San Francisco's Bold AIDS Mission Is "Getting to Zero" by 2030

There’s still no vaccine and no cure, but the medical community is increasingly focused on ambitious plans to bring about an end to HIV/AIDS.

This PBS NewsHour segment launches “The End of AIDS?,” a weeklong segment by Pulitzer Center grantees John Kane and William Brangham, with a look at intense prevention efforts underway in one of the cities most impacted by the epidemic, San Francisco.

See the special NewsHour feature "The End of AIDS."


Gwen Ifill: Now we kick off a special series about efforts to try to end the AIDS epidemic.

Leaders and researchers from around the globe will be meeting at the International AIDS Conference in South Africa next week. One major focus, how to stop the epidemic.

But with no vaccine or cure in sight, how likely is that? This week, we’re looking at efforts around the world.

We start in San Francisco, where we have followed people for the past six months.

Correspondent William Brangham and producer Jason Kane reported this series, with the support of the Pulitzer Center on Crisis Reporting.

William Brangham: San Francisco’s gay pride events went off this summer like they usually do, loud and colorful and celebratory.

But there’s additional reason to celebrate. San Francisco, one of the cities where the AIDS epidemic first emerged, and one that suffered terribly from it, has now launched the country’s most ambitious campaign to control it.

It’s called Getting to Zero.

Luis Canales is a living example of that campaign. Canales is HIV-positive. He got infected having unprotected sex with another man three years ago. But — and this is one of the linchpins of San Francisco’s effort — Canales was tested and then started on HIV treatment immediately after diagnosis.

Luis Canales: Yes, right away. And I think it was the next day, I came in and started my meds.

Dr. Steven Deeks: University of California, San Francisco: That, as a physician is my goal, to keep people on therapy for their own good.

William Brangham: Steven Deeks is Canales’ doctor.

Dr. Steven Deeks: Luis, how you doing?

Luis Canales: Pretty good.

William Brangham: This approach is called Rapid.

And Deeks says, the sooner the virus can be stopped with antiretroviral drugs, the better, but it’s not just for the patient.

Dr. Steven Deeks: From a public health perspective — and I think this is what’s really driving a lot of interest in the RAPID program — someone’s on therapy, they can’t pass the virus to other people.

William Brangham: Dr. Diane Havlir of U.C. San Francisco pushed the city to embrace RAPID treatment years before other cities did. She’s also one of the architects of the entire Getting to Zero plan.

She says the idea that treatment should wait because of cost, or side effects, or fear people won’t stick with it is outdated.

Dr. Diane Havlir, University of California, San Francisco: If you have heart attack, you do need to take medicines for your heart, in most cases for life. We don’t say, how do you feel about this? Do you want to go home? We say, you need to start these medicines now. This is a serious condition. It’s the same with HIV.

William Brangham: Widespread testing and treatment for HIV is considered the single best way to curtail this epidemic.

Treatment prevents infected people from progressing to AIDS, and it reduces the likelihood that they will infect others. The Getting to Zero campaign wants to cut those new HIV infections in the city by 90 percent by 2020. That would mean cutting them from 300 a year now down to about 30. They also want to cut HIV deaths by a similar percentage, from about 150 a year today down to just 15.

They want to get both down to zero by 2030. Of course, the best way to stop HIV is to stop people getting infected in the first place, so San Francisco is aggressively promoting its prevention strategy.

Jason Lloyd is a 41-year-old gay man in San Francisco.

Man: Your first and last name?

Jason Lloyd: Jason Lloyd.

William Brangham: He doesn’t have HIV. And to stay that way, back in January, he was about to start taking what’s called PrEP, pre-exposure prophylaxis. It’s a daily dose of the drug Truvada that will greatly reduce his chance of infection if he’s exposed to HIV.

Jason Lloyd: There is always in the back of my head when I go to get tested, is this going to be — is the test going to come back positive? Because I do have risky activity, although it might be low-risk, still risky.

William Brangham: Truvada was approved as a prevention tool by the FDA in 2012. Despite its proven ability to prevent HIV, it’s been very controversial, and it hasn’t been widely embraced elsewhere. Some fear those who take it will engage in riskier behavior, though there’s very little evidence of that occurring.

Right now, an estimated 6,000 people in San Francisco are taking Truvada for HIV prevention, and Jason Lloyd is joining their ranks.

Jason Lloyd: And so I will start taking it tonight. So, we will see.

William Brangham: Of course, Truvada is for those who are uninfected. Keeping those who are infected healthy and linked to care is another main thrust of San Francisco’s plan.

Max Ruben works for San Francisco’s Public Health Department. For months, he’s been making regular visits to see an HIV-positive man named Barry Stover.

Max Ruben, San Francisco Public Health Department: Barry. Morning, bud. How’s it going?

Barry Stover: I found out I had HIV. I was ready to kill myself, but I didn’t.

William Brangham: Stover was diagnosed in 2015 after years of living on the streets, addicted to drugs. He’s still using today, and the first few times we met him, he was supposed to be taking his daily HIV medications, but it wasn’t clear that was happening.

Barry Stover: I try to take ’em, but I just don’t like taking pills.

William Brangham: After their visit, Ruben walked Stover to one of the city’s health clinics. With regular visits, they hope he will be more consistent with his medications.

Dr. Diane Havlir: No one is proposing that every single person with HIV gets a daily visit. However, if we want to fully control the epidemic, we are going to need to do that for some people, and it’s completely justified. It’s either pay now or pay later.

