Santa Clara County Seeks to Halt HIV

Santa Clara County supervisors have asked their county health department to devise a plan to halt the transmission of HIV within the 15 cities under their jurisdiction.

At its meeting Tuesday, December 15 the five-member Board of Supervisors unanimously adopted a request brought forward by gay Supervisor Ken Yeager for the county to create its own Getting to Zero plan, similar to the action health officials in San Francisco took last year.

Yeager would like to see the county emulate San Francisco's goal of reducing new HIV infections by at least 90 percent come 2030. According to the latest figures from the Santa Clara County Public Health Department, there were 155 new HIV cases in 2014, with infections among men increasing 20 percent from 2013.

"Other areas are doing great work in this area and I hope we can learn from their plans and incorporate best practices into ours," Yeager told the Bay Area Reporter.

County Health Officer Dr. Sara Cody is tasked with bringing the outlines of a plan, as well as a cost estimate for putting it into place, to the supervisors sometime in February.

"It is a very audacious goal," Cody told the B.A.R. in a phone interview following the board's vote.

She demurred when asked what the cost of the plan would be, saying that, "My guess is this will be rather resource intensive."

One of the first steps she intends to take toward crafting the county's plan will be to confer with her counterparts in San Francisco to learn more about the city's Getting to Zero plan.

It is based on a three-pronged strategy of expanded access to pre-exposure prophylaxis (better known as PrEP), rapid access to antiretroviral therapy, and retention of HIV-positive people in care. Santa Clara's plan is expected to mirror the city's approach.

Until now, Santa Clara County health officials had not set a timeframe for ending HIV transmission. Cody told the B.A.R. she is unsure if San Francisco's 2030 goal would be feasible for Santa Clara to replicate.

The two jurisdictions differ in how they operate and provide HIV prevention services and care for those living with HIV and AIDS. San Francisco is both a city and a county, and despite it overseeing a more compact area, its HIV cases are three times the size of those found in Silicon Valley. It recorded 302 new HIV infections in 2014.

Like with San Francisco's HIV cases, the majority of cases in Santa Clara County are among men who have sex with men. And men in both counties age 50 years and older account for large percentages of the people living with HIV or AIDS; in Santa Clara it is 48 percent of the 2,902 residents in the county who are HIV-positive.

Latino men who have sex with men aged 20 to 39 largely accounted for the uptick in HIV cases that Santa Clara saw last year. Cody said the county will not know if HIV cases continued an upward climb in 2015 until sometime next year due to the delay in its receiving data from state health officials.

One challenge the county health department faces is that 30 percent of the people living with HIV in Silicon Valley are not receiving treatment. Another is how accessible PrEP is for HIV-negative people, particularly those not receiving care from the county health system.

As Yeager's office noted in its proposal to the board, the county-run Santa Clara Valley Medical Center is in the process of adopting national clinical guidelines on the appropriate utilization of PrEP by primary-care clinicians and training for clinicians on how to implement the guidelines.

"There is a great deal of excellent work being done within Santa Clara County that can be built upon for the Getting to Zero initiative, work that could be coordinated, assessed and strengthened from a county-wide, whole system perspective to help us win the battle against HIV/AIDS," wrote Yeager in his proposal to the board.