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40th Anniversary of the HIV/AIDS Epidemic: The Current State in San Francisco.

Updated: Aug 23, 2022

By Eduardo Morales, Ph.D.


The Centers for Disease Control and Prevention first reported the first cases of HIV/AIDS in the U.S. during June of 1981. In the recent release of their 2020 Annual Report by the San Francisco by the Department of Public Health (SFDPH), it noted gradual declines in new HIV/AIDS cases. However, the data is compromised by the lack of public accessing HIV testing during the COVID-19 pandemic. A rally was held at steps of SF City Hall on Monday, March 21, 2022, and called on San Francisco leaders to take back HIV as a major priority. San Francisco employed strategies to respond to COVID-19 built upon novel comprehensive approaches used for HIV/AIDS. Meanwhile, the SFDPH 2020 Annual Report notes important differences by ethnicity and race.

According to the US Census Bureau as of April 1, 2020, the San Francisco population (N=873,965) estimates are 52.8% White alone with 40.2% being White alone, not Hispanic or Latinx, 36.0% Asian alone, 15.2% Hispanic or Latinx, 5.6% Black or African American alone, 4.5% two or more races, and 1.2% being of other ethnicities and races. In sharp contrast the 2020 Annual Report notes newly diagnosed HIV cases (N=131) were reported to be 37% Latinx, 28% White, 21% Black/African American, 11% Asian/Pacific Islander, 2% Native American and 1% were other/unknown race and ethnicity. For Black/African Americans this is more than triple the population estimate of 5.6%. Meanwhile for Latinxs this is more than double the San Francisco population estimate of 15.2% Latinx persons.

When examining data of those living with HIV in 2020 (N=15,811), 57% are White, 21% are Latinx, 12% are Black/African American, 4% are Asian/Pacific Islander, 3% are other/unknown race and ethnicity and less than 1% are Native American. Here again Black/African American are more than double while Latinxs are higher than the expected 15.2% when compared to the US Census data. Persons diagnosed with HIV/AIDS were more likely to be men. In 2020 San Francisco newly diagnosed persons had higher proportions of women, Black/African Americans, Latinx, Asian/Pacific Islanders, trans women who have sex with men, persons who inject drugs and heterosexuals.

Data for California in 2019 in this report noted more dramatic differences by race and ethnicity. For newly diagnosed cases in California (N=4,396) 48% were Latinx, 25% were White, 18% were Black/African American, 6% were Asian/Pacific Islander, 3% were other/unknown, and less than 1% were Native American. For those living with HIV in California (N=137,785) 38% were Latinx, 37% were White, 17% were Black/African American, 4% were Asian/Pacific Islander, 3% were other/unknown and less than 1% were Native American.

Overall, in the past decade, Latinx persons in San Francisco had the largest proportional increases of newly diagnosed cases while the proportion of new diagnosed cases among Whites declined. For years 2011 through 2020, most of the newly diagnosed HIV cases were men who have sex with men. By age groups, 30-39 years old accounted for the highest proportion of diagnose each year, while in 2019 and 2020 persons diagnosed at age of 50 years and older increased. No children below age 13 were diagnosed with HIV during 2011 to 2020. However, as of 12/31/2020 Latinx adolescents and young adults accounted for 41% of young adults living with HIV in San Francisco.

HIV among trans women (N=96) from 2011 to 2020 accounted for 3% of all new HIV diagnoses with 43% of these being Latinx, 26% being Black/African American, 15% being White, 10% being Asian/Pacific Islander, and 6% being other/unknown. Among the 420 trans women living with HIV in San Francisco, Latinx were 37% and Black/African Americans were 30%.

The SFDPH 2020 Annual Report on HIV Epidemiology contains much detailed information and is accessible to download from the website. In examining the HIV/AIDS epidemic in San Francisco and throughout California, interventions must be culturally specific and linguistically diverse. Medications used to prevent infection commonly referred to as PrEP varies due to inconsistencies in taking these medications to prevent infection across California according to newly funded state grantees. Also PEP medications are available if one suspects to be infected within a 72-hour window. While those with HIV and taking HIV medications are less likely to infect others, the use of condoms continues to be recommended as well as not sharing needles. There are numerous cofactors affecting the spread of HIV. This report by SFDPH provides good comprehensive information. However, throughout California and the U.S. HIV/AIDS needs more attention especially given the complications of COVID-19 and other unforeseen diseases that complicate our general health.


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