Tuesday, September 22, 2020
News + Politics Major HIV success reported in SF -- but what...

Major HIV success reported in SF — but what about the people who were kicked out?

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As many as 20 percent of HIV-positive people have left SF in the past five years. Is the housing crisis skewing the numbers?  

The 2015 Pride Parade contingent that accompanied Community Grand Marshal Brian Basinger of the AIDS Housing Alliance
The 2015 Pride Parade contingent that accompanied Community Grand Marshal Brian Basinger of the AIDS Housing Alliance. Basinger says that more than 20% of HIV-positive people have been displaced from San Francisco in the past five years. Photo by Gerard Koskovich

By Marke B. 

JULY 13, 2015 — Last month the San Francisco Department of Public Health, in association with HIV prevention consortium Getting to Zero, announced astonishing all-time record lows in HIV diagnoses and deaths in 2014 (PDF) — down 17% from the previous year.

The general trend in new HIV infections and deaths has been downward since HIV combination drug therapy was introduced in the late 1990s, and a more aggressive campaign to administer anti-retroviral therapy (ART) immediately at diagnosis was instituted in 2010.  Both of these therapies have had enormous success in transforming HIV, for many, into a manageable chronic disease instead of a deadly one, and, crucially, suppressing the disease in infected individuals enough to radically decrease the chances of transmission.

But 2014’s reported decline is still major — from 371 new diagnoses and 209 deaths in 2013 to 302 new diagnoses and 177 deaths last year, according to the department.

A chart showing the recent decline of reported HIV infections and deaths of HIV-positive people, presented by the Getting to Zero consortium to the city's Health Commission, using the most recent data sourced from the San Francisco Department of Public Health. Here, ART stands for antiretroviral therapy and PrEP stands for Pre-Exposure Prophylaxis.
A chart showing the recent decline of reported HIV infections and deaths of HIV-positive people, presented by the Getting to Zero consortium to the city’s Health Commission, using the most recent data sourced from the San Francisco Department of Public Health. Here, ART stands for antiretroviral therapy and PrEP stands for Pre-Exposure Prophylaxis.

For a city in which almost 16,000 people are living with HIV, those numbers are encouragingly low. Some have been quick to attribute the decline, especially in new diagnoses, to PrEP — Pre-Exposure Prophylaxis, i.e. giving HIV-treatment drug Truvada to HIV-negative people at risk, as a preventative measure to be used in combination with safer sex techniques.

But barriers still remain to further reduction, especially in terms of equal access and treatment: As Dr. Susan Buchbinder, director of SFDPH’s HIV prevention unit, pointed out to the Examiner, HIV-positive black people have a lower survival rate than other ethnicities, and vulnerable populations like the poor or homeless have a tougher time entering and staying in treatment. There has also been an increase in new transmissions among youths, specifically young men of color.

And then there’s the question of displacement — in the past five years, an estimated 15-20% of the HIV-positive population has been affected by evictions, priced out, or simply moved. Could that be skewing the numbers?

And could high housing costs in a city that offers world-class HIV treatment be keeping people away from the health care they need?

In response to the latest report, Brian Basinger of SF’s AIDS Housing Alliance sent me a statement:

We all applaud the news that new HIV infections have declined in San Francisco. While the discussion has primarily focused on the probability that PrEP has been a significant contributor to the decline in new HIV infections, there has been little conversation on the drivers of the 17% decline in HIV deaths, down to 177 (which is still 4 times higher than the number of homicides in San Francisco last year, at 45).

There has not been the introduction of any radically new and improved therapy to treat those of us already infected with HIV that we can attribute the decrease in deaths to, so we must look for other contributing factors for explanation as to why fewer San Franciscans with HIV are dying.

The reason is displacement. They’re getting kicked out of their homes and dying elsewhere. Out of sight. Out of mind.

People with HIV continue to get kicked out of their homes by speculators and experience homelessness at extremely disproportionate rates. Those who are the most vulnerable to increased mortality — disabled long-term survivors — are getting displaced out of San Francisco. They are not moving to gentrifying Oakland. They are moving to Oklahoma, to Lake County, and to other areas that do not have adequate services to maintain one’s health.

SFDPH’s own available numbers on HIV-positive outmigration (PDF) suggest a possible loss of up to 15% of the population in the past two years, whereas our investigations have revealed a loss of 20.3% in the past five years. One-third of San Francisco’s HIV population has experienced a housing crisis. We need to take those numbers into account.

When I asked her about the numbers, Dr. Buchbinder told me the HIV mortality numbers include all people diagnosed HIV-positive in San Francisco, even if they died somewhere else. (When someone is diagnosed HIV-positive, their case is assigned an ID from the Centers for Disease Control and Prevention that tracks the location of future treatments.)

