California: HIV Prevention Director Ups Public Role

The HIV prevention director at San Francisco's Department of Public Health began the first of several neighborhood meetings by asking residents "where we should best put our resources to stop the epidemic in San Francisco."

"We are in an endemic rather than an epidemic state, but things are still too high," Dr. Grant Colfax said Wednesday night in the Castro district. "I am hoping to hear ideas on how we use our resources best to draw the epidemic down."

The city estimates 800-1,000 people are newly infected each year. While HIV rates have held steady in recent years, data show that a gay man in his 20s in the city has a 60 percent chance of becoming infected over his lifetime, and "among African-American men it is even higher," Colfax said.

Colfax is working with health providers to ensure routine voluntary rapid-result HIV screening. He has also expanded more sensitive RNA testing at several sites to catch infections earlier than typical tests. Colfax and department staff members are working with San Francisco General Hospital to implement a $250,000, CDC-funded rapid HIV testing program in its emergency room that will begin in May.

There are many San Franciscans who still do not know they are HIV-positive, Colfax said. "If we can help these people find out they are positive, then we know their risk behaviors will change," he said.

Colfax said he is also looking into addressing drug use among "party guys," men who use drugs only occasionally but who put themselves at risk for HIV when they do. Among occasional methamphetamine users, who constitute 80 percent of all meth users, HIV transmission "is significant," he noted.

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