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Since 2007, San Francisco, California, has transformed its traditional safety-net health care "system"--in reality, an amalgam of a public hospital, private nonprofit hospitals, public and private clinics, and community health centers--into a comprehensive health care program called Healthy San Francisco. The experience offers lessons in how other local safety-net systems can prepare for profound changes under health reform. By July 2010, 53,546 adults had enrolled (70- 89 percent of uninsured adults in San Francisco), and satisfaction is high (94 percent). Unnecessary emergency department visits were less common among enrollees (7.9 percent) than among Medicaid managed care recipients (15 percent). These findings indicate that other safety-net systems would do well to invest in information technology, establish primary care homes, increase coordination of care, and improve customer service as provisions of the national health care reform law phase in. [ABSTRACT FROM AUTHOR]

The article focuses on the development of a prediction model to maximize the effect of syphilis patients partner notification in San Francisco, California to identify sex partners needing treatment. It states that multivariate analysis is used to randomly show the number of treated patients interviewed from July 2004 to June 2008 on the half of data set. The results showed that 1665 partners in 1340 patient interviews were named and 827 of those were treated.

Background: Populations at highest risk for HIV infection face multiple barriers to HIV testing. To facilitate HIV testing procedures, the San Francisco General Hospital Medical Center eliminated required written patient consent for HIV testing in its medical settings in May 2006. To describe the change in HIV testing rates in different hospital settings and populations after the change in HIV testing policy in the SFDH medical center, we performed an observational study using interrupted time series analysis. Methods: Data from all patients aged 18 years and older seen from January 2003 through June 2007 at the San Francisco Department of Public Health (SFDPH) medical care system were included in the analysis. The monthly HIV testing rate per 1000 hadpatient-visits was calculated for the overall population and stratified by hospital setting, age, sex, race/ethnicity, homelessness status, insurance status and primary language. Results: By June 2007, the average monthly rate of HIV tests per 1000 patient-visits increased 4.38 (CI, 2.17-6.60, p,0.001) over the number predicted if the policy change had not occurred (representing a 44% increase). The monthly average number of new positive HIV tests increased from 8.9 (CI, 6.3-11.5) to 14.9 (CI, 10.6-19.2, p,0.001), representing a 67% increase. Although increases in HIV testing were seen in all populations, populations at highest risk for HIV infection, particularly men, the homeless, and the uninsured experienced the highest increases in monthly HIV testing rates after the policy change. Conclusions: The elimination of the requirement for written consent in May 2006 was associated with a significant and sustained increase in HIV testing rates and HIV case detection in the SFDPH medical center. Populations facing the higher barriers to HIV testing had the highest increases in HIV testing rates and case detection in response to the policy change. [ABSTRACT FROM AUTHOR]

To understand recent temporal trends in acquired immunodeficiency syndrome (AIDS) mortality in the era of highly active antiretroviral therapy (HAART), trends in causes of death among persons with AIDS in San Francisco who died between 1994 and 1998 were analyzed. Among 5234 deaths, the mortality rate for human immunodeficiency virus (HIV)-related or AIDS-related deaths declined after 1995 (P < .01), whereas the mortality rate for non-HIVor non-AIDS-related deaths remained stable. The proportion of deaths of persons with AIDS associated with septicemia, non-AIDS-defining malignancy, chronic liver disease, viral hepatitis, overdose, obstructive lung disease, coronary artery disease, and pancreatitis increased (P < .05). The standardized mortality ratio was high for these causes in both pre- and post-HAART periods, except for pancreatitis, a possible complication of HAART, which demonstrated an increasing standardized mortality ratio trend after 1996. With increasing AIDS survival, prevention of chronic diseases, assessment of long-term toxicity from HAART, and surveillance for additional causes of mortality will become increasingly important. [ABSTRACT FROM AUTHOR]

Provides information on a study which assessed the feasibility of providing postexposure prophylaxis after sexual or injection drug use exposures to HIV in San Francisco, California. Methods of the study; Results; Limitation of the study.

The purpose of this study was to describe HIV risk behavior among runaway youth in San Francisco by age at onset and sexual orientation. Participants were a cross-sectional sample (N = 334) of male and female youth aged 12 to 21 years seeking health care at two clinics serving runaway youth. Gay/lesbian/bisexual youth reported higher levels and earlier onset of sexual and drug-using behavior compared with their heterosexual counterparts. Gay/lesbian/bisexual youth in this sample are at exceptionally high risk for HIV infection. [ABSTRACT FROM AUTHOR]

The authors assessed temporal trends in acquired immunodeficiency syndrome (AIDS) survival for 15,271 persons in San Francisco, California, diagnosed between 1987 and 1996 with an opportunistic illness included in the 1987 AIDS case definition. Predictors of survival were evaluated for 5,686 persons who were diagnosed between 1993 and 1996 and met the 1993 AIDS case definition. Median survival was 19 months for persons diagnosed between 1987 and 1989, 17 months for persons diagnosed between 1990 and 1992, 15 months for persons diagnosed between 1993 and 1994, and 31 months for persons diagnosed between 1995 and 1996. Decreased mortality was associated with use of antiretroviral therapy without protease inhibitors before AIDS (relative hazard (RH) = 0.88, 95% confidence interval (CI): 0.8, 1.0) and after AIDS (RH = 0.83, 95% CI: 0.7, 0.9) and use of antiretroviral agents with protease inhibitors before AIDS (RH = 0.25, 95% CI: 0.2, 0.3) and after AIDS (RH = 0.36, 95% CI: 0.3, 0.4). Increased mortality was found for persons aged ≥40 years (RH = 1.43, 95% CI: 1.3, 1.6), persons initially diagnosed with an opportunistic illness (RH = 1.97, 95% CI: 1.8, 2.2), and homosexual injection drug users (RH = 1.33, 95% CI: 1.2, 1.5). Survival after AIDS has increased. Treatment with antiretroviral agents, particularly protease inhibitors, strongly predicts improved survival. [ABSTRACT FROM PUBLISHER]

This article presents a survey examining opinions and experiences of using Reality, the "female" condom, for anal sex was completed by a convenience sample of 100 men who have sex with men (MSM). MSM continue to experience a high incidence of HIV in San Francisco, California, primarily because of continued unsafe sex, particularly anal intercourse, in a community with a high prevalence of infection. Condoms are the most commonly promoted HIV prevention method and are known to decrease the transmission of HIV. However, condom use is far from consistent among highly informed and severely affected gay male communities due to several barriers, including lack of spontaneity, decreased sensation, and breakage. Overall acceptability of Reality for anal sex among the 100 MSM completing the survey was high. Approval was significantly higher among subjects at highest risk of transmitting or acquiring HIV, namely HIV positive men, men in non-monogamous relationships, and men with serodiscordant partners. For prevention of HIV transmission, it may be most important to offer these segments of the population the widest possible variety of options for risk reduction. The majority of respondents indicated they would use Reality again and a substantial number preferred Reality to conventional, penile condoms.

Explores the HIV/AIDS epidemic in the gay male community in San Francisco, California. Estimated number of gay men diagnosed with AIDS; Decline in the incidence and mortality rates of AIDS in the area; Effectiveness of community mobilization in reducing infection rates; Need for innovative techniques to address the special needs of gay men.

Examines the association between type of insurance and use of outpatient services and treatment by men infected with HIV. Emergency room services; Zidovudine (ZDV) treatment and prophylaxis against Pneumocystis carinii pneumonia (PCP); Predictors of avoidance of use of health insurance for medical expenses; Use of data from the San Francisco City Clinic Cohort in California.

Prior studies of the association between socioeconomic status and length of survival among persons infected with the human immunodeficiency virus (HIV) have produced conflicting results. To investigate this issue further, the authors examined data on 18,167 San Francisco, California, residents aged 13 years or older who were diagnosed with acquired immunodeficiency syndrome (AIDS) between January 1, 1985, and December 31, 1995. Three validated US census-based measures of socioeconomic status were used: poverty, predominantly working class neighborhood, and low educational level. Median length of survival was found to be similar for persons living in neighborhoods characterized by poverty (22 months) and those in higher income neighborhoods (23 months), for persons living in predominantly working class neighborhoods (22 months) and those in predominantly professional/managerial neighborhoods (23 months), and for persons living in neighborhoods characterized by low educational level (23 months) and those in neighborhoods characterized by higher educational level (23 months). After adjustment for sex, age, ethnicity, AIDS risk group, site of AIDS diagnosis, time period of AIDS diagnosis, and AIDS-indicator illness, no association was found between survival and living in a neighborhood characterized by poverty (relative hazard (RH) = 1.03, 95% confidence interval (CI) 0.97–1.08), between survival and working class occupations (RH = 1.03, 95% CI 0.98–1.08), or between survival and low educational level (RH = 0.96, 95% CI 0.90–1.01). The lack of an association between socioeconomic status and length of survival with AIDS may be due to the high mortality from AIDS in the era prior to highly effective antiretroviral therapy or to similar levels of access to care in San Francisco. Am J Epidemiol 1998;148:282–91. [ABSTRACT FROM AUTHOR]

Several studies have shown that human immunodeficiency virus type 1 (HIV-1) is associated with an increase in the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma among homosexual men. The role of HIV-1 in increasing the incidence of other malignancies is more controversial. The incidence of non-Kaposi's sarcoma cancer was examined from 1978 to 1990 among 15, 565 homosexual men who participated in studies of hepatitis B virus infection in the late 1970s in New York City, New York, and San Francisco, California. The standardized incidence ratio (SIR) for all cancers was 1.6 (95% confidence interval (Cl) 1.4–1.8). Excesses were observed for non-Hodgkin's lymphoma (SIR = 12.7; 95% Cl 11.0–14.6), Hodgkin's disease (SIR = 2.5; 95% Cl 1.5–3.9), and anal cancer (SIR = 24.2; 95% Cl 13.5–39.9). As seen with non-Hodgkin's lymphoma, a cancer known to be associated with HIV-1, Hodgkin's disease incidence was significantly higher in more recent years compared with earlier years. No cases of Hodgkin's disease were found among HIV-1 antibody-negative men, and Hodgkin's disease was diagnosed near the time of initial acquired immunodeficiency syndrome diagnoses. Anal cancer incidence did not correlate with HIV-1 antibody status and did not tend to occur near the time of AIDS diagnoses. This study confirms the association of non-Hodgkin's lymphoma with HIV-1 infection and suggests an association between Hodgkin's disease and HIV-1 infection. An excess in anal cancer was observed but did not appear to be associated with HIV-1 infection. Am J Epidemiol 1996; 144: 916-23. [ABSTRACT FROM AUTHOR]

