and 2013 in San Francisco. Respondent driven sampling was used to sample participants. Eligible persons were 18-50 years old and had sex with at least one opposite gender partner in the past year. We obtained samples of 371, 421, 165 heterosexuals in 2007, 2010 and 2013, respectively. Some demographics varied across the 3 years. Residential neighborhoods changed, homelessness and healthcare coverage increased. Binge drinking, cocaine and heroin use increased while methamphetamine use declined. There were no changes in numbers of partners, unprotected vaginal intercourse or unprotected anal intercourse. Commercial sex work increased. Even with "fine tuning" of eligibility criteria to attempt to find heterosexual HIV cases, we estimate that HIV prevalence was 0.3, 0.2 and 2.4 % in 2007, 2010 and 2013 respectively. The increase was not statistically significant. For the present, effective prevention among persons in the populations most severely affected by HIV remains the priority, for their own benefit and to prevent transmission to other vulnerable populations to which they may be connected.

A new trend in the HIV epidemic among men who have sex with men, San Francisco, 2004-2011.

BACKGROUND: In San Francisco, men who have sex with men (MSM) have historically comprised 90% of the HIV epidemic. It has been suggested that given the ongoing HIV transmission among this population, there is the possibility of a high-level endemic of HIV into the future. We report on the possibility of another phase in the HIV epidemic among MSM in San Francisco. METHODS: Behavioral surveillance systems monitor HIV prevalence, HIV incidence, and behaviors among populations at high risk for HIV infection. Among MSM, time-location sampling is used to obtain samples for standardized behavioral surveys, HIV-antibody and incidence testing. We analyzed National HIV Behavioral Surveillance data from MSM sampled in 2004, 2008, and 2011. RESULTS: Three hundred eighty-six, 521, and 510 MSM were enrolled in each of the waves. Only slight changes were seen in demographics over time. We detected significant declines in unrecognized HIV infection and methamphetamine use, a significant increase in HIV testing in the past 6 months, and no changes in HIV prevalence, history of gonorrhea infection, or having multiple sex partners. Among HIV-infected men, current antiretroviral treatment (ART) use seems to have risen from 2008 to 2011. CONCLUSIONS: The trends of the last 7 years point to stable HIV prevalence as rising ART coverage results in improving survival coupled with decreasing incidence as ART use achieves viral load suppression at levels more than sufficient to offset ongoing sexual risk behavior. "Treatment as prevention" may be occurring among MSM in San Francisco.

Using social networks to reach Black MSM for HIV testing and linkage to care.

Black men who have sex with men (MSM) are disproportionately affected by HIV infection. Black MSM in San Francisco may have higher rates of unrecognized HIV infections. Increased HIV testing among Black MSM may reduce the numbers of unrecognized infections, inform more men of their status and thus reduce the potential for ongoing transmissions. Social network HIV testing programs have focused on asking HIV-positive and/or high-risk negative men to recruit their social or sexual contacts. We used a network approach to deliver HIV testing to Black MSM in San Francisco and collected risk assessment data. Participants were asked to recruit any of their social contacts who were also Black MSM. Recruitment by risk level and HIV status was heterogeneous. HIV infection among this population is associated with older age, having a high school education or higher and currently being homeless. Fully 23% of HIV positive Black MSM are unaware of their infection. Only a third of unrecognized infections were recruited by a known HIV-positive participant. Linkage to care was a challenge and underscores the need for comprehensive systems and support to link Black MSM to care and treatment.