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JOHN CARLOS FREY: At Ward 86, a bustling outpatient HIV clinic at San Francisco General
Hospital, nurse Diane Jones drops everything when this pager goes off. It means that someone in the city just tested HIV positive.
DIANE JONES: So, I’m going to make him an appointment.
JOHN CARLOS FREY: Jones is following a protocol called ‘RAPID’ which is designed to get new HIV positive
individuals into treatment immediately.
DIANE JONES: Just got diagnosed today, last negative was June.
JOHN CARLOS FREY: Jones scrambles to make plans for the new patient who is seen just hours later.
It’s part of an ambitious plan in San Francisco to completely end new HIV infections.
Each year about 50,000 people in the United States are infected with HIV. And while the disease has moved off the front
pages as treatment has made infection more of a manageable chronic condition, an estimated 13,700 people still die from AIDS
in the U.S. each year.
Globally, an estimated 1.5 million people are killed. It’s the 6th leading cause of death.
In San Francisco there are relatively few new HIV infections — 302 in 2014, the latest year statistics are available, and
it overwhelmingly afflicts gay men. The number of new HIV infections has been falling for eight years.
Today, public health officials, doctors, and activists are increasing their efforts to bring that number all the way down
DIANE HAVLIR: We are talking about ending the HIV epidemic.
JOHN CARLOS FREY: Dr. Diane Havlir is chief of the HIV/AIDS division at San Francisco General Hospital
and a founder of the city’s ‘Getting to Zero’ Consortium.
DIANE HAVLIR: HIV is one of the worst epidemics of its time. It’s taken a huge toll on our city, a huge
toll all around the world. We know how to prevent this disease, we know how to treat this disease. So why would we not want
to prevent every single infection, and prevent every single death?
JOHN CARLOS FREY: In San Francisco, which has spent 400 million dollars fighting HIV over the last decade,
this plan calls for controversial new drugs as well as established prevention strategies. But it starts with immediate treatment
for new HIV infections.
DIANE HAVLIR: It did, okay.
JOHN CARLOS FREY: One of Dr. Havlir’s patients, Jose, who is openly gay but asked that we conceal his
identity because his family doesn’t know about his health issue, went through the ‘RAPID’ protocol when he was diagnosed with
HIV almost a year ago.
DIANE HAVLIR: Say ahhhh.
JOHN CARLOS FREY: Within 24 hours of being diagnosed Jose was here at Ward 86, and days later receiving
JOSE: I was on medication on the third day. And undetectable within less than 30 days.
JOHN CARLOS FREY: Undetectable, meaning his HIV viral load had been reduced by medication to the point
where it couldn’t be detected.
And the faster a new patient is undetectable, the faster he reduces his chance of transmitting the virus to others. In
San Francisco, about two-thirds of HIV-positive individuals are virally-suppressed, like Jose, more than double the national
average. But that requires an enormous effort.
SANDRA TORRES: They might end up in the hospital, that’s when we’re going to meet them again.
JOHN CARLOS FREY: We followed social worker Sandra Torres on the bus as she checked up on a few patients
who needed extra help keeping up with their appointments. She and other social workers are continually tracking people down.
SANDRA TORRES: We’re going to knock on the door.
JOHN CARLOS FREY: In the gritty Tenderloin district, we went to a single-room occupancy hotel where an
HIV-positive patient was staying. He’s an intravenous drug user and not taking medication.
SANDRA TORRES: Hi Honey, how you doing?
JOHN CARLOS FREY: Torres dropped off an appointment reminder, and I asked her about the patient afterward.
JOHN CARLOS FREY: It seems like an enormous effort for one person.
SANDRA TORRES: That’s what it’s gonna take, though. That is absolutely what it’s gonna take.
JOHN CARLOS FREY: But in San Francisco, getting to zero is also banking on the expanded use of a new tool:
a drug that protects individuals from becoming infected with HIV.
It’s called Truvada.
SCOTT WIENER: If you take the pill once a day, and you take it consistently, you will reduce your risk
of HIV infection by, at least, 90 percent, and perhaps as high as 99 percent.
JOHN CARLOS FREY: Scott Wiener is an elected city supervisor and a member of the ‘Getting to Zero’ consortium.
SCOTT WIENER: It just makes sense for people to consider-this additional prevention tool. It made sense
for me. And I’m I’m glad that I’m on it.
JOHN CARLOS FREY: Wiener, who represents the largely gay Castro district and who is gay himself, went
public about his own use of the drug regimen last Fall and makes taking the once-a-day-pill part of his routine each morning.
SCOTT WIENER: My decision to disclose is really to raise awareness, so more people know about it and look
into it, to try to increase access and provide momentum– for better access and to try to reduce stigma. So whatever stereotypes
people have, maybe we can help break those stereotypes.
JOHN CARLOS FREY: Including the stereotypes raised by some critics that taking a pill that prevents HIV
infection would lead to more promiscuous behavior.
