California's Sad Progress in the Fight Against HIV

California just released its most current HIV data and the news isn’t good. Despite major advances in HIV treatment and prevention, the state’s annual rate of new infections decreased just over 2% from 2013 to 2017. Nearly 5,000 Californians are diagnosed with HIV every year.

Compare that to other states where government and public officials have implemented aggressive efforts to combat the virus. In 2014, New York State convened a task force to end AIDS as an epidemic by 2020. The state has committed more than $20 million to fund strategies developed by the task force and new diagnoses declined 20% over the last four years.

Sadly this news comes as no surprise to California’s HIV service providers and community advocates. The state slashed over $80 million from HIV programs nearly a decade ago and little has been restored. Those cuts all but eliminated state funded prevention efforts in some areas, including HIV testing, and many community-based organizations simply do not have enough resources to effectively reach vulnerable populations and connect them with life-saving services.

In California as elsewhere, the gap between whites and communities of color is increasing. From 2013 to 2017, the rate of new HIV infections among whites declined nearly 13%, while decreasing only 2% among blacks and increasing nearly 4% among Latinos. Increasing inequities underscore the urgent need to improve and expand HIV prevention efforts in these communities.

Disparities in black communities are particularly striking. Young black gay and bisexual men acquire HIV at a rate 5 times higher than their white counterparts. The rate of new diagnoses among black women is nearly 7 times that of white women. More than half of black transgender women are estimated to be living with HIV.

California must reinvest in HIV or the state will continue to fall further behind. The rollout of PrEP in California is a prime example. PrEP, or pre-exposure prophylaxis, is a daily medication that is up to 99% effective at preventing HIV. The CDC has estimated that expanding PrEP coverage alone could reduce new infections by nearly 20%.

While California has launched a program to help low-income individuals afford PrEP, the state has devoted very little funding to increasing awareness and helping at-risk individuals navigate the increasingly complex healthcare system. PrEP uptake in California remains low and problematic geographic and racial/ethnic disparities are extreme.

The CDC estimates that over 156,000 Californians could benefit from PrEP, but less than 13,000 individuals were prescribed PrEP in 2017. PrEP uptake lags in communities that could most benefit from it, including black and Latino gay and bisexual men, women of color, and youth.

So-called “treatment as prevention” is another highly successful intervention to stop the epidemic. When people living with HIV have consistent access to treatment, their viral load is suppressed to undetectable levels which makes it impossible to transmit the virus. The knowledge that HIV treatment is prevention has created a powerful movement within the HIV community called “Undetectable is Untransmittable” or “U=U.”

In California, however, nearly half of people living with HIV lack consistent care or access to treatment. Black and Latino Californians are less likely to be virally suppressed than their white counterparts. Communities of color may experience multiple barriers to maintaining access to care, including stigma, medical mistrust, and structural barriers such as poverty and homelessness.

Aggressive efforts to end the HIV epidemic are paying off in San Francisco. The city launched a “Getting to Zero” initiative in 2014, which focuses on expanding use of PrEP, initiating HIV treatment immediately after diagnosis, and helping people living with HIV remain in care. Public health officials are now reporting record-low new cases, down over 40% since 2013.

Every community impacted by HIV in California can replicate San Francisco’s success. But the effort will require political leadership at every level of government, close coordination with community and the private sector, and sufficient resources to get the job done.

Earlier this year, over 140 community organizations called on Governor Newsom and the Legislature to convene a statewide task force on HIV and the related epidemics of hepatitis C and STDs. This bold and innovative public health initiative is a critical step toward reclaiming the state’s leadership role in the fight against HIV.

When the International AIDS Conference convenes in San Francisco in 2020, the city will be celebrating its well-deserved success. But unless the Governor and Legislature act now, California will be reporting the same lackluster progress and communities across the state will still be struggling with an epidemic we know we can end.