County of Santa Clara
Board of Supervisors
Supervisorial District Four
Supervisor Ken Yeager
79391
DATE:
December 15, 2015
TO:
Board of Supervisors
FROM:
Ken Yeager, Supervisor
SUBJECT: HIV/AIDS "Getting to Zero" initiative in Santa Clara County
RECOMMENDED ACTION
Direct County Executive to report back to the Board of Supervisors no later than February
2015 on the proposed steps and potential fiscal and resource needs to operationalize a
"Getting to Zero” initiative in Santa Clara County. (Yeager)
The report should include the following elements:
a)
An estimate of the cost of launching a local Getting to Zero initiative for discussion in the
Mid-Year Budget, as well as a process and timeline for releasing Requests for Proposals
to deliver components of the campaign as appropriate.
b)
An initial plan that outlines next steps, timeline, and a process for engaging stakeholders
to develop a local Getting to Zero initiative. The plan should include consideration of
the following potential components: launching a countywide campaign to raise
awareness of the importance of getting tested, educating providers and consumers about
pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), ensuring test
and treat guidelines and universal screening guidelines are being followed consistently
throughout the County, reducing barriers to retention in care for HIV positive
individuals, working with school districts on HIV education and prevention, and
expanding STD clinic capacity as needed.
c)
An explanation of the measurable outcomes expected from this initiative and how these
outcomes will be monitored and reported.
FISCAL IMPLICATIONS
To be determined in report back.
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Page 1 of 4
REASONS FOR RECOMMENDATION
For many years, Santa Clara County and key community partners have successfully delivered
a range of critical HIV prevention and treatment programs and services. But, there is more
we can and should do to eradicate this disease. Today we have more tools available than ever
before to treat and prevent HIV. The newest tests can detect the virus within as little as 10
days of transmission. We have more effective medications with fewer side effects. We know
that treatment prevents the spread of HIV and improves the health of HIV positive
individuals. New prevention methods, including pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) have proven highly effective at preventing HIV among
individuals at high-risk for contracting the disease. Moreover, with the Affordable Care Act,
tens of thousands of low-income residents who previously lacked health coverage now have
it, potentially expanding opportunities to encourage testing and treatment.
While Santa Clara County performs significantly better than the national average, still nearly
30% of people living with HIV are not engaged in medical care for their disease. Some do
not know they are infected. Others aren’t remaining in care after they test positive. While
Santa Clara Valley Medical Center – through the PACE clinic – follows the most up-to-date
test and treatment guidelines, the County and our community partners should work to ensure
that all HIV providers are doing the same, to maximize the impact of preventive benefits of
HIV treatment. We must also continue to work hard to retain HIV positive individuals in
care. There remain significant gaps in knowledge about PrEP and PEP among many
providers and patients who could benefit from the medication. Furthermore, the population
at highest risk for HIV is evolving and new outreach strategies need to be developed to
ensure we are treating and preventing infection among our highest risk groups.
For all of these reasons, Santa Clara County should join what is increasingly becoming
known as the “Getting to Zero” campaign, which seeks to reach zero new HIV transmissions,
zero HIV-related deaths, and zero stigma. As we have done with the diabetes prevention
initiative, we should pull stakeholders together to develop and launch our own local Getting
to Zero effort. This initiative could include launching a countywide campaign to raise
awareness of the importance of getting tested, educating providers and consumers about PrEP
and PEP, ensuring test and treat guidelines are being followed consistently throughout the
County, ensuring universal screening guidelines are being followed consistently throughout
the County, reducing barriers to retention in care for HIV positive individuals, working with
school districts on HIV education and prevention, and expanding STD clinic capacity as
needed.
The initial report back to this referral would provide a plan that outlines the next steps,
timeline and resources needed to launch a Getting to Zero initiative in Santa Clara County. It
should include estimates of what an overall campaign would cost for discussion in the MidYear Budget as well as a process and timeline for releasing potential Requests for Proposals
to deliver elements of the campaign as appropriate. The plan should be inclusive of various
Santa Clara Valley Health and Hospital System agencies and community stakeholders,
include measurable outcomes expected from the campaign, and leverage existing resources
including the Center for Population Health Improvement.
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: December 15, 2015
Page 2 of 4
BACKGROUND
Even though tremendous progress has been made in recent decades, HIV/AIDS remains a
major health concern. There are currently more than 3,500 people living with HIV/AIDS in
Santa Clara County. After several years of steady decline, the rate of new HIV diagnoses
actually increased last year, particularly among men who have sex with men (MSM). The
rate of newly diagnosed and reported cases of HIV locally grew from 8.5 cases per 100,000
residents in 2013 up to 10 cases per 100,000 in 2014. This change was driven primarily by a
20% increase among males ages 13 and older, including a 46% increase among Latino males.
The number of MSM newly diagnosed with HIV climbed from 75 cases in 2013 to 106 cases
in 2014. All told, there were 155 newly diagnosed cases of HIV in the County last year.
Nationally, while reported diagnoses of HIV have decreased overall in recent years, there are
large disparities among groups. Increasingly, new HIV infections are concentrated among
younger gay and bisexual men, particularly men of color. Whereas, between 2003 and 2014,
the number of individuals with newly diagnosed HIV infections declined 25% overall,
diagnoses among MSM increased by 5%. More than two-thirds of new diagnoses now occur
among this group. Diagnoses among young gay and bisexual men more than doubled during
this period.
In 2008, the Centers for Disease Control and Prevention awarded Fenway Health, AIDS
Action Committee of Massachusetts, and the Multicultural AIDS Coalition $3.78 million for
a five-year HIV prevention partnership that focused on gay, bisexual, other MSM and
transgender women, the groups at highest risk of HIV infection in the United States.
Referred to as “Getting to Zero,” the initiative targets hard-to-reach, high-risk members of
these communities and connects them to HIV counseling and testing, health care, and
prevention services.
On World AIDS Day 2011 (December 1, 2011), the United Nations announced a global
effort to end the HIV epidemic. The “Getting to Zero” effort promotes three main objectives:
reaching zero new HIV infections, zero HIV related deaths, and zero stigma. Since its
launch, a number of other jurisdictions whose communities have been significantly impacted
by HIV have launched similar efforts.
In 2014, a volunteer, multi-sector, independent consortium launched a “Getting to Zero”
initiative in San Francisco. San Francisco’s 2015 Getting to Zero strategic plan is focused on
three initiatives: expanding PrEP, rapid initiation of anti-retroviral therapy, and retention in
care. The San Francisco plan builds on a robust HIV surveillance system, widespread testing
services, syringe access services, and comprehensive HIV care in the public and private
sector.
Santa Clara County Public Health Department has a 30 year long history of leadership in
responding to the HIV epidemic. Public Health has successfully implemented several
programs and strategies that have reduced new HIV infections, HIV related deaths and
stigma which could serve as a foundation for this initiative. Experienced community-based
organizations, like The Health Trust, provide a range of critical support services to hundreds
of low-income residents living with HIV/AIDS. Additionally, medical leaders from the Santa
Clara Valley Medical Center are in the process of adopting national clinical guidelines on the
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: December 15, 2015
Page 3 of 4
appropriate utilization of PrEP by primary-care clinicians and plan to train clinicians on how
to implement these 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.
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: December 15, 2015
Page 4 of 4