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Plan To Eradicate HIV/AIDS From San Diego County Advances

HIV particles (red) invade a human immune cell. When HIV is transmitted through sex, only the strongest establish long-term infection.
Chris Bjornberg Science Source
HIV particles (red) invade a human immune cell. When HIV is transmitted through sex, only the strongest establish long-term infection.

Plan To Eradicate HIV/AIDS From San Diego County Advances
San Diego Sets Ambitious Goal To Eliminate HIV/AIDS GUESTS:Terry Cunningham, chair, HIV Health Services Planning Council Patrick Loose, director, HIV, STD, and Hepatitis branch, San Diego County Department of Health & Human Services

This is KPBS Midday Edition, I am Maureen Cavanaugh. Can San Diego County reduce new transmission rates of HIV AIDS to zero? The goal of the new initiative approved by the San Diego County of supervisors. It includes media outreach and improved coordination among health care providers in the County. And the getting to zero initiative also wants to make HIV screening a routine part of medical checkups. Joining me is Patrick Loose director of the HIV, STD, and Hepatitis branch of San Diego County Department of Health & Human Services . Patrick, welcome to the program. Think you Maureen. And we also have Terry Cunningham the chair HIV Health Services Planning Council . How many people are living with the virus? We estimate that currently about 20,000 people here in the county are living with HIV. Are there some people who have do not know it ask back yes. Yes. Completely unaware an obviously not being treated? That is correct. What about transmission rates, are they going all or down? They have been going down since 1990. However, over the past four years they have rounded out in we are at about 480 new cases per year which is an average of one new diagnosed infection every 18 hours. What populations are the most affected? We are little different than the rest of the country. The County of it typically occurs in gay men and men who have sex with other men's. In that group, we know that the Mayor -- African-American men are disproportionally impacted. Why is getting to zero the name of this initiative? It was the goal that was set by the United Nations for world he'd stay -- worlds AIDS Day from 2015. It has been a movement for the last five years. And it encompasses a great deal of work and information to be done in order to make sure that those people that don't know that they are infected find out there status. -- Their status. You have done a great deal of work in this whole initiative. Is there any community that has gotten close to zero in promoting this getting to zero initiative? There are a lot of communities that are working toward it. But no one has really got to zero at this time. San Francisco has adopted this model. And they are working toward it. Definitely toward 90% decrease by 2020. Of course, we want to me really bad and make sure that we are -- want to mirror that and make sure we are close to zero. What are the main areas in which San Diego has to get better in its HIV, AIDS prevention? Need to get more awareness campaigns going so that the general community realizes that AIDS is still here. It's still an epidemic. Many people think that their anti-retroviral drugs, that this epidemic is over and you just need to take a pill. That is not true. HIV is basically lying in wait and could research at any time. We really need to get into communities, make sure that they understand that people need to be tested. A lot of people don't know that they have HIV because the manifestation of the disease doesn't happen for 10 years to 15 years, and people can be infected that whole period of time and have no idea that they have got the disease. I would imagine that most people have already been aware of public awareness campaigns, media campaigns about safe sex and so forth. Is this directed to get people who perhaps did not go through the first couple of waves of HIV and AIDS awareness? There is definitely that, but we are also seeing a resurgence of AIDS in the older populations also. Whether it's AIDS fatigue, hearing so much about it and being part of the community in the early days of the epidemic when it was incredibly horrific. And just having AIDS fatigue and not paying attention to the messages that they've already heard. And to that I would like to add when we look at heterosexual transmission which understandably is a small portion of our population. But when we look at heterosexual -- heterosexuals over the age of 50 and under the age of 50 cut the rate is three times as higher for individuals over 50. These are individuals who never understood what risk for HIV really was. There is a need to reach up broad community in San Diego. And those could also believe that it may never happen to them. That is right. Patrick hasn't the CDC been recommending that HIV screening become a routine part of healthcare for a while? In September 2006, the CDC issued guidelines with a recommended routine testing of all adults in America or settings and actually an individual over the age of 13. Why has that not happened? There are a couple reasons why that has not happened. When is that there is a disconnect between the provider and the payer. There is not clarity in some healthcare systems that this should happen. There is also discomfort on the part of some providers to have these conversations. Even now? Oh, yes. So some healthcare providers themselves don't want to bring up the subject? Right. It is not a comfortable conversation to have about a person's sexual life which is unfortunate. To be fair, a lot of primary care physicians we talked to say I have 15 minutes with my patient. I have 100 things that have to talk about with my patient. I don't see how I can fit the sin. Patrick, would affect to think routine screening would have on transmission of HIV? When the CDC made the recommendation cut the deck to two screening programs that dramatically change the field of HIV. The first was the implementation of screening of all the blood supply. Because of that, we a virtually eliminated any transfusion related HIV transmission. The second is routine testing of all pregnant women. Because we now routinely test all pregnant women for HIV without regard to risk top we have dramatically reduced the number of cases of mother to child transmission. In San Diego County, we only have about one or 2 cases of this year. So that could have a big impact? Yes. When people are informed of their status, the change their behavior and reduce the likelihood that they will transmit the virus. Terry, another one of the task force is folks who are out of care that have the disease, what strategies would make that work? Patrick's office has just started a new strategy called data to care. That would be looking at those people whose viral loads are not suppressed who have been on the -- medications, and getting interventions going towards those individuals so that they will get back on treatment and take care of themselves so that they don't transmit the virus. Now, Patrick, San Diego is to the region. And it is part of a region with Tijuana and Baja. It is not isolated. I am wondering if this initiative has any chance of working, if Tijuana is not involved in some way? Thank you for bringing that up. It's absolutely true. For the past year, we have been meeting with our counterparts in Tijuana and Baja California to talk about how we can collaborate more closely on issues related to HIV and STD. So we can do by national exposure notification. That way if someone is diagnosed here in needs to and from a partner in Tijuana, how do we do that? And for people who are receiving treatment here in San Diego but are migrating back into Mexico, how do we coordinate their treatment so there is no interruption? Patrick, how much with the county be spending on this new getting to zero initiative? We received funding from a number of funding source -- sources. Some of it is from the state cost methods from the federal government can't the CDC, and helped resources services administration. Right now are combined budget is around $16 million. Is there any new money coming in specifically for this initiative? We have been very successful over the past years competing for grants. We were awarded in 2011 money from the state of California to submit expanded HIV testing. Last year we were awarded money by California to implement products for HIV prevention. We are seeking additional funding. Roughly we will find out today to continue innovative programs. I'm Mark Sauer to join at something? Just having the board -- I'm sorry did you want to add something? Just having the board behind us, that opens up a lot more areas. There is also transmission through IV drug use are you also looking at them targeting that this initiative? Back it will be the full -- It will be the full continuum of risk. It will be every aspect. San Diego has been fortunate that we have not seen the rates -- But Tijuana has. Tijuana has. We have seen an increased use of fear when in the County. Were watching this very closely. Speaking of watching very closely, how well you know whether or not this initiative is working? How would you track that, Patrick? There are a couple key indicators we will look at the first is, every year we look at the percentage proportion of people who we know who have HIV who are nine care. We went to see those numbers go down. We also track the number of newly diagnosed cases in San Diego. If we are successful in the first figures, we would see increases. After that, we would want to see some dramatic decreases. In other words you want to see the numbers go up and then go down? Yes. Thank you very much I've been speaking with -- Just don't forget getting to zero also means getting to zero HIV stigma because there is still a stigma against people with HIV disease. I am glad you mentioned that, Terry Cunningham chair of HIV Health Services Planning Council . And it also had Patrick Loose director of HIV, STD, and Hepatitis branch San Diego County Department of Health & Human Services . Think you both very much.

