Imagine an AIDS-free San Francisco. That the city that's home to San Francisco General Hospital's Ward 86, the nation's oldest HIV/AIDS clinic, and has lost 19,000 people since the beginning of the disease, could even be in a position to envision that scenario is staggering. But we are making real progress. From 2004 to 2011, the number of new infections dropped by half in the city, to stand at around 300 per year. But the goal isn't 300—it's zero. It's a target that's closer than you'd think—and one that carries problems of its own.
That's the thesis of a fascinating feature article in this month's issue of The Advocate that argues that San Francisco could well become the first city to have zero new HIV transmissions and zero AIDS patients. It sounds utopian, but it's a goal that is supported by emerging treatment breakthroughs, including PrEP and antiretroviral therapy. There have also been cases in Europe, most prominently in France in 2006 of patients functionally cured of HIV through experiment methods.
It's not just about the science, though. That's available world-wide. What makes San Francisco stand out, according to The Advocate, is its public health support system coupled with its frank and liberal attitudes towards sexuality, including a program called RAPID, which is "aimed at getting HIV patients on ART the same day they’re diagnosed. In some cases this means that healthcare workers escort patients to Ward 86 in a cab." Thanks to efforts like that one, San Francisco's percent of diagnosed cases in which the virus is suppressed stands at 50%—double the national average. It's also a question of accepting social norms making the policy progress easier.
To be fair, these ambitious goals will not prove to be a panacea for many of those currently living with the disease. Says Michael Scarce, an activist and medical sociologist, "All of the comorbidities and socioeconomic factors that intersect with HIV would need to be eliminated, if we’re going to truly be AIDS-free. I don’t know of that ever happening in the history of Western civilization." Scarce, who himself was recently served an eviction notice, points to endemic problems of substance abuse, poverty, and homelessness. Thanks to our run-away housing affordability crisis, The Advocate concludes, "San Francisco is now in the uncomfortable position of having a cure within reach while being unable to offer it to many of the people who made it possible."
Which is a point worth emphasizing. This is what progress looks like: Having to solve problems that are incrementally less terrible than the problems you had to solve before. Not to put too fine a point on it, but having to figure out housing for HIV patients is a better issue to be having to address than where to find cemetaries. The life expectency of an AIDS patient at the beginning of the outbreak was 18 months. That's not someone who worries about rising rents or gentrification.