San Francisco moves to curb disproportionate HIV/AIDS rates among black residents

In an effort to address disproportionately high HIV/AIDS rates among people of color, the city of San Francisco is developing new strategies to reduce the number of new infections among those in this demographic who live with the virus by 50 percent.

The San Francisco Department of Public Health has funded a program that urges residents to know their status. "It's About You" targets not only black gay and bisexual men; but couples, young men, women and faith-based organizations. The Black Coalition on AIDS and other local service providers hope to establish both mobile and in-house testing sites.

The SFDPH is also reviewing proposals for new contracts with HIV/AIDS service providers that will take effect in July.

Vincent Fuqua, health educator for the SFDPH's HIV Prevention Section, told EDGE the process has changed to reflect the city's disproportionate HIV/AIDS rates.

"This is the first time we have a category for African American men who have sex with men as a special population group," he said. "This is the first time that a community agency can apply for funding to specifically target African American men who have sex with men."

According to the SFDPH's 2009 HIV/AIDS Epidemiology Annual Report, blacks represent six percent of the city's total population, but account for 14 percent of those living with HIV/AIDS. Black MSM account for 40 percent of African Americans with HIV/AIDS in San Francisco.

The 2010 San Francisco HIV Prevention Plan-New Directions-attributes these statistics to discrimination based on race and sexual identity and lack of access to HIV testing. A lack of basic health care, increased drug use and economic disparities are also factors.

"There is still a lot of stigma surrounding HIV," said Francis Broome, director of prevention and health education at the Black Coalition on AIDS. "Social marketing campaigns and community leaders have increased visibility in the Black community, but more work needs to be done."

The HIV Prevention and Planning Committee cites a lack of knowledge about a person's HIV/AIDS status as a "critical co-factor." A 2008 study found 57 percent of black MSM who were tested did not know they were living with HIV.

Charles Fann, health promotions manager at Tenderloin Health, said his group and other service providers are "trying to remove the excuses" for not getting tested while not intruding into people's private lives. Activists point to a lack of testing-whether it is because of work conflicts or not knowing about free testing sites-as reasons the epidemic continues.

"We are providing testing in the neighborhoods, on weekends, at community event and at the street fairs," said Fann.

While access to testing is crucial, service providers maintain simply knowing one's status is not enough.

"Testing needs to be wrapped around information," said Tony Bradford, program manager for Black Brothers Esteem, a community group with the San Francisco AIDS Foundation. "You find out your status, but now what do you do?"

Phoenix Rising, which Black Brothers Esteem runs, targets both positive and negative gay, bisexual and black MSM through their support groups. It focuses on community building and sharing information about the virus.

"They provide preparation for the next step", said Bradford. "People can teach each other how to maneuver the services in the city."

He added support groups will continue to play a crucial role in preventing new HIV/AIDS infections in the city.

The Black Coalition on AIDS, Black Brothers Esteem and other groups are collaborating with one another and the SFDPH to stage community events in effort to raise awareness and open communication about the virus. HIV/AIDS service providers across the city aim to reduce infection rates through collaborative efforts.

"Over the next five years we will see a lot more community events, and the expectation is to have a testing component," said Fuqua.

New Directions also recommends a "one-stop-shop" for HIV prevention and care.

Tenderloin Health, which is located in a neighborhood with one of the highest demographic viral loads in the city, is a series of easily accessible buildings that include testing, case management and medical facilities and a pharmacy. "It allows for the providers to better coordinate care," explained Fann.

San Francisco's HIV/AIDS service providers also hope to learn from those who live in the city's hardest hit neighborhoods but remain negative.

"There's a lot of focus on the problem, but a lot can be learned from the successes," said Fann. "If you have two individuals with the same background, same knowledge but one is positive and the other is negative, we can learn from him."