Gentrification and declining Black population may be a key factor behind San Francisco’s declining HIV rates

Dramatic declines in HIV diagnoses in San Francisco have been attributed to testing, treatment and PrEP, but the declining Black population in the city is an unexamined factor, Dr Jade Pagkas-Bather of the University of Chicago and colleagues argue in the December issue of The Lancet HIV. There has been a 22% fall in San Francisco’s Black population since 2000.

“We posit that the declining overall HIV incidence, including among White MSM [men who have sex with men], is not only explained by the use of treatment as prevention and PrEP, but is also due to the declining Black population and rising HIV incidence among Black MSM, who have historically been more likely to acquire HIV due to structural, racial, and criminal justice-related factors than have White MSM,” Pagkas-Bather says.

There are clear inequalities in access to treatment and prevention interventions in San Francisco:

  • 67% of Black people with HIV are linked to care, compared to 87% of White people.
  • 68% of Black people with HIV are virally suppressed, compared to 76% of White residents.
  • Six months after starting PrEP, 21% of Black MSM are still taking it, compared to 42% of White MSM.
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