The phone rang only three times before a silvery male voice picked up. He sounded particularly upbeat for a phone line which specializes in crisis counseling. This specific hotline is called HIV nightline of San Francisco and advertises confidential conversation for anyone who is suffering from HIV diagnosis or is looking for information on the virus.
“Yes, I am familiar with Getting to Zero in San Francisco by 2030. I know a lot of people involved with the organization,” explained the anonymous man at the end of the line.
He is referring to Getting to Zero which is a volunteer based organization located in different large cities across the U.S. They hope to take a completely different approach in treatment to decrease the amount of HIV positive people in the country.
The counselor explained that people who find out that they are infected with the virus, due to unsafe sexual encounters, often turn to unhealthy coping mechanisms or their mental health begins to deteriorate. Results of this can lead to drug abuse, depression, suicidal thoughts or even all of the above.
“I have had a lot of really scary, alarming phone calls in which I am trained to help calm the caller, a lot of patients just don’t know who to talk to at first,” he said. “They don’t know what to do. They’re scared.”
The HIV counselor explained that patients that have been referred to Getting to Zero are immediately treated.
The program works with San Francisco General Hospital to ensure that patients can begin extensive treatment the day that they are diagnosed. Newly diagnosed people are offered multidisciplinary services including social support, HIV education, and mental health counseling, and have samples collected for laboratory tests.
Participants also receive same-day medical appointments and access to an on-call provider, along with taxi vouchers if needed to get to the clinic. They are given a five-day starter pack of medication and encouraged to take the first dose on the spot.
This is in no way similar to how AIDS treatment is usually followed out, but Getting to Zero is hopeful that it will be the future.
It is believed that the first case of HIV was found present in 1920 taken from a blood sample from a man in the Democratic Republic of Congo.
It wasn’t until the 1980s that HIV made an appearance in the United States among young gay men in Southern California. At first, doctors related the virus to an immune deficiency that was spread only through male-to-male sexual contact or through people who used drugs via injection.
By 1984 it was found that males could transmit the virus to females through heterosexual sex. By 1985 AIDS had become the leading cause of death for adults 25 to 44 years old and about 50,000 Americans had died because of related causes.
Today, more than 1 million Americans still carry the infection. Most of them are men and minorities. But current day medications are better than they have ever been and HIV positive people are living longer than they ever have.
The beginning of AIDs treatment was mostly therapy and trial and error vaccines. Zidovudine was introduced as the first form of medication that could prevent HIV replication in the human body thus stopping patients from becoming ‘sicker’ and decreasing symptoms.
The problem with Zidovudine was the it was only “monotherapy” which in medicine world means treatment using a single drug. This makes it really easy for patients to develop resistance to the drug.
Getting to Zero wants to higher the bar of treatment standards by combining new medication along with immediate treatment. They plan on doing this by focusing on two out of five of their company partners called ART and RAPID.
ART is short for antiretroviral therapy. As opposed to monotherapy, this approach is the combination of three or more medicines. This is more effective because the combination of different drugs decreases the chances of viral resistance.
The RAPID committee comes into play by ensuring that antiretroviral therapy is begun immediately after the patient is diagnosed.
Christopher Pilchner a doctor at University of California San Francisco, did a recent study on the rapid approach with. Before Getting to Zero it took on average 128 for diagnosed patients to receive treatment.
“The RAPID program was designed to speed up this process by collapsing some of the steps of the care continuum,” Pilcher explained.
The results of the study concluded that immediate treatment and continuation of close care with these patients was extremely effective.
Specifically this organization is using a strategy that has been labelled Collective Impact which is a framework to tackle deeply entrenched and complex social problems.The Stanford Social Innovation Review, written by John Kania and Mark Kramer in 2011, was the first published work on how to apply collective impact. This review identified this approach as an organization’s backbone to achieving their goals through different sectors set with a common agenda. Successful achievements of this approach typically include five defined elements.
This foundation consists of a step-by-step process coordinating common agendas, common process measures, mutually reinforcing activities, communications, and of course the backbone organization.
The obvious problem that this multi-sector approach is addressing is that HIV is an epidemic in our world. They are using San Francisco as one of the first initial focus groups to obtain metrics because it is a city with high numbers of the virus that can be easily counted for research.
The possible outcomes of this approach are ideally to create a city where there are virtually no noted cases of persons who are infected with HIV. An ideal result for Getting to Zero would of course be to permanently remove the virus from the country and eventually the world.
-- Nicole Henson