A plan to eradicate or substantially reduce HIV/AIDS in San Diego County within 10 years, including more extensive testing of residents, was approved Tuesday by the Board of Supervisors in a unanimous vote.

The "Getting to Zero" initiative was introduced by board Chairman Ron Roberts and Supervisor Dave Roberts, who also worked closely with San Diego City Councilman Todd Gloria.


"We can, in fact, do this," Gloria said in his address to the board. "We can stop this disease and relegate it to the history books."

Of around 20,000 San Diego County residents who are infected with HIV/AIDS, more than 10 percent are unaware of their HIV status, and about 6,400 who are aware aren't getting the treatment they need, according to health officials.

According to Ron Roberts' office, testing at county-funded health clinics sometimes finds cases in which the patient is unaware they have HIV. A goal of the county plan will be to check area residents for HIV/AIDS as part of routine testing for diseases.

"HIV/AIDS continues to be a major threat, with one new diagnosis each day," he said. "The goal is to get this disease under control ... and ultimately its elimination."

Ron Roberts and Dave Roberts requested in 2014 that a committee be formed to assess the status of HIV in the county. The committee met nine times in 2014 and 2015 before coming up with a list of recommendations.


"The (U.S. Centers for Disease Control and Prevention) has identified HIV as a winnable battle," Dave Roberts said. "We will implement the recommendations of the task force."

The task force issued a list of six recommendations, including developing a media campaign to increase awareness and decrease the stigma of AIDS; make medical care and treatment available to anyone who needs it; and developing culturally appropriate strategies for addressing the needs of women, young adults, African American and Latino gay, bisexual and other men who have sex with men, transgender people, Native Americans and men who have sex with men over 50.

The vote calls for an implementation plan to carry out the recommendations of the task force and establish a comprehensive policy to align programs and partners throughout the county.

"San Diego has the potential to be the first major metropolitan area to achieve this amazing goal," task force Chairman Terry Cunningham said.

Supervisor Dianne Jacob said with only 20,000 cases in a county of more than three million people, testing everyone is not necessary.

"It's an ambitious goal to stamp it out completely," Jacob said. "The focus should be on high-risk individuals."