Packer takes over HIV prevention office

A familiar face is taking the lead at San Francisco's HIV Prevention Section, at least temporarily.

Tracey Packer became acting director of the agency after the departure last week of Dr. Grant Colfax. President Barack Obama has selected Colfax as the new director of the Office of National AIDS Policy.

Among other functions, the city's HIV prevention office funnels money to numerous nonprofits that are trying to help reduce new infections by half by 2017.

"I'm really excited to have this opportunity, and I'm really committed to ensuring that we're [using] a collaborative approach with our clients, our communities, our providers, and the press to be successful in preventing new infections in San Francisco," Packer, 52, said.

"Having the voice of the consumer, the client drive our work is key to our success," she added.

Packer, an HIV-negative straight ally, has worked in HIV prevention for the city for 20 years. She began as a health educator and, before Colfax's departure, served as the section's deputy director. Packer was the unit's interim director from the end of 2005 to September 2007. Her salary is approximately $100,000.

San Francisco Health Director Barbara Garcia praised Packer in her recent written report to the city's Health Commission.

"Her background and experience in leading the community planning process will go a long way to helping us continue the successful HIV prevention program that has become a national model throughout the country," Garcia said.

Challenges

Packer has her work cut out for her.

"We still have 500 to 1,000 new infections each year. We need to address that," she said of perhaps the biggest challenge.

Progress that the city's made in reducing infections has meant it can be harder to get funding, however.

The Centers for Disease Control and Prevention's allocation to San Francisco is being reduced as the federal agency shifts spending to places that "bear the greatest burden of new infections," such as the southeastern U.S., Packer said

For fiscal year 2012-13, the HIV Prevention Section, which currently has a budget of about $17 million, is expecting a cut of $3.1 million from the CDC and the California state Office of AIDS.

In the 2013-14 fiscal year, the city's prevention agency is expecting a cut of $2.1 million from the CDC.

Those decreases come on top of cuts to San Francisco's share of federal Ryan White HIV/AIDS Treatment Modernization Act money. City officials, including Mayor Ed Lee, have expressed a commitment to preserving services that have been paid for by that funding.

"In terms of specific service cuts, we have not identified that at this time, but we know it could be a potential of a 20 percent cut to our community programs," Packer said, referring to the $3.1 million reduction.

She added that the department would "look at internal cuts as well," but it hasn't been determined whether there would be staff cuts. The prevention section has a staff of about 50, plus recruiters that they hire as they roll out studies.

Packer, who recently met with a group of providers to talk about finances, said she didn't know of any mergers coming among the organizations.

Priorities include continuing to strengthen the "really strong partnership" the prevention office has with community-based agencies, clients, research participants, and others, Packer said.

She also emphasized "the importance of the strategy that San Francisco is using to prevent HIV." That strategy's focus includes preventing new HIV infections through getting people tested and linking HIV-positive people to "appropriate, effective care," and addressing disparities.

"The providers have it down, and they are doing an amazing job providing services," Packer said.

PrEP

San Francisco is expected to become the first city in the country to offer gay men an anti-HIV pill that has proven successful in stopping transmission of the virus that causes AIDS.

Officials with the National Institutes of Health and the city's health department have been working on an agreement to launch a demonstration project for usage of pre-exposure prophylaxis, or PrEP. The combination pill contains tenofovir and emtricitabine (Gilead Science's Truvada) and has proven to be highly effective during clinical trials studying its efficacy.

Last year, Colfax said, "We are hoping the demo project would be implemented in the first quarter of 2012."

Packer said last week that the department's STD Prevention and Control Services Section and City Clinic, which is part of the health department and offers testing for sexually-transmitted diseases and other services, are "very close" to rolling out the demonstration project.

"We're really excited about this opportunity," Packer said. "I think it's the first demonstration in the country, if not the world, looking at the feasibility of PrEP."

Concerns

Colfax recently ushered in a new direction for how the city, and the community-based agencies it funds, approach reducing the spread of HIV.

A higher focus is being given to testing people regularly and offering treatment sooner to people who are HIV-positive in an attempt to further reduce new infections in San Francisco. More attention is also being paid to the overall HIV viral load in the community, as new research has shown reducing viral load counts helps bring down new HIV infections.

Health education and risk reduction has been de-emphasized.

Asked what he would like to see from the city's prevention agency, Armando Hernandez, who manages the Si a la Vida program at Instituto Familiar de la Raza, brought up the changes. His program provides a range of culturally based services for Latinos at risk of infection, and those living with HIV/AIDS in San Francisco.

"I really, honestly do see the value of testing and treatment, but not at the expense of primary prevention, and the psycho-social issues that place people at increased risk," Hernandez said.

He said problems such as a lack of decent employment opportunities can lead transgender clients to engage in sex work, and "The more unsafe sex they have, the more money they can make," he said.

His agency's staff used to ask clients more about housing, employment, and other concerns. Now, he said, "The emphasis has shifted toward how many transgender women can we test every month" and similar concerns.

Speaking to the example of housing, Packer said, "We of course need more supportive housing, but HIV prevention absolutely allows for that linkage, and we strongly encourage our organizations to be linked to housing organizations" so they can refer clients.

She also said that "Evidence-based interventions that are addressing the factors that put people at risk for HIV is essential for this approach that we're using."

Despite his issues with the prevention section's shift, Hernandez had praise for Packer.

"She truly cares about the work that we're all doing, and I think she really wants to work collaboratively with all the organizations in San Francisco," he said.

Kaushik Roy, executive director of the San Francisco nonprofit Shanti, also gave high marks to Packer.

In response to emailed questions, Roy said Packer "has been highly competent, professional, approachable, attuned to the needs of San Francisco and its many communities, and is very knowledgeable about the system of care." He added that she's "a natural fit" for the director's position.

Shanti uses HIV Prevention Section funding to support its Learning Immune Function Enhancement program. LIFE offers workshops, individual health counseling, and other services for people living with HIV. Roy said outcomes include more engagement in primary care and clients having "greater levels of self-esteem and confidence in their ability to manage their HIV disease."

Packer's future

As to whether she wants her current job permanently, Packer said, "I am here to serve and to provide the support to our communities, our clients, and our staff as long as I can. We'll see what happens."

Asked in an email about a search for a new HIV Prevention Section director, health department spokeswoman Eileen Shields responded, "Can't we just let Tracey have her moment here?"