“The numbers of deaths include everyone diagnosed in SF who died, regardless of where they died,” she wrote me in an email. “We do matches with local death certificates, the State Office of AIDS, National Death Index, and social security death files. We believe our numbers for deaths are very complete, although there can be a lag time in getting the reports into the NDI.”

Yet that still leaves the question of how many people who were diagnosed elsewhere have died. A significant portion of San Francisco’s HIV-positive population moved here after being diagnosed, and may be left out of the total count.

“Imagine someone born and raised in SF who goes away to college,” Basinger wrote to me. “Gets tested in his college town. And then moved back to SF after graduation. It sounds like their death would not be counted in the SF death count.

“It also sounds like none of the people who move to SF (like after they test positive in Alabama), are counted in our death count. Even if they have lived here for 30 years.”

San Francisco offers some of the best and most accessible treatment for HIV-positive people in the world — effective HIV treatment was pioneered here 30 years ago, at SF General’s legendary Ward 86. Despite strides in nationwide medication and treatment, however, you won’t find the kind of care, access, and cultural support you can receive in San Francisco in the places where many of those who can’t afford to stay here now must reside.

“We’re talking about people who live on a fixed disability income of less than $900 a month,” Basinger told me. “An aging generation of early contractors of the disease who are now well into retirement age. And LGBT seniors are among the most vulnerable to evictions.”

Because there has been no official request from the Mayor’s Office or Board of Supervisors, there is no official count of how many HIV people have been evicted or displaced — although, as noted above, SFDPH estimates outmigration at up to 15% in the past two years, and AIDS Housing Alliance estimates it at slightly more than 20% in the past five years.

As the SF Getting to Zero consortium, made up of local prevention agencies and formed with the laudable goal of getting HIV infections and deaths to zero, acknowledges, “Housing remains the biggest single gap. GTZ members have spoken about the critical importance of addressing housing to achieve GTZ goals at Board of Supervisor hearings and at GTZ meetings.”

As for the decrease in new infections, questions remain about that as well. Although HIV continues to affect people from all backgrounds and situations, those most at risk continue to be poor, of color, young, and queer — populations being severely affected by San Francisco’s housing crisis. Are new HIV-positive diagnoses decreasing in part because those most at risk can no longer afford to live here?

“Along with access to treatment and education, stable housing is the most important factor in successfully reducing both HIV transmission and mortality,” Basinger  told me. “San Francisco has excellent access through programs like Healthy SF, a very low level of stigma around the disease, and a high level of care and support. Yet you need housing stability to help ensure you adhere to the treatment programs that keep you alive.

“If you’re constantly stressed out about your living situation, or if you’re evicted, those have huge negative effects on your treatment and health. And if you never have access to those things to begin with, or lose access due to prohibitive costs, then you’re basically made invisible.

“Housing for HIV-positive people is one of those rare problems that if you throw money at it, it actually gets solved,” Basinger continued. “Imagine how low these numbers could be if those most affected by HIV could afford to live here.”

Marke B.
Marke Bieschke is the publisher and arts and culture editor of 48 Hills. He co-owns the Stud bar in SoMa. Reach him at marke (at) 48hills.org, follow @supermarke on Twitter.

57 COMMENTS

  1. Proud to be supporter, LGBTQ awareness we must get Ellis Act on ballot this only measure housing policies. We pay taxes Scott,London and Ed instead favors the developers whom playing game of pursuit yeah displacement. Ratio affluent LGBTQ realtors blame buying homes with cash dashing away. Housing policies disunity LGBTQ’ need cease associating false assurance hierarchy whom don’t care Frank Nolan,Rob and Dave Winecountyrealty selling most. TIC and realty where do stand segregation effecting LGBTQ society I forgotten only affluent have voice. LGBTQ society fight is among us! Tim Cook,Ellen,Rick Martin,Tom Ford,Peter Thiel,Chris Hughes and Matt Bomer able decrying denial failed lobby for equality housing. LGBTQ going fight for equality housing,insurance and employment rights marriage is minor essential neglected!

  2. There are examples in this article about deaths and ruined lives as a result of eviction. But why do you care so much unless it’s your conscience trying to convince yourself

  3. The average person in the United States moves 11.4 times in their life….. How deluded is your claim is that moving “ruins” lives? No wonder depression is so rampant, everyones life has been “ruined” on average 11.4 times…

  4. No one needs to “see” a deluded and irrational perspective. I don’t need to “see” the christian cult perspective or the serial killer perspective.

  5. Yes, just like they sided with marriage equity, the law compels them to. Your deluded fantsy that renters have the same rights as owners, is just as crazy as christians who think they have a devine right to discriminate. And the only way tenants “win” is procedural errors in the cases, which can be fixed and refiled.

