2021 HIV Epidemiology Annual Report

September 13, 2022

The annual report shows improvements in HIV testing at medical sites and in linkage to care for those newly diagnosed with HIV, but, compared with 2020, an increase in new HIV diagnoses especially among those experiencing homelessness and those using injection drugs   


San Francisco, CA – The San Francisco Department of Public Health (SFDPH) today released the 2021 HIV Epidemiology Annual Report that outlines San Francisco’s progress towards San Francisco’s goal of “Getting to Zero” new HIV infections, while highlighting the challenges faced by people who are experiencing homelessness and people who inject drugs.  


The report shows that the number of new HIV diagnoses was 160 in 2021, a 16% increase from 2020. However, the number of new diagnoses is lower than the 173 reported in 2019. It is unclear whether the rise in diagnoses from 2020 is a result of an actual rise in transmission, or if more people accessed testing as the COVID-19 pandemic subsided and the lower number in 2020 was an underestimate of new infections in that year.   


While HIV testing at medical sites improved and now exceed pre-pandemic levels, and linkage to care nearly matched pre-pandemic levels with 94% of people newly diagnosed with HIV entering care within one month, HIV testing at community sites is still lagging from 2019 levels. Also of concern, the proportion of new diagnoses among people experiencing homelessness has increased in the last decade to a high of 24% in 2021. The report reveals that those who were homeless and were diagnosed with HIV in 2020 were less likely than housed populations to have timely linkage to care and viral suppression.  While new diagnoses have been declining over the past 10 years across all racial/ethnic groups, disparities remain, with HIV diagnosis rates in 2021 3.3 and 2.8 times higher among Black/African American and Latino men compared with white men, respectively.   


“It is welcome news that more people are able to access lifesaving HIV testing and are being linked to care,” said Director of Health, Dr. Grant Colfax. “However, we are seeing health disparities among BIPOC communities and people experiencing homelessness that are deeply concerning. We must continue to focus our efforts on delivering services and outreach to people most affected through collaborations with community groups in providing low-barrier, stigma-free approaches to care."  


The report also shows that overall deaths among people diagnosed with HIV have been increasing. While deaths due to HIV-related causes have continued to decline, for the first time, accidental deaths, which include drug overdoses, surpassed non-AIDS cancers as the second most frequent underlying cause of death in 2017-2020. The percentage of deaths due to drug overdoses among people diagnosed with HIV increased from 11.1% in 2009-2012 to 15.0% in 2017-2020. In response to the high rates of overdoses citywide, SFDPH is strengthening the continuum of services for people who use drugs with a comprehensive strategy that includes the widespread distribution of naloxone and harm reduction supplies, a street overdose response team, establishing drug sobering centers and other supportive spaces for people who use drugs, reducing stigma, and expanding access to low-threshold treatment.  


“We must acknowledge that people living with HIV can face considerable structural barriers to care and behavioral health challenges that go beyond the immediate medical impacts of the disease,” said Health Officer, Dr. Susan Philip. “Our approach with community partners must ensure a ‘whole person’ approach that includes wraparound supports to address the many needs of a person.”    


To address increasing HIV diagnoses in populations experiencing disparities in the rate of HIV infections and care outcomes, SFDPH developed a framework called Health Access Points (HAPs). There are HAPs for seven priority populations, including people who use drugs (PWUD), Black/African Americans and Latinx persons. Our community partners leading the PWUD HAP are Positive Health Program Ward 86, Glide, St. James Infirmary, and Alliance Health Project. The goal of the HAPs is to provide equity-focused, stigma-free, and low barrier access to person-centered, comprehensive HIV, HCV, STI and substance use prevention and treatment services, as well as primary care, mental health services, and food and housing services. All seven of the funded HAPs also have an increased emphasis on harm reduction services and overdose prevention.  


Project OPT-IN, a team of DPH staff and community partners, works to provide these services to PEH.  Another DPH program, LINCS (Linkage, Integration, Navigation and Comprehensive Services) ensures that all people newly diagnosed with HIV are linked to care rapidly and provides support to people experiencing homelessness and others who have fallen out of care. The LINCS program has been instrumental in improving rates of linkage to care and viral load suppression in priority populations.  


“Getting to Zero, San Francisco, a collaborative consortium of over 300 members, relies heavily on these annual reports to direct our efforts to address disparities in HIV diagnosis and outcomes,” said Dr. Susan Buchbinder, co-chair of the Getting to Zero Steering Committee. “We are working closely with our partners to speed up innovative strategies, including long acting antiretrovirals, for communities in greatest need of prevention and treatment. Getting to Zero launched a committee to address overdose prevention and the needs of unstably housed persons. We have also been addressing the MPX outbreak and are working to ensure that people living with HIV have access to information and services for MPX prevention and treatment.”  


For more information about the 2021 HIV Epidemiology Report, read the full version here:  




Media Desk

Department of Public Health Communications

City and County of San Francisco

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