Women's HIV Program

News and Resources

Director's Update

September 1, 2008

This fall marks the 15th anniversary of WHP.  When we opened our doors in 1993, we were the first program in the nation dedicated specifically to caring for HIV+ women. 

I'd like to say how excited I am about our upcoming 15th anniversary celebration. It will be held at the glamorous Ruby Skye nightclub on Tuesday night, October 14th, from 6:00 to 9:00 pm. Performances that night will include Rhodessa Jones and The Medea Project, Bonnie Hayes, and Linda Tillery. Special awards will be given to Barbara Rodgers, Susan Shea, and Cassandra Steptoe, and Mayor Willie Brown will open the evening. I sincerely hope that you can come. For more information, click here .

In this update, I’d like to reflect on the dramatic changes in the epidemic since then, and talk about the challenges and opportunities that lie ahead.

The most dramatic change has been the prognosis of HIV.  When I first started practicing, HIV, in general, was a fatal disease.  The medications we had before 1995 didn’t work. In 1995, the new “cocktail” combining three medications was introduced and, overnight, HIV became a treatable condition.  Now, when I meet a woman in clinic who has been recently diagnosed and is not yet sick, I tell her that she most likely has the opportunity to live a normal life span.  In truth, the medications are very difficult to take.  Many women are also confronted by other health conditions or the myriad dangers associated with living in poor urban environments.  Many other women are diagnosed too late for the medications to work effectively.  Nonetheless, the support and comprehensive services available at WHP have allowed the vast majority of our patients start, and stay on, these life sustaining therapies.  As a result, we now have more patients than ever and frequently focus on other health issues faced by our aging patients, (e.g. heart disease, obesity, intimate partner violence, etc.).

Another noticeable change in clinic has been the decrease in HIV+ newborns.  WHP is the only clinic in San Francisco that sees HIV+ women and their +kids in the same place.  We used to have a bunch of HIV+ babies and tots in clinic with their moms.  Since the advent of the new HIV medications, our program preventing “vertical” transmission from mom to baby has been nearly 100% effective (there is usually a 25% chance of passing the virus from an infected mom to her infant without using mediations).  Today, we have had many babies born to HIV+ patients in clinic, and none have acquired the virus form their moms.  In San Francisco, between 0 and 4 HIV+ babies are born each year (most  to moms who are out of care or didn’t know that they were positive), which is a huge success compared to earlier years. 

The other big change is the “face” of those affected.  The epidemic used to primarily affect gay white men.  Initially, women represented only 7% of AIDS cases (advanced illness).  Now, women represent 27% of AIDS cases and, of those newly diagnosed, 1 in 3 are women.  Minorities now make up the majority of those affected; more black people have died each year from AIDS than white people since 1997 and, of those newly diagnosed, over 70% are minority. Unfortunately, the change in demographics of those affected is coincident with a loss of urgency about the HIV epidemic (these realities, disturbingly, are likely related).  The “crisis” atmosphere that helped create and fund the effective and compassionate system of care in the early years of the epidemic is fading.  As such, our program faces the dilemma of stable, or decreasing, federal support while our costs and patient load continues to increase.  Our current awareness and fund raising efforts are designed to counteract this trend. 

WHP, despite this environment, is strong and stable.  Our clinical programs continue to thrive and we can be proud that WHP provides the best possible services and opportunities to some of the most vulnerable women in the Bay Area. Our Executive Committee continues to grow and is functioning at the highest level in its history. Our infrastructure is increasingly strong and we have realized the needed promotional materials to allow the program to increase its visibility and support. We have also developed an array of new relationships and strategic partnerships that will help ensure the financial stability of the program and lay the groundwork for future expansion of services. It has been another great year for the program.

There are, however, a number of challenges at hand. The Federal grants that have supported the program for 15 years will stay "flat funded" again this year, at best, despite predictable increases in operating expenses. The new Centers for Disease Control (CDC) call for greatly expanded HIV testing will lead to an increase in newly diagnosed women seeking care. The epidemic continues to affect more and more women, especially minority women. Many of the City's surviving pediatric cases are rapidly approaching adolescence, a time when the program seeks to assume full care of them. As such, the program is faced with the need to serve more people with fewer resources.

We have, however, predicted these challenges and are prepared to face them vigorously. Our Executive Committee is now finalizing a complete reevaluation of our 5-year strategic plan. This plan allows us to remain focused on our core mission and strengths, and to expand services with foresight and care. WHP continues to develop a strong foundation to withstand ebbs in funding, and one that we can build upon. This effort has included an attempt to raise the visibility of the program commensurate with its historic role in the AIDS epidemic. WHP has also developed new relationships with individuals, corporations, and foundations who share our vision for a compassionate and successful response to the burden of HIV in women.  For example, our second annual fundraiser last year featured Tracy Chapman, who generously donated her appearance and live performance to this cause.  That event also drew many influential activists, artists, and politicians, including Alice Walker and Rhodessa Jones. 

Much of our success has been due to the passion and activism of the members of our Executive Committee, and due to the generosity of individual donors. I am sincerely grateful that I work alongside such dedicated and compassionate people.

Together, we will ensure that vulnerable women and families affected by HIV receive every opportunity to lead healthy and successful lives.
May you and your families have a healthy and prosperous year!

Eddy Machtinger, MD