Bay Area Reporter - August 21, 2008
Seth Hemmelgarn, s.hemmelgarn@ebar.com

San Francisco's health department is set to apply to the Centers for Disease Control and Prevention for renewal of federal HIV prevention funds that should allow the city to continue supporting ongoing prevention efforts.

The CDC currently allocates about $8.8 million to the city. The HIV prevention section has a total prevention services budget of almost $16 million.

An interim progress report includes brief previews of public information campaigns the department is considering developing in 2009. The application was approved by members of the HIV Prevention Planning Council at its August 14 meeting.

One possibility for a social networking campaign would be to increase testing among black men who have sex with men, a population facing disproportionate HIV rates. According to the report, black MSM comprise 7 percent of the general population, but they make up 12 percent of AIDS cases.

There's expected to be a presentation on potential strategies and priorities related to the topic at next month's HPPC meeting.

The HIV prevention section also wants to increase the frequency with which men who have sex with men get tested. One survey showed 8 percent of the men who hadn't tested in the last 12 months had a new positive test when they were checked again.

Dr. Grant Colfax, the health department's HIV prevention director and co-chair of the planning council, told the Bay Area Reporter he's "hopeful" the application, which is part of a non-competitive process, will be accepted, but "We don't know whether we'll be funded to do anything or not."

Walter Chow, a public health adviser with the CDC who attended last week's meeting, wrote in an e-mail to the B.A.R. that the city "can be confident of the $8.8 million."

According to Chow, San Francisco received just over $9 million in 2007. He attributed the decrease to the need to address the federal budget deficit.

Other plans

The HIV prevention section will continue to "jump start" HIV testing in medical settings, and continue working "with local hospitals and medical providers to provide routine HIV screening in high prevalence areas," according to information presented to the council at last week's meeting.

The prevention section is also hiring a linkages and partner services coordinator to help ensure that everyone testing preliminary positive on an HIV rapid test receives their confirmatory test result, and also support efforts to make sure that clients who test positive get linked to medical care and are offered partner services.

The section is also developing a new comprehensive plan for 2010.

The HIV prevention section prepared the application, and the HPPC concurred at its August 14 meeting that the application met with the priorities set forth in the 2004 prevention plan.

National estimates

Also at the meeting, Colfax reviewed recently released national estimates from the CDC that indicate there were approximately 56,300 new infections in 2006. As has been widely reported, the CDC had previously estimated there were 40,000 new infections in the United States each year.

According to Colfax, the epidemiology section, led by Dr. Susan Scheer, will use the CDC's methodology to calculate incidence for San Francisco. He said rather than being a "magic number," the new incidence estimate would be another data point to consider.

In its 2007 HIV/AIDS Epidemiology Annual Report, the health department noted that in San Francisco, the number of new HIV diagnoses fell from 839 in 2003 to 500 in 2006, a 40 percent decline.

At the meeting, Colfax reminded people that HIV incidence refers to the number of people who were newly infected with HIV in a given period, while HIV diagnoses indicates the number of HIV diagnoses during a given period, regardless of when the infections occurred.

Councilmembers' comments

Ken Pearce, a member of the planning council who is living with HIV, said HIV-positive people "need better representation" on the council. According to the progress report, which notes HIV status should be self-identified, seven of the council's 37 voting members are people living with HIV/AIDS.

In a phone interview, Colfax told the B.A.R. , "We obviously seek diversity among our council members," including people who are both HIV-positive and -negative, but "there's not a requirement people self-disclose HIV status as part of membership."

In an e-mail, Pearce wrote, "I do honor those who do not wish to disclose their status. I just choose to ask for greater participation in our wonderful community from folks who can and want to use their disclosed status as tickets to the poz community's attention, comradery, and perhaps changed behavior."

Pearce and two other councilmembers also wanted to know more about PEP, the post-exposure prophylaxis treatment for those exposed to HIV. Colfax told the B.A.R. it's up to the council to consider whether there are more opportunities and support "for either refining or expanding PEP programs, and it's something that will be vetted as part of the community planning process." However, he said, "if more resources go there, those resources have to come from something else ... We need to continue the dialogue, obviously."

City Clinic is the central place where there's a specific PEP program supported by the health department, Colfax said.

Vaccine

At the meeting, Dr. Susan Buchbinder, director of the health department's HIV research section, said that the National Institutes of Health has decided not to fund the PAVE 100 study.

As reported last month, that trial had been put on hold when an earlier trial, the Step trial of a Merck vaccine, was stopped after it appeared that the vaccine didn't protect against HIV infection or reduce the viral load in people who became infected, and it met "futility criteria" - no matter how long the study continued, it was not going to get the desired results, Buchbinder noted. She emphasized the vaccine can't infect anyone.

Buchbinder told the B.A.R. in an e-mail that the HIV Vaccine Trials Network has been asked by the NIH to design a trial with the vaccines that were going to be used in PAVE 100. She wrote that this will be a smaller, more focused study trial to see if the new vaccines will prevent infection in MSM in the United States.

Men will have to be both circumcised and not have antibodies to Adenovirus 5 (Ad5), a cold virus that has been modified to deliver the HIV vaccine.

People in the Step trial were found to be at greater risk for infection if they were uncircumcised and if they had antibodies to Ad5.

For more information on the planning council and to see more data that was presented at the meeting, visit http://sfhiv.org/community_hppc_full_council_2008.php.

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