The author reflects on San Francisco, California's 2007 universal-access health care program. Launched in April 2007, the program, Healthy San Francisco, is designed to provide affordable and comprehensive health care to uninsured residents of the city, regarded as a health care safety net. Though the author concedes it is too early to accurately evaluate the success of the initiative, he argues that it should inspire others at the state and federal levels in regards to health care reform.

Recent studies have documented dramatic decreases in opportunistic infections, hospitalizations, and mortality among HIV-infected persons, owing primarily to the advent of highly active antiretroviral medications.(n1, n2) Unfortunately, not all segments of the population living with HIV benefit equally from treatment. In San Francisco, only about 30% of the HIV-infected urban poor take combination highly active antiretroviral medications,(n3) as compared with 88% of HIV-infected gay men.(n4) Practitioners who care for the urban poor are reluctant to prescribe these medications, fearing inadequate or inconsistent adherence to the complicated medical regimen. Persons typically must take 2 to 15 pills at a time, 2 to 3 times a day. Some of the medications require refrigeration, which may not be available to the homeless poor. Most homeless persons do not have food available to them on a consistent schedule. Therefore, they may have difficulty adhering to instructions to take medications only on an empty stomach or with food. Lack of a safe place to store medications may be an issue for some. In addition, many urban poor live with drug, alcohol, or mental health problems, which can interfere with taking medications as prescribed. Inconsistent adherence to medication regimens has serious consequences. Patients do not benefit fully from treatments, and they will become resistant to the medications in their regimen as well as to other medications in the same classes as those in their regimen. Development of resistance has implications for the broader public health, because inadvertent transmission of multidrug-resistant strains of HIV has been demonstrated.(n5) Concern that the urban poor will not adhere to highly active antiretroviral medication regimens has led to debate on the role of clinicians and public health officials in determining who can comply with these regimens.(n6) Rather than define the characteristics that would predict adherence to these regimens, the... [ABSTRACT FROM AUTHOR]

The article contemplates if the ban of the sale of tobacco in pharmacies can be extended. The author stresses that public support is needed for such ban. A survey conducted in San Franciso, California shows that 56% of the respondents favoured the ban and 27% opposed. The benefits of prohibiting the sale of tobacco in pharmacies are discussed.

The article examines the effectiveness of patient-delivered partner therapy (PDPT) and chlamydial and gonococcal reinfection in San Francisco, California. The study shows that there are no significant difference between patients receiving PDPT from those who do not receive PDPT. It notes that men who have sex with men, men who have sex with women and females show no significant reductions in relative risk or reinfection.

The article discusses the prevalence and factors of Viagra use in combination with crystal methamphetamine and its associations with HIV risk behavior in a probability sample of men who have sex with men (MSM) in San Francisco, California. It shows that MSM who use Viagra with crystal methamphetamine have high prevalence rates of HIV and engage in HIV risk behaviors.

In 1999, the Centers for Disease Control and Prevention launched the National Plan to Eliminate Syphilis. From 1999 to 2003 in San Francisco, early syphilis was epidemic, increasing from 44 cases to 522 cases a year. Syphilis cases were more likely to be in gay or bisexual men, those with human immunodeficiency virus (HIV) infection, those who had anonymous partners, and those who met sex partners on the Internet. Increases in sexual activity and sexual risk behavior in men who have sex with men during this period have been attributed to the improved physical health of HIV-infected men on highly active antiretroviral therapy, HIV treatment optimism, increases in methamphetamine use, and the use of Viagra. The San Francisco Department of Public Health's response to the epidemic included enhanced surveillance, expanded clinical and testing services, provider and community mobilization and sexual health education, and risk factor identification and abatement through investigations, public health advocacy, and treatment. Collaborations with community-based organizations and local businesses were key to the successful implementation of disease-control efforts. A multitude of converging risk factors and new environments contributed to the syphilis epidemic, requiring a comprehensive, innovative, and flexible disease-control strategy. [ABSTRACT FROM AUTHOR]

Determines risk behaviors and HIV incidence among repeat testers at publicly funded HIV testing sites in San Francisco, California. Seroincidence of HIV infection; Association of repeat testing with tester characteristics; Application of multivariate models.

Presents information on a study that estimated HIV incidence among male-to-female transgendered persons who repeatedly tested for HIV antibodies at public San Francisco, California counseling and testing sites between July 1997 and June 2000. Methodology of the study; Results and discussion on the study.