Sign of the times: San Francisco shifts delivery of AIDS care

Some fear treatment and prevention efforts could get lost in the shuffle when responsibilities are moved to the larger realm of public health.

By Susan J. Landers, AMNews staff. April 16, 2007.

Washington -- San Francisco has long been an epicenter in the fight against AIDS. Now, it again appears to be in the vanguard -- this time for beginning to shift the disease, in terms of city services, from its own separate office into the mainstream of public health.

The move is one concrete example of the changed thinking that surrounds HIV/AIDS. What used to be a diagnosis considered a swift death sentence is increasingly viewed as an illness with which people can live for years. Sometimes they also can face a range of other chronic conditions that can affect nearly anyone.

With the May 1 retirement of its director, Jimmy Loyce, the San Francisco Dept. of Public Health's AIDS Office will close and begin transferring at least some of its functions to other departmental divisions. But Loyce's job is the only one to go. The other workers will still be at their posts, they just may be in different offices.

And even if he hadn't been retiring, the reshuffling still would have taken place, because the timing is right. The city is moving away from the idea that AIDS stands alone, Loyce said.

San Francisco's action joins other activity signaling that the disease is moving into the mainstream. The Centers for Disease Control and Prevention recommended last September that everyone ages 13 to 64 be offered an HIV test, and reports indicate that many primary care physicians already treat patients with HIV.

Kima Taylor, MD, MPH, deputy commissioner of the Baltimore City Health Dept., can remember when only infectious disease specialists took care of people with HIV. But that's not the case today.