JOHN CARLOS FREY: We’re talking about a drug that in some circles has a stigma of opening the door to
a free-wheeling sex society. HIV’s no longer a threat and we don’t have to worry about unprotected sex. Do you get any of
SCOTT WIENER: There are some people who have that view. And it’s really the same argument as when people
would argue if you give women access to the birth control pill, you’re just gonna encourage them to be promiscuous.
Or if you vaccinate young girls against HPV you’re gonna turn them into, I think one person said, “You’ll turn them into
Or if you give Sex Ed to high-school students or middle-school students you’re gonna encourage them to be promiscuous.
These are completely specious arguments. This is about giving people every tool available to protect their sexual health.
JOHN CARLOS FREY: The Food and Drug Administration approved the drug Truvada for HIV prevention three
years ago. And last year The Centers for Disease Control issued guidelines recommending the drug for anyone with a substantial
risk of HIV infection.
In San Francisco, researchers believe that wider adoption of Truvada could dramatically reduce new HIV infections.
JOHN CARLOS FREY: In a study published in September, San Francisco’s largest private health insurer, Kaiser
Permanente, found that not one of its 657 clients taking Truvada had become infected with HIV during an observation period
of more than two years.
Another study published this month in the Journal of the American Medical Association showed similar results: out of 437
individuals taking Truvada for a year, only 2 contracted HIV after not properly taking the drug
But so far only a few thousand San Franciscans have taken Truvada in the last year. So why isn’t the use of this drug more
There are some side effects, as well as speculation that doctors may be hesitant to prescribe a preventative drug to healthy
patients, and then there’s the price. Although covered by most insurance, Truvada, is listed at more than $1000 a month
Even so, it’s not nearly the solution that its proponents make it out to be according to Michael Weinstein, president of
the AIDS Healthcare Foundation, one of the largest AIDS organizations in the world.
MICHAEL WEINSTEIN: I think the evidence shows that it is not a good public health strategy.
JOHN CARLOS FREY: Why is that?
MICHAEL WEINSTEIN: Well, because people don’t adhere.
JOHN CARLOS FREY: While studies have shown that the regimen can be over 90% effective when taken everyday,
Weinstein points out that the efficacy drops off when people miss their daily dose. He also says that relying on a pill instead
of a condom may lead to a rise in other sexually transmitted diseases.
MICHAEL WEINSTEIN: The motivation that people have for taking Truvada is to be able to have sex without
JOHN CARLOS FREY: Do you think that people don’t want to wear condoms either?
MICHAEL WEINSTEIN: I think men in general don’t wanna wear condoms. That’s just an absolute truth. I mean,
and it’s not surprising. But, you know, we don’t wear seatbelts either, you know, or helmets or a lot of other things. But
they’re a necessity.
JOHN CARLOS FREY: So wouldn’t it be better then to just take a pill every day instead of worrying about
MICHAEL WEINSTEIN: You know what? If it was guaranteed that everybody would take it every day as prescribed.
Obviously our attitude about it would be completely different if we didn’t have to rely on the person to take that pill every
JOHN CARLOS FREY: While Kaiser Permanente’s recent study of Truvada users found that none had contracted
HIV, it also showed that 41 percent of participants reported a decrease in condom use, and after one year of Truvada use,
50 percent were diagnosed with another STD.
JOHN CARLOS FREY: San Francisco Department of Public Health Chief Barbara Garcia says the city is working
to make sure the drug is taken as prescribed, and that doesn’t lead to other safe sex practices being abandoned.
BARBARA GARCIA: We have already started in trying to educate young people, particularly about this. And
that’s one of the challenges of having even if we had a cure, that would be the same challenge we would have.
JOHN CARLOS FREY: Do you see that happening though? I mean, obviously, if you’re having unsafe sex, you’re
going to be transmitting other sexually-transmitted diseases here
BARBARA GARCIA: And, in fact, we’ve seen a little bit of a rise in S.T.D. here in San Francisco. And we’re
addressing that as well.
JOHN CARLOS FREY: It’s not clear that an increase in STDs is related to an increase in the use of Truvada.
And Garcia is committed to the drug regimen being a part of ‘Getting to Zero’ in San Francisco. And believes that the city’s
approach to ending HIV, including the lives and money it will save, will eventually trump any controversy.
JOHN CARLOS FREY: You can prove to them that you can save money by your model?
BARBARA GARCIA: Absolutely. An H.I.V. prevention versus an H.I.V. positive client in care, yes, we can.
JOHN CARLOS FREY: San Francisco has made tremendous advances in battling an epidemic that his this city
harder than most. And according to Dr. Havlir actually getting to zero is within reach.
DIANE HAVLIR: I think we would all acknowledge that it is going to be difficult to do, but I think if,
as we say, if anybody can do it, we think that we can show people how it can be done starting here.
JOHN CARLOS FREY: San Francisco’s Mayor Ed Lee announced last month that he is allocating $1.2 million
a year for “Getting to Zero.” The funding will increase rapid testing programs, expand the use of Truvada, and enlarge the
number of HIV positive patients who receive care.
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Francisco bolsters anti-AIDS campaign with new funding appeared first on PBS