potrero view

February 2010

Sickest AIDS Patients Live in Southeast San Francisco

By Michael Condiff

According to public health and social service experts, persons with HIV/AIDS often don’t seek treatment for the disease for a myriad of reasons, including ignorance of their status and mistrust of the public health system. Understanding those reasons is of particular importance to Potrero Hill and Bayview residents, since San Francisco Department of Public Health (DPH) research indicates that the City’s sickest AIDS patients live in Southeast San Francisco.

DPH’s research involved mapping viral loads taken from AIDS patients from 2005 to 2007.  It concluded that although a greater number of the City’s 15,000 documented HIV/AIDS cases are in other neighborhoods, such as the Castro, the densest grouping of persons with high viral loads is in Southeast San Francisco, and specifically Potrero Hill and Bayview.

Viral load – the number of viral particles in a person’s bloodstream – is used to measure the intensity of HIV/AIDS. Lower viral loads mean less risk of infecting others. However, the opposite is also true, and experts say the high-viral-load hotspots are perpetuating the disease, particularly in African-American communities, where the average individual viral load is roughly one-third higher than that of Latinos or European-Americans.  “As long as we don’t deal with that problem…we’re promoting the continued spread of HIV in perpetuity,” said Dr. Julio Montaner, president of the International AIDS Society.

Bayview and Potrero Hill have emerged as HIV/AIDS hotspots for cultural and economic reasons, including poverty and homelessness.  Both neighborhoods are less accessible to the rest of the City, with fewer travel patterns to other communities. The back and forth that does exist is often with other challenged neighborhoods, like the Tenderloin. This concentration creates a sort of petri dish for health concerns, including HIV/AIDS.  Moreover, within those communities, individuals face issues that impede knowledge of their status, dissuade them from seeking and/or following through with treatment, or simply take precedence over treatment.  

“These issues are all complex, comprehensive and powerful,” said Jacob Moody, executive director of the Bayview Hunters Point Foundation, which operates an AIDS support unit and is part of the Southeast Partnership for Health.  According to Moody, mental health and substance abuse factors often compromise a person’s ability to enter treatment or complete treatment modalities.  “Unfortunately, many just aren’t in position emotionally to deal with the structure of treatment, or aren’t stable enough to seek help,” he said. “And the reality is that some of the people we’re talking about wake up in the morning and ask themselves, “Do I eat today? Or, do I buy drugs?” For them, treatment is way down on the list of priorities.”

Fear and lack of knowledge as to what comprises treatment also are factors, said Dr. Tewodros Teketel, treatment adherence support specialist for the Black Coalition on AIDS (BCA).  “There’s still a lot of misconception about HIV treatment; people are afraid of what effects it will have on their bodies,” said Dr. Teketel. “They’re still thinking about the early days of HIV, when drugs and treatment programs weren’t yet advanced.”

According to Francis Broome, BCA’s director of prevention and education, misconceptions about proper HIV/AIDS treatment in African-American communities is symptomatic of a general distrust of the public health system.  “Some folks still have Tuskegee on their minds,” said Broome, referring to the 40-year study conducted mid-century last in Alabama in which scientists denied syphilis treatment to a group of 600 African-American men. “Some still believe AIDS is part of a government conspiracy. They just don’t believe their best interests are at heart. How do you counteract that sort of distrust?  As a result, we have clients who do not access the public health care system as much as they should.”

Broome said lack of faith in the health care system, combined with the societal stigma surrounding HIV/AIDS, factors into a Center for Disease Control estimate that 25 percent of persons infected aren’t aware of their status.  “We have people who come in and discover they’ve been [HIV] positive for eight or ten years,” he said. “Maybe they’ve gotten sick over the years and thought it was just a cold, or maybe deep down they’ve known, but were in denial, were afraid of being excommunicated from their communities or families. Some people think that if they keep it hush-hush, the problem will go away. It doesn’t.”

Moody said despite potentially deadly results, the fear of contracting HIV/AIDS carries little weight in lower-income African-American communities.  “It’s just another thing that’s going to kill you,” Moody said. “It hasn’t been elevated beyond violence or diabetes or any of the other things that threaten African-Americans on a daily basis. The threat of AIDS doesn’t hold the same power that it does in the gay, white community.”

According to Dr. Grant Colfax, DPH’s director of HIV prevention and research, reaching AIDS patients in Potrero Hill and Bayview is a priority.  “If any place is able to reduce infections by treating people effectively, San Francisco should have the best chance,” he said.  Roughly 80 percent of persons infected with HIV/AIDS in San Francisco are receiving treatment, up from 55 percent in 2005, despite the fact that about 800 new cases are reported each year.  “We’re actually doing extremely well for a city this size,” Dr. Colfax said. “So, the question becomes:  how do we build on 80 percent?  We know that in the Southeast part of the City, we’re way below that number. So, we’ve got to figure out a way to engage these people in conversation, find out why they’re not getting treatment. How do we get those people in or get treatment to them? We have to explore those questions, and then have conversations with treatment providers and consumers as to what the answers might be.”

 

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