HIV

San Francisco’s latest HIV data report—what did we learn?

An in-depth explanation from SFAF’s director of Research & Evaluation

By Mike Barry, PhD, MPH

October 8, 2025 5 Minute Read

San Francisco street scene, Photo: Getty Images

Last month, the San Francisco Department of Public Health published the 2024 HIV Epidemiology Annual Report. This report–weighing in at a hefty 116 pages–highlights progress in our movement to end the HIV epidemic. PrEP is continuing to reduce new HIV infections, people newly diagnosed with HIV are being quickly linked to care, and people with HIV are living longer, healthier lives. In addition to seeing the progress we’re making, this yearly report allows us to identify key opportunities to expand our impact on populations with unmet needs for HIV prevention and care services.

I’ve read the report—so you don’t have to. Here’s your go-to summary of what we learned this year.

New HIV diagnoses

In 2024, 146 people living in San Francisco were diagnosed with HIV. While this is a slight absolute increase from 140 in 2023, and any increase in new infections isn’t great news to see, I’m recognizing that this small increase is likely not representative of a larger trend upwards in new HIV infections in the city. In other words, it’s not indicative of a meaningful (numbers and statistics-wise) increase in the City’s diagnosis rate.

Source: SF HIV Epidemiology Report, 2024 by SFDPH Population Health Division

As a city, and as a community, we should be proud of the incredible progress we have made in reducing the number of new infections that happen every year through PrEP, through U=U, and increased testing and treatment. And, we must continue to push forward and identify where increased efforts must be made to further reduce new infections so our annual diagnosis rate doesn’t plateau.

So although we’re not seeing a significant rise in new HIV infections, here’s some bad news: Cisgender women accounted for 18% of 2024 new diagnoses. This, unfortunately, is a notable increase from 8-13% of new diagnoses each year in the past decade.

The Black community is especially affected—a trend we have seen in previous years that continues to hold true. New HIV infections among Black residents were 5.5 times higher than expected, given the size of the Black population in San Francisco. New HIV infections among Latine community members was nearly twice as high as would be expected given the population size.

And, the proportion of new HIV diagnoses as expected and the Latine community accounted for nearly twice as many new diagnoses as expected, given their respective share of the City’s population. Most notably, Black cisgender women carried approximately 6-times the diagnosis rate observed among white women. Among cisgender men, Black and Latine communities, respectively, carried approximately 6- and 2.5-times the rate of the white community.

Because most cisgender men diagnosed with HIV are men who have sex with men (MSM), it’s clear that Latino MSM, Black MSM, and Black cisgender women continue to be priority populations in our HIV response, and urgently need tailored HIV prevention services.

SFAF’s Magnet clinic offers HIV, PrEP, and sexual health care. Photo features volunteer models.

Additionