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At Least 6000 People Thought to Be on HIV PrEP in San Francisco

New numbers from the city's largest pre-exposure prophylaxis (PrEP) programs, along with estimates from primary providers and other smaller sources, suggest that more than 6000 people in San Francisco are receiving or have received Truvada for HIV prevention, most of them gay and bisexual men.

The U.S. Food and Drug Administration approved Truvada (tenofovir/emtricitabine) for HIV pre-exposure prophylaxis in July 2012. Adoption was initially slow, but took off in San Francisco starting in late 2013 as gay men began to promote PrEP within their communities.

Studies of gay and bisexual men and transgender women have shown that Truvada reduces the risk of HIV infection by more than 90% if used consistently, with no new infections among people who take it at least 4 times a week.

The San Francisco AIDS Foundation's Strut sexual health program celebrated its 1000th PrEP prescription at a party on May 26.

Standing over a cake in the shape of a blue Truvada pill, Strut nursing directorPierre-Cédric Crouch said that when he first heard about PrEP he thought people would come into Magnet, learn about PrEP, and then get it from their providers, "but it didn’t work out that way."

PrEP was initially expected to account for 20% of clients at Magnet, which became part of the Strut health and wellness center in January. Now about half of Strut's daily clients come for PrEP, according to former director of sexual health services Steve Gibson, who is now HIV prevention branch chief at the California Office of AIDS in Sacramento.

At the National HIV Prevention Conferencelast December Gibson reported that adherence to PrEP remained high among Magnet's clients and there were no new infections among those who took Truvada regularly.

As of last week the total number of PrEP clients at Strut, which focuses on gay men, was "just shy of 1,100," according to Crouch. In addition, there are 60 PrEP clients currently enrolled at the San Francisco AIDS Foundation's Market Street headquarters, which receives referrals from Glide (which sees a diversepopulation of homeless and low-income clients in the Tenderloin) and St. James Infirmary (which serves sex workers of all genders).

"Hitting 1,000 enrollments in our PrEP health program has highlighted the tremendous demand for PrEP in San Francisco," Crouch said. "Our clients have been returning to the clinic with happier and healthier relationships and sex lives. We’re delighted to share that experience with them."

PrEP Elsewhere in San Francisco

It is difficult to estimate how many people have used PrEP, since this information is not centrally collected. But experts estimate that upwards of 40,000 people in the U.S. are taking it, with San Francisco being ahead of the curve.

Strut is not the largest PrEP program in the city -- a distinction that goes to Kaiser Permanente San Francisco, which serves approximately 225,000 patients, or roughly a quarter of the city's population.

Brad Hare, Kaiser’s director of HIV care and prevention said that his program sees about 90 PrEP clients a month -- a majority of them men who have sex with men -- and expected to reach 1800 prescriptions in early June.

Hare's team reported last fall that there had been no new HIV infections among the first 650 people who received PrEP at Kaiser SFsince 2012.

Turning to city-run facilities, just over 500 people have started PrEP at San Francisco City Clinic since February 2015, according to Robert Wilder Blue, the clinic's coordinator of HIV prevention services.

Prior to that, City Clinic enrolled 300 people in one of the country's first PrEP Demo Projects, some of whom may have gone on to receive regular ongoing prescriptions. Albert Liu from the SF Department of Public Health reported earlier this year that no one who used PrEP consistently became infected with HIV during the Demo Project. In addition, SF DPH's Hyman Scott said that there were approximately 220 people on PrEP at the department's primary care clinics.

Finally, at a World AIDS Day update on San Francisco's Getting to Zero initiative last December, the consortium's PrEP committee reported that as of November 2015 roughly 700 people were receiving PrEP at hospitals (including SF General Hospital, UCSF Medical Center, and the SF Veterans Affairs Medical Center) and more than 1700 were known to be receiving PrEP through private providers and medical groups -- numbers that have no doubt risen.

"I think about half of people in San Francisco get their PrEP from primary care providers," said PrEP researcher Robert Grant from the UCSF Gladstone Institutes, noting that UCSF's PrEP service sees between 100 and 200 people. "While we should celebrate the big services, we should also highlight how primary care providers have stepped up."

Altogether, this brings the total number of people receiving PrEP in the city to over 6000, though this is likely an underestimate due to missing sources including the rest of the UCSF health system, other hospitals, and non-DPH-affiliated health centers.

If approximately 7% of San Francisco's population of 850,000 is LGBT, and half of those are men, this suggests that around 20% of gay and bi men are on PrEP.

"Seeing such a significant interest in PrEP is very encouraging," said Hare. "But we have to remember that PrEP isn't right for everyone, and not everyone who could benefit from PrEP has access to it. There is still much work to be done."

6/3/16