William Brangham: A few blocks away, Kenneth Grosenbach and his girlfriend Michele Campbell are trying to stay on their medications as well.

He’s HIV-positive. She isn’t. Because he’s taking his meds, she’s far less likely to get infected. She’s also taking PrEP, which gives her even more protection.

It’s hard to convey just how brutal Kenny Grosenbach’s life has been so far. Born to a teenage rape victim, he was abandoned when he was 10. He says he’s been selling sex and addicted to drugs for the last 20 years Grosenbach admits he’s had trouble in the past staying on his HIV medication, but now he says he’s got a reason to stay alive.

Kenneth Grosenbach: What encouraged me to get my medicine, and start my medicine, is that I found somebody that I really care about. I found somebody that cares about me.

Michelle Campbell, San Francisco: Now that we’re together and we want to start a normal life, we need to start doing normal things.

William Brangham: To stop the AIDS epidemic, two years ago, the U.N. set an ambitious goal, and it’s one that we’re seeing implemented here in San Francisco. It’s to get 90 percent of HIV-positive people tested, 90 percent of them onto treatment, and 90 percent of them to have their virus fully suppressed.

Whether that’s achievable and whether that’ll stem the epidemic is still an open question. The challenge of hitting those targets became clearer when we returned to the city three months later.

Woman: What is the reason to see the pharmacist tomorrow?

Kenneth Grosenbach: Because I have zero medicines. Yes, I need my medicine.

William Brangham: Kenny Grosenbach is now homeless. He’d just been kicked out of his place, and he stopped taking his HIV medication.

Kenneth Grosenbach: I have to say that these few months have been hard. I went completely backwards. I am not really being too much on the responsible end for my meds or for my relationship. I am just trying to make it day by day.

William Brangham: “Science” magazine’s Jon Cohen, who’s covered HIV/AIDS for more than 25 years, and who helped us report this series, says Kenny Grosenbach is a testament to just how hard it’s going to be to achieve the U.N.’s targets.

Jon Cohen “Science” magazine: Who are these people who are so hard to test, who are so hard to link to care, and who are so hard to get suppressed? Kenny’s that guy.

He’s really tough on every level for the health care system. He knows his status. Linking him to care, he’s been linked to care, but keeping him virally suppressed? Well, he has a really hard time staying on his medication. And it ties back to housing, right? I mean, this is a guy who’s living on the streets.

William Brangham: But for most people, the Getting to Zero campaign has been working.

This summer, six months after we first met him, Jason Lloyd was still taking the PrEP drug, Truvada. He said some of his friends take it, too. They help remind him to take his, and it’s all becoming very normal-seeming. We caught up with him as he was getting made up for one of his drag performances. His stage name is Beyonda, Beyonda Mazing.

And contrary to the critics’ fears about taking Truvada, the pill hadn’t turned him into a wild risk-taker. In fact, he’d been having a bit of a dry spell.

Jason Lloyd: I’m actually having less sex since I started taking Truvada than before. Yes, I feel more like a Truvada monk than a Truvada whore.

William Brangham: Luis Canales has also been taking his medication consistently, and he’s had no side effects.

Luis Canales: Meds every day. Whenever any of my doctors need to see me, I go in and see them.

William Brangham: Partly because of how quickly he was put on treatment, extensive tests cannot find the virus anywhere in his body. And doctors are now studying him to see if they can learn any clues about how to cure people.

And across town at Barry Stover’s place, more good news. After struggling to stick with his meds, Stover’s been doing it.

Barry Stover: I’m undetectable, so…

William Brangham: You’re undetectable?

Barry Stover: Yes. That’s what — what my doctor said, so…

William Brangham: Congratulations.

Barry Stover: Yes.

William Brangham: That’s a big deal.

Barry Stover: Yes.

William Brangham: But things just keep spiraling down for Kenny Grosenbach and Michele Campbell. They are both homeless now. She was kicked out of her place. And both are completely off their medications.

HIV is likely replicating rapidly in Kenny’s immune cells, and because Campbell is off Truvada, she’s at high risk of infection.

They said the main thing they focus on now is their addiction.

Michele Campbell: It seems like since we have been out on the streets. Getting high has been, like, the priority, just because we just forget about everything else.

Kenneth Grosenbach: You don’t have to feel at all.

Michele Campbell: I really just want to get off the drugs, and start taking medication, and start living our life and actually be happy, because this is miserable out here.

William Brangham: San Francisco is still a few years away from its Getting to Zero target. Despite the struggles they face, Dr. Diane Havlir remains optimistic they will get there.

Dr. Diane Havlir: The worst thing that you can do is fail, but, if you don’t try at all, you’re never going to have the chance of succeeding. So, obstacles and barriers for me are just part of the journey and don’t deter me.

William Brangham: Even as the city cheers its advances, the difficulty of bringing the AIDS epidemic to an end is obvious.

Public health officials say, after nearly 35 years since the epidemic surfaced, the world has never had this many proven tools so close at hand to fight HIV. But putting those tools to work for everyone remains the challenge going forward.

For the “PBS NewsHour,” I’m William Brangham in San Francisco.

Judy Woodruff: Tough to watch.

We continue our series tomorrow looking at the challenges in Atlanta, where black gay men are among the hardest-hit.

William Brangham: The alarm bells rarely stop in the inpatient and isolation wards at Grady Memorial Hospital. Here in Atlanta, just down the street from CDC, in 2016, in the age of lifesaving antiretroviral drugs, hundreds of people are still dying every year from AIDS.

Judy Woodruff: Tune in all this week for our series The End of AIDS.