Bay Area Reporter - May 14, 2009
Matthew S. Bajko, m.bajko@ebar.com

It is estimated between 800 and 1,000 people each year become infected with HIV in the city, with the overwhelming majority of cases among gay men. The foundation, the city's largest AIDS agency, believes it can reduce that amount by 400 cases over the next six years.

Mark Cloutier, the foundation's CEO, announced the goal and timeline at the agency's annual leadership dinner Thursday, May 7. He said his agency has also set two other goals it wants to achieve by 2015.

It wants everyone living in San Francisco between the ages of 13 and 64 to know their current HIV status. And the agency wants all HIV-positive people to be receiving appropriate primary care and treatment.

"If people know their HIV status and people who have HIV are receiving appropriate care, then infection rates will go down," Cloutier told the more than 400 people at the dinner, held this year at the Intercontinental Hotel south of Market Street. "Even in a sea of economic tidal waves, cutting infection rates in half is our number one priority."

It is a goal that the city's health department failed to achieve last year under its HIV Prevention Plan, which called for a 50 percent reduction in new HIV infections among gay and bisexual men between 2003 and 2008. Instead, it achieved a mere 10 percent cut in new infections, though it did reclassify its HIV epidemic to being endemic to signal that HIV cases have remained flat in San Francisco for nearly a decade.

The city's HIV Prevention Planning Council is currently at work adopting a new five-year HIV plan this year to be released in 2010. HIV Prevention director Dr. Grant Colfax said he expects the council to once again include a 50 percent reduction goal in the revised plan, which would run through 2015.

"I think it is a laudable goal," Colfax said last Friday in an interview. "We have evidence-based strategies we know are effective in reducing HIV infections. In the next five years we do have, at this point certainly, the will in San Francisco to reduce infections to that level."

Nevertheless, the foundation's benchmark is an ambitious goal that relies on two factors that may not come to fruition: the first being that Congress and President Obama will enact a national universal health care plan. More importantly, the foundation's goal is based on the expectation that the experimental HIV prevention strategy known as PrEP, for pre-exposure prophylaxis, will prove to be successful in preventing transmission of the disease.

Under PrEP, HIV-negative people take antiretrovirals to ward off HIV. Studies looking at PrEP's efficacy are currently under way and the first results from those trials should be released as early as June.

Health officials have already begun meeting with HIV agencies to discuss what to do should PrEP prove to be a useful tool. The foundation also recently held a forum with the community to discuss the issue.

Colfax said HIV providers are grappling with several questions regarding PrEP, such as "if efficacy is shown û and we don't known if it is efficacious or not û how does prevention respond accordingly and what do we need to plan accordingly? What resources should be made available to determine if this is a feasible strategy in San Francisco?"

In an interview with Political Notes, Cloutier said he is confident of reaching the goal because of several new tools the foundation and city health officials are already using. Both City Clinic and Magnet, the foundation-funded gay men's health center in the Castro, are now using RNA tests to determine if someone has HIV. While more expensive than other HIV tests, RNA testing is more accurate and can discover HIV infections sooner.

Also at Magnet, patients now enter information about their sexual risk taking into a handheld device, rather than answering questions from a counselor. The approach generates more honest answers, said Cloutier.

"We can then use that information to figure out whom to target the tests to," he said.

Due to the faltering economy and both the state's and city's dire fiscal picture, which will only worsen should a host of ballot measures aimed at shoring up the state's budget be rejected by voters as expected in the May 19 special election, the public health safety net that the foundation is relying on to help it reach its goal may be decimated under budget cuts.

In particular, two key pieces Cloutier pointed to as helping HIV-negative people remain negative û mental health and substance abuse services û are already targeted to be cut under the health department's plan to balance its budget.

Colfax said he is currently in a "wait and see" mode in terms of knowing what funding levels he will have to work with in the next fiscal year, which begins July 1.

"I don't have a crystal ball to know how many resources we will have. Certainly that is a challenge," he said. "Through this whole budget process, we have been affected and forced to make cuts. There are so many different variables right now, I wouldn't speculate on one specific projection."

The Board of Supervisors is currently holding hearings looking at Mayor Gavin Newsom's budget proposal. The city is required to have a signed balanced budget by June 30.

State leaders are already grappling with what to do after the May 19 vote. One solution being discussed to overcome the standstill in the Legislature is to hold a constitutional convention, which would make it easier for Democrats to push through budget proposals.

Under the normal budgeting process, even though the Republicans are the minority party, they hold enormous sway due to the two-thirds majority needed to pass a budget.

Local Dem leaders weigh in on nightclub issues

At their May 14 meeting, members of the Democratic County Central Committee are expected to vote on a resolution calling for reform of the state's Department of Alcoholic Beverage Control as well as asking the city's supervisors to conduct hearings on how much street fairs, bars and entertainment venues must pay for city fees and permits.

Nightlife issues have made headlines for months as the ABC has cracked down on numerous venues, both gay and straight, for code violations. At the same time city and police officials have cracked down on outdoor events for not addressing complaints about nudity, public drunkenness, and lewd behavior, and have grappled with how to reign in violence associated with nightclubs and bars.

Of particular concern to the LGBT community has been the notice Dore Alley fair organizers received from the police last month that their event could be in jeopardy due to complaints about public sex acts at their fetish fair. LGBT event promoters have also been outraged at the ABC's seeking to terminate the license of the DNA Lounge, a straight-owned club in SOMA that hosts many gay-themed parties.

The resolution also notes that increased costs for police staffing have "threatened the survival of critical community events like the Trans March, the Dyke March, and Pink Saturday."

Pushed by out DCCC members Scott Wiener and Debra Walker , the resolution calls for the local party to support efforts by openly gay state Senator Mark Leno (D-San Francisco) to "reform the ABC to ensure that the ABC is able to enforce the law effectively and ensure public safety while also promoting, rather than impeding, safe and responsible entertainment."

It also calls on the supervisors to examine "unreasonable fees and regulatory obstacles" the city is imposing on entertainment and culture venues and events. It would also put the local Dem Party in support of empowering the Entertainment Commission to address violence at entertainment venues "by suspending or otherwise taking action against" problematic clubs and bars.

Wiener and Walker, who are both expected to run for supervisor seats next year (in Districts 8 and 6, respectively), state in their resolution that the city needs to protect its nightlife and cultural events because they are "essential to the city's identity" and contribute "to the city's economic vitality through jobs, tax revenue, and destination travel."

The meeting begins at 7 p.m. Thursday at Unite HERE Local 2's office at 209 Golden Gate Avenue.

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Got a tip on LGBT politics? Call Matthew S. Bajko at (415) 861-5019 or e-mail m.bajko@ebar.com.

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