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San Francisco 90-90-90 Targets (2015)

93%

79%

91%

Source: SF Department of Public Health, HIV Epidemiology Section

San Francisco HIV Care Continuum (2015) PLHIV: 16,200

93%

75%

73%

67%

Mayor's Message

"San Francisco is a national leader in treatment, housing and care for those living with HIV/AIDS, and we remain committed to providing hope, finding a cure, and one day bringing an end to this epidemic. We have the world's best health care, top scientists, compassionate policies, community advocacy and the public-private partnerships needed to make it a reality. Zero is within reach."

Edwin Lee
Mayor of San Francisco, USA
GETTING TO ZERO
Tonya Chafee
Affiliation:
University of California San Francisco
Committee:
Adolescent/Young Adult Comittee
Adam Leonard
Affiliation:
San Francisco Department of Public Health
Committee:
Adolescent/Young Adult Comittee
Susa Coffey
Affiliation:
University of California San Francisco
Committee:
RAPID Committee
Edwin Charlebois
Affiliation:
University of California San Francisco
Committee:
Retention Committee
Miguel Ibarra
Affiliation:
Asian Pacific Islander Wellness
Committee:
Retention Committee
Clarissa Ospina-Norvell
Affiliation:
University of California San Francisco
Committee:
Retention Committee
Al Liu
Affiliation:
San Francisco Department of Public Health
Committee:
PrEP Committee
Bob Grant
Affiliation:
University of California San Francisco
Committee:
PrEP Committee
Wayne, Steward
Affiliation:
University of California San Francisco
Committee:
Stigma Committee
Vincent Fuqua
Affiliation:
San Francisco Department of Public Health
Committee:
Stigma Committee
Liebi, Courtney
Affiliation:
UCSF
Committee:
Co-ordinator
Achievements, challenges, and next steps:

Since its inception 2014, the Getting to Zero Consortium has established a diverse Steering Committee providing overall leadership to the Consortium and four committees to move each of the GTZ initiatives forward. Each committee independently develops action plans, milestones, a budget, and metrics to track progress. We have hold quarterly Consortium meetings, presented a plan and budget to the San Francisco Board of Supervisors who committed to back-fill positions cut through federal, state, and local budget tightening and endorsed ongoing support for successful existing programs. The Consortium has also launched its website (www.gettingtozerosf.org) and met with numerous local, national, and international groups and delegations about GTZ efforts. Challenges have included the need for additional resources and coordination for each of the committees to successfully achieve their goals and milestones, which are being addressed through several funding proposals. Each of the committees will be providing updates on their activities at annual Town Hall meeting on World AIDS Day.

SOURCE : Getting to Zero list of members per Committee, see http://www.gettingtozerosf.org/our_work/

Backbone support

Strategic planning and leadership of the San Francisco Getting to Zero Consortium is provided by a Steering Committee composed of senior leaders across public, private, and the non-profit sector. In addition, the Consortium is supported by a part-time coordinator who provides overall program support and coordination across committees and leads website development and updates.

Continuous improvement and communication

A Steering Committee provides overall direction and at least one steering committee member liaisons with each working committee (PrEP, RAPID, Retention, and Ending Stigma). Each committee is led by co-chairs who coordinate overall activities of the group and assure goals and priorities are developed and metrics are met. Communication is promoted through regular committee meetings, email and conference calls, online project management tools, and quarterly Consortium meetings with the public. In addition, new information, updates, and events from each committee are posted on the SF Getting to Zero website: www.gettingtozerosf.org. Finally, all Consortium members participate in an email listserv providing rapid dissemination of new research, upcoming events, requests for support, and cross-pollination of ideas.

Mutually-reinforcing activities

This collective impact approach calls for investment and participation by public health, university, private foundation, health system, pharmaceutical industry, and business sector partners to achieve our goal. Specifically, the Getting to Zero Consortium is comprised of representatives from the SF Department of Public Health, UCSF, many San Francisco-based CBOs, activists, government representatives, and other interested members. Under the direction of a Steering Committee and with broad partnerships with community organizations, the Consortium will coordinate efforts around the city, leverage existing resources, and secure multi-sector funding and support to achieve the goals of Getting to Zero. We are committed to exchanging best practices with other cities pursuing similar initiatives.

Common agenda

San Francisco is on the path to become the first municipal jurisdiction in the United States to achieve the UNAIDS vision of “Getting to Zero”: Zero new HIV infections, Zero HIV deaths and Zero HIV stigma. From the very beginning and throughout the HIV epidemic, the City has led the way in responding to the enormous challenge of HIV and setting standards for prevention, care and treatment recognized around the world. In 2014, we established the San Francisco Getting to Zero Consortium—a multi-sector independent consortium operating under the principles of collective impact. Our overall goal is to improve the health for persons at risk for or living with HIV/AIDS in San Francisco, with an emphasis on underserved populations. Our short-term goal is to reduce both HIV infections and HIV deaths by 90% from their current levels by 2020. Our strategic plan calls for 3 signature initiatives to start – 1) expansion of PrEP (use of antiretroviral medications for prevention), 2) RAPID ART (expedited initiation of antiretroviral therapy and linkage to HIV care at the time of diagnosis), and 3) Retention in HIV Care (maintaining HIV-infected persons in primary care) -- that focus on eliminating new HIV infections, preventing HIV-related disease complications and reducing the health disparities for HIV infected and affected populations in San Francisco. Additionally, the Ending Stigma committee is identifying priorities and goals for this critical effort.

Health & safety context

The San Francisco Department of Public Health supports a robust HIV surveillance system, widespread HIV testing, syringe access programs, comprehensive HIV care, and was the first in the country to recommend treatment for all persons living with HIV, a policy which has since been adopted nationwide. The City has also led the way in implementing programs for pre-exposure prophylaxis (PrEP) for HIV prevention. As a result of these activities, HIV prevention and treatment have become more successful each year. Despite improvements in rates of new diagnoses and viral suppression rates, there remain significant disparities in HIV prevention and health outcomes. In particular, African Americans have the highest rates of new HIV diagnoses, and have been under-represented in PrEP prevention programs. Viral suppression and survival rates are also lower in women, African Americans, and people who inject drugs. Furthermore, some preventable deaths, including overdoses, are on the rise in people living with HIV, and STDs and drug use are increasing in men who have sex with men.

To address these disparities, we need to ensure that all San Franciscans, including youth, are knowledgeable about HIV, know how to protect themselves, and have skills to support HIV-infected friends. All San Franciscans need easy access to medical, mental health, and substance use services and stable housing. We also need efforts to mitigate and measure stigma, because even today, persons living with and affected by HIV still face stigma from family, friends, and community that hampers access to prevention and care. It will take a broad coalition of community members, schools, businesses, government agencies, and HIV providers to work together to address these challenges.

San Francisco’s Getting to Zero

San Francisco’s Getting to Zero (GTZ) initiative is a multi-sector, independent consortium operating under the principles of collective impact. Modeled after the UNAIDS goals, their vision is to reduce HIV transmission and HIV-related deaths in San Francisco by 90% before 2020. The San Francisco Getting to Zero initiative is a volunteer-led effort. It is committed to: maintaining current funding levels for HIV prevention and treatment; not competing for new funding through Getting to Zero efforts; and prioritizing reaching underserved populations. They are not a new agency or organization but a framework based on the principles of collective impact. Their goals are established and prioritized in working committees with efforts based on measurable objectives and plans, including budgets, for implementation.

San Francisco is on the path to achieve the UNAIDS vision of “Getting to Zero”: zero new HIV infections, zero HIV deaths, and zero HIV stigma by 2020. From the very beginning and throughout the HIV epidemic, San Francisco has led the way in setting standards for prevention, care, and treatment recognized around the world. The ambitious Getting to Zero initiative is made possible because of the tremendous work being done by existing organizations and the thousands of San Franciscans who choose to take an HIV test, opt into HIV care, negotiate safer sex practices, and champion an inclusive community.

Getting to Zero goals are to reduce both HIV infections and HIV deaths by 90% from their current levels by 2020. Their newly launched Ending Stigma Committee will identify a measurable goal for reducing HIV-related stigma. The GTZ strategic plan describes a comprehensive approach that continues funding for successful efforts and calls for 3 signature initiatives to start or expand—PrEP expansionRAPID (Rapid ART Program for HIV Diagnoses), and retention in care—which focus on eliminating new HIV infections, preventing HIV-related deaths, and reducing health disparities for HIV-affected populations in San Francisco. GTZ coordinates efforts around the city and leverage existing resources to maximize return on investment, working under the umbrella of the City of San Francisco.

 

Community Leadership Messages

"We would not be where we are without the leadership of the department of health."

Jeff Sheehy
Director
UCSF San Francisco AIDS Research Institute

"Boldness’ means we speak up in the face of doubt and adversity. We did that in the 1980s, when the HIV epidemic first appeared. We did that in 2010, when we were the first to recommend treatment for all persons living with HIV. We’re doing it now, with the current research and studies we have toward finding a cure, with vaccine research, and being at the forefront of PrEP"

Diane Havlir, MD
Professor of Medicine
UCSF School of Medicine

"Speaking out about the link between HIV/AIDS and its social drivers – housing, mental illness and substance abuse – will be crucial as a part of our work to get to zero HIV infections, zero HIV deaths, and zero HIV stigma"

Austin Padilla
Founding Member
Getting to Zero – San Francisco

"People ask us what the ‘special sauce’ is that accounts for San Francisco’s success against HIV. It’s the full engagement of all segments of society -- activists, providers, researchers, and the SF government – all working toward a common goal."

Susan Buchbinder, MD
Director, Bridge HIV, San Francisco Department of Public Health
Clinical Professor, Medicine and Epidemiology

"We have made tremendous progress in HIV prevention and treatment, but now is not the time to let up on our efforts and declare victory… With a little more time, effort, resources, and teamwork, we can fully realize the benefits of these highly effective prevention and treatment tools and be the first city to get to zero."

Barbara Garcia
Director of Health
San Francisco Department of Public Health

"The devastating impact of HIV continues to spread around the world despite access to treatment, care and support. It’s imperative that we continue to research new ways to prevent HIV infection"

Robert Grant, MD, MPH
Chief Medical Officer
San Francisco AIDS Foundation

"Our work is not done until the disparities among vulnerable populations living with or at risk for HIV are eliminated"

Dana Van Gorder
Executive Director
Project Inform

"We don't believe in doing things top-down here," said Scott Weiner, a member of the city's Board of Supervisors or city council. "The reason San Francisco has had so much success is not because city government saying 'this is what we’re going to do,' but because of an amazing coalition of community-based advocates."

Scott Weiner
Member
San Francisco Board of Supervisors and City Council

"To the extent San Francisco has been a sanctuary for so many different people and issues, I think that we should aim to be a sanctuary where there are no new HIV/AIDS infections here in San Francisco"

David Campos
Member
San Francisco Board of Supervisors and City Council

"I'm involved with Getting To Zero because achieving the three goals of GTZ will save and transform the lives of thousands of San Franciscans."

Chip Supanich
Member
HIV Community Planning Council and Shanti

"Getting to Zero is also a call to action for health equity in HIV prevention, care, and treatment for all of our communities."

Scott Hyman, MD
Member
Getting to Zero Steering Committee; Bridge HIV

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