This is "Think Tank," an occasional series of conversations with Bay Area power players, conducted by San Francisco editors. Interviews have been condensed and edited for clarity.
Name: Neil Giuliano
Job: CEO, San Francisco AIDS Foundation
That’s the date, you recently announced, by which San Francisco could be free of AIDS. Is that really possible?
I don’t think that date is unrealistic. With people being in treatment, and then with good prevention work—condoms, antiretrovirals, post-exposure prophylactics—we will be able to get to a day when a new HIV infection is incredibly rare in San Francisco.
But even when the medical breakthroughs are there, some people will still have risky sex.
In San Francisco, there are between 16,000 and 17,000 HIV-positive people. Half of those have been living with the virus for a long time. It’s a very educated community when it comes to HIV. That puts us in a special category.
That sounds a lot like San Francisco exceptionalism.
If you look back at Obama’s national HIV/AIDS strategy, it had its early days with people here who pioneered the notion of treatment as prevention. San Francisco was ahead of the curve, and we’re seeing other cities catch up. The data speaks for itself: From 2004 to 2011, our annual rate of new infections went from 600 to 300. That doesn’t happen if you aren’t doing something that’s working.
So you’re saying that because we have the right strategies in place, all we have to do now is let the clock run down on the virus?
Well, we can’t take our foot off the gas. We have to find the folks who are infected and don’t know it. That means we have to step up our testing. And we’re now moving toward dealing with HIV as a chronic issue. People are living with HIV—they’re living a long time—but we don’t want new infections. So how do you keep yourself healthy and well? How do you make the right decisions, from a sexual health standpoint? Quite often, new infections are a result of alcohol and substance use. That’s why we’re helping people in our mental health counseling program. All these things are related.
You’ve had a long path to this position. You were previously a fourterm mayor of Tempe, Arizona—one of the nation’s first out gay mayors.
I was closeted, but not—it was known. And two years into my 10 years as mayor, I came out. People were already whispering about it; I just wanted to get it over with. But I was elected 20 years ago—the culture is vastly different now. We have openly gay mayors in Seattle, and Houston, and Lexington, Kentucky.
So are you planning another run for office?
This is my public service right now. It’s a really historic time to be able to be in San Francisco and ending HIV.
How does it feel?
It’s empowering. I have tremendous respect for people who have come before me, and for people who are living with HIV. I do this work with great honor for those who are gone: friends of mine, people I dated. I had a friend who attended high school with me. He went to college, came out, and was very active in the gay community. He contracted HIV and died in 1991. I stayed in the closet, did a whole lot of things differently. This friend of mine—he’s gone. I’m in this work for people like him. I could work a lot of places. This is different.
Originally published in the July issue of San Francisco