The state’s largest HIV cluster is located in San Antonio, with 34 confirmed cases of viruses that are genetically similar and, therefore, linked, according to San Antonio Metropolitan Health District officials. In Bexar County, the number of people newly diagnosed with HIV has increased by more than 50% in the last decade, from 234 in 2006 to 360 last year, higher than the state average.
At a time when the number of people testing positive for HIV is on the decline nationwide, San Antonio is trending the other way. To address the problem of rising HIV infection rates, local community leaders and HIV advocates participated in a forum Wednesday to launch an anti-HIV initiative.
The Fast Track Cities initiative is an international effort that uses global and local data to accelerate local responses to HIV. The program aims to get more HIV-infected people diagnosed and undergoing treatment.
“San Antonio is in a unique position where we can end HIV in [the city],” said Dr. Barbara Taylor, assistant professor of infectious disease at UT Health San Antonio.
The effort comes at a time when the Centers for Disease Control (CDC), working alongside the Texas Department of State Health Services and Metro Health, have identified 16 HIV clusters in Texas, which has one of the highest infection rates in the country. The CDC recently awarded Texas a grant to investigate the clusters.
Metro Health Director Colleen Bridger told the Rivard Report that the Fast Track Cities’ 90-90-90 plan means that 90% of people who are HIV-positive will know their status, 90% will be connected to a medical home, and 90% will be on antiretroviral therapy.
“That’s the key,” Bridger said, stressing the importance of getting those infected with HIV on regular medication.
Effective HIV treatment reduces the viral load in body fluids, lessening the likelihood of transmission. If a patient’s viral load is undetectable for six months, the person is considered infected but not infectious, which Bridger says “is the path to eradicating HIV.”
The 90-90-90 plan aims to have 90% of all people receiving antiretroviral therapy in viral suppression by the year 2020.
Anita Kurian, assistant director of communicable diseases at Metro Health, told 125 forum participants that 6,343 people in Bexar County currently are diagnosed with HIV. Of that number, 85% are male. In 2015, almost 5,800 people in Bexar County had been diagnosed.
In Bexar County, the rate of HIV infection – 19.1 cases per 100,000 people – is well above the U.S. average of 12.3 cases per 100,000. HIV is spreading among gay Hispanic men — particularly those under the age of 30, according to the CDC.
Organizations such as the San Antonio AIDS Foundation, UT Health San Antonio, the Alamo Area Resource Center, and University Health System participated in the forum, stressing the importance of educating the public to reduce the stigma of HIV.
Attendees were divided into groups based on the 90-90-90 plan criteria and area of expertise, and were tasked with creating action plans to improve HIV outcomes in Bexar County.
Forum attendees discussed how activists and organizations need to promote sex positivity to reach more people at risk for HIV infection. Organizations promoted more open discussion about HIV as a way to normalize testing for the infection. Medical professionals discussed their experiences with implementing standardized HIV testing in their practice.
“I think this is the first time we have the mayor, the [Bexar County] judge, and political support for this kind of thing,” Taylor said. “This is really important.”
One way to get more people on medication is to get earlier diagnoses. Bridger said she is looking into making HIV testing mandatory for anyone aged 13-64 who goes in an emergency room. She said people often go the ER with flu-like symptoms and are discharged without being properly diagnosed.
“We need people to get an HIV test just like they would get an annual cholesterol test,” Bridger said. “The vast majority of people won’t have HIV, but [this way] we can reduce ability to spread it to others.”
Frank Rosas is 61 and has been HIV-positive for 25 years. Since moving to San Antonio 14 years ago, he has seen how Catholicism, conservatism, being Latino, and other cultural factors contribute to the stigma surrounding HIV and testing.
Rosas said that educating young, at-risk populations on treatment and prevention is crucial to keeping people healthy.
“We don’t see many young people at the table here,” Rosas said of the forum attendees. “It’s about us networking and getting the word out.”
Brandon Stevens, 29, is gay, but not HIV-positive. Having been tested for HIV several times, he considers it “just another way of taking care of ourselves and those we come into contact with.”
In 2014, mayors from 27 cities in more than 50 countries signed the Paris Declaration on Fast Track Cities, committing to accelerate local efforts to combat HIV/AIDS. In November, San Antonio will formally join those cities by signing the agreement, becoming one of just 13 cities in the U.S. to do so.