  6. The courts are siding with the owners in almost all cases. But if you don’t want the guilt of ruining someone’s life then don’t go into the rental business

  7. Yeah and having an abortion is MURDER, to so many who think you have no right to control your own body You have just as much right to control your property as your body, When a tenant moves out are they treating the landlord like a dog? Sorry but it’s a contract and they have to be fair. You can’t leave at will and expect the landlord to have no right to exit that same contract You greedy people just love to shit on self enabled landlords.

  8. You really think its that simple? Try getting a divorce after twenty years of marriage and find out what type of legal hassles you will face. You want your property to be yours unencumbered by legal hassles? Don’t rent. I’m sorry but you can’t have it that easy. You can’t provide a home to people and then treat them like dogs

  9. The Ellis Act is an honorable way to go, you have every right to control the destiny of your own property

  10. Your property is yours, just like your vagina is yours, Just because you might have shared said vagina with someone for 20 years mean not mean you have to keep sharing it against your express wishes to do what you want with your vagina, or share it with someone else. .LIFE, LIBERTY AND PROPERTY they are equal in the 14th amendment.

  11. I’m not sure what you are referring to when you say someone is requiring you to do something – if you are referring to rent control/guaranteed housing, long term tenants don’t have any legal protection in the United States. That’s why so many people are complaining about being evicted. I honestly think that exploding housing prices are bad for a community – bad for owner occupied rentals, bad for tenants, bad for most small businesses. The only people who seem to be profiting are the people making a quick conversion to condominiums or the people using their homes as hotels.

  12. I think I can see the other perspective. I thought about my own situation in terms of renting; it’s very attractive. Two downsides: rent control could always end, somehow, and then what?, and, with renting, there’s no equity accumulation.

    But let’s get back to the responsibility. If someone requires you to do something, and guarantees that situation to someone else, don’t say bear the ultimate responsibility of carrying forward on that promise?

  13. 1) it is not the death sentence today that it once was – that is actual science
    2) Why would we assume that people would not leave of their own accord just because they have HIV?

  14. I will trust the statistical survey evidence. My personal experience is that many HIV+ people of my generation have in fact been forced out of San Francisco, if they made the mistake years ago of renting a flat instead of an apartment in a large complex. To try and claim that it’s not a death sentence somehow implies that people just picked-up and moved in ridiculous.

  15. I don’t know your situation and I wouldn’t want anyone to be forced to move. The courts are siding with the property owners about 90 percent of the time but you need to see the problem from both parties perspective

  16. So, to not be forced to continue to rent to someone, I must “evict” myself from the property I own – and live in.

    It makes you wonder exactly by whom the property is really “owned”.

  17. What is the evidentiary basis for the claim that 15% to 20% of people with HIV have left the city?

    Especially given that medical information abut individuals is private and confidential?

  18. Sorry, but this seems like a very uncomfortable leap. How do you know these people didn’t leave of their own accord ? Aids is not the death sentence it once was, and SF isn’t the place that every single person in the world wants to live in. Is the goal here to get more people with aids to live comfortably in San Francisco or should it be to drive down the rates of infection even further ?

  19. But if you were FORCED to remain in business, then what is your real, personal liability? Doesn’t the responsiblity really lay with those who REQUIRED that you keep that business arrangement?

  20. I left of my own accord. Too many ghosts. No live people left. But if I’d stayed I mighta been screwed out of my rent controlled apartment when 87 Dolores caught fire.

    Does anyone know what happened to the people in the rent-controlled apartments there?

  21. Access to treatment and PrEP are much more widespread than evictions.

    One leads to undetectable viral loads, the other offers protection rates similar to condoms.

    The City has led the way in making both classes of drugs available.

    That is the simplest answer to plummeting HIV seroconversion rates.

    If targeting LGBT seniors at 55 Laguna is difficult, then the City should target HIV+ seniors, two classes which can be discriminated in favor of in housing.

  22. thanks, Mary for attempting to explain to Kevin Smith; his comments are simply tacky; reads too much Ayn Rand perhaps

  23. There is a difference between property you live in and property you rent. If you rent to people there are laws that protect them from abuse and exploitation.

    Every situation is different. If you rent to a young couple saving to buy their first home, or a graduate student or someone in his or her twenties and explain that you have a one year lease that might not be renewed then everyone understands the situation.

    If you rent to someone for a long period of time like twenty years you are providing that person with a home. That is how they are going to see it. If you then forcibly remove someone from a home and a community you may very well be ruining someone’s life. If you don’t want blood on your hands then don’t evict someone you have rented to for a long time.

  24. your statement is incorrect and hurtful – cruel; did you even read the article? anything to tear down rent control – calling people brats- “secure valuable real estate for your greedy selves” please check yourself

  25. Using Eviction = Death as a attention getting device, by a bunch of coddled rent control privilege brats, is a outrage to the real people who faced and died of a horrible disease … Shame on your disrespect and selfishness.. You would do anything, no matter how tasteless and cheap, to secure valuable real estate for your greedy selves.

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