San Francisco says it’s close to ending HIV— so why are dozens of people still dying of AIDS?

In October 2019, San Francisco authorities proudly announced a record low number of new HIV cases in the city — fewer than 200 for the entire year. It was a count worth celebrating, as the city pushes toward being among the first in the world to end transmission of HIV. But there’s another number lurking: Each year, roughly 80 people die of AIDS in San Francisco.

The worst years of the epidemic ended more than two decades ago. HIV is largely seen as a chronic but survivable disease now. As such, AIDS deaths have become a sort of marker of San Francisco’s most intractable problems: homelessness, untreated mental illness and addiction, and racial disparities. A close look at who dies of AIDS is also an analysis of how one of the wealthiest cities in the world still struggles to protect its most vulnerable populations.

An analysis of modern AIDS deaths also offers a grim but rare opportunity to follow the real-time eradication of a disease, and who gets left behind. Just as polio and smallpox were wiped out decades ago, HIV may well be on the cusp of eradication, at least in San Francisco. In just a generation, HIV/AIDS already has transformed from an out-of-control epidemic to a largely manageable public health issue. But ending the epidemic entirely will never happen without addressing city-wide problems that are in many ways far more complex than a single virus. And reaching the people most at risk of dying will require aggressive and unconventional public health strategies. 

This project, under the auspices of the 2019 Data Fellowship, involves collecting as much information as possible on every person who died of AIDS in San Francisco over a year or two, and looking closely at what traits these people shared, how their lives complicated their care, and how public health authorities are trying (and failing) to overcome those complications. The primary resource will be death certificates, but the reporting will also include other records such as obituaries and social media posts, and interviews with survivors. From there, the reporting will shift to identifying trends and developing portraits of those who have died.

The reporting will be complicated by access to some records, and by the challenges of piecing together the stories of people who may have lived largely in the shadows. But it’s past time to draw their stories into the light.