Bay Area Reporter - April 24, 2008
Matthew S. Bajko, m.bajko@ebar.com

Last night (Wednesday, April 23) Colfax kicked off the first in a series of meetings he plans to hold in various neighborhoods around the city in order to hear directly from the community what it would like to see from the HIV prevention section.

It is the first time the HIV prevention director has held such a listening tour since Steven Tierney was hired to the post nearly a decade ago. The first meeting took place in the Castro, and the second is planned for the Tenderloin in late May. [See ebar.com for coverage of the meeting.]

In July Colfax will further increase his interaction with the public when he takes over the co-chair position on the HIV Prevention Planning Council reserved for the HIV prevention director. Tracey Parker has been serving as co-chair since she was named interim HIV prevention director after Tierney resigned in late 2005.

In an interview with the Bay Area Reporter last week, Colfax said he wants to hear from the public "where we should best put our resources to stop the epidemic in San Francisco. We are in an endemic rather than epidemic state, but things are still too high. I am hoping to hear ideas on how do we use our resources best to draw the epidemic down."

The city estimates between 800 to 1,000 people each year become infected, and as of March of this year, reported 8,992 people were living with AIDS. While the HIV section has seen HIV rates hold steady in recent years, data indicates that a gay man in his 20s living in San Francisco has a 60 percent chance of becoming infected over the course of his lifetime.

"That is completely unacceptable," said Colfax. "Among African American men it is even higher."

Colfax is a big proponent of using testing to help further drive down HIV infections. He has pushed to see rapid testing expanded, working with health care providers to see that they view HIV tests as part of their routine procedures. And he has expanded the use of viral RNA testing at several sites to better screen for HIV infections that may not be detected by other tests.

Over the last six months he and his staff have been working with San Francisco General Hospital on implementing rapid testing in its emergency room. The $250,000 project is funded by the Centers for Disease Control and Prevention and will kick into high gear come May.

"One of our concerns is there are a lot of people in San Francisco who are HIV-positive who do not know they are positive. If we can help these people find out they are positive, then we know their risk behaviors will change," said Colfax, who continues to see patients at the hospital.

Colfax oversees a $16 million budget, much of which comes from the CDC. So far the city has not reduced its share of the funding, despite a record budget deficit. An HIV researcher for many years, Colfax merged the HIV research branch with the prevention section as part of his promotion last fall. He is overseeing several clinical trials examining if certain medicines can reduce a person's addiction to methamphetamine.

He also is looking at how to address drug use among "party guys," those men who only use drugs - whether it be meth, cocaine, poppers, or binge drinking - on occasion but put themselves at risk for HIV when they do.

"Eighty percent of meth users are episodic users. They aren't going to go into a drug treatment facility," said Colfax, who added that HIV transmission among occasional users "is significant."

As for social marketing campaigns, Colfax said the section is discussing launching several, with the focus most likely to be on testing, prevention with positives, or expanding its "resist meth" campaign.

Early on Colfax faced some criticism of how committed he was with working with various communities of color. Some members of his staff reacted negatively to his not naming African Americans to top management posts. More recently, leaders of AGUILAS, which focuses on gay Latino men, complained their needs were being neglected and went to the Board of Supervisors to seek funding.

Colfax said he is committed to helping the group remain open. He has also commissioned two health plans to look at developing strategies for both the African American and Latino communities.

He brought in community leader John Newsome to work with staffer Vincent Fuqua on the plan for black men who have sex with men. He appointed staffer Oscar Macias to oversee the Latino plan.

"Addressing health discrepancies in communities of color is extraordinarily high on the priority list for me," said Colfax.

Newsome said he hopes to have a draft report to Colfax by the summer.

"I think it is clear that the challenges facing African Americans are outpacing the resources and strategies, and the same is true of the broader community with respect to HIV prevention," he said. "I think it speaks highly of Grant's leadership. I also think it speaks highly of the department and the city."

Colfax's leadership, thus far, has received mostly praise. AIDS activist and HPPC member Hank Wilson said he has been pleased with Colfax's initial steps, such as criticizing a Swiss AIDS Commission report that found sex without condoms was safe in certain circumstances; and releasing an alert on poppers and protesting Google running sponsored ads for poppers, whose use has been tied to HIV transmission.

"I see Grant as a change agent as opposed to justifying and excusing the status quo. He gets that the epidemic is dynamic, constantly changing, and that prevention efforts should reflect and adapt to community change, as well as spur it," Wilson wrote in an e-mail.

Tierney, who now sits on the Health Commission, also gave Colfax high marks, not only for opening community dialogue but also for pushing to see how the health department measures its success.

"He is articulating a clear position of wanting there to be clear health outcomes," said Tierney, a professor at the California Institute for Integral Studies. "A lot of times in HIV work you measure activities rather than outcomes. He's doing a lot of work to change that to measuring health outcomes."

AIDS activist Michael Petrelis, however, said so far he is unimpressed. He criticized Colfax for not meeting with the community sooner and questioned why he only worked with the San Francisco AIDS Foundation in crafting the response to the Swiss report.

When pushed on the fact Colfax had met his requests that he meet with community members outside the HPPC's monthly meetings, Petrelis said, "I will give him credit for the meetings. But I don't see an ongoing commitment to public meetings. When push comes to shove, I don't see any commitment for ongoing public dialogue."

The next meeting takes place from 6 to 8 p.m. May 21 at the Central YMCA, second floor, 220 Golden Gate Avenue at Leavenworth. For more information, call (415) 554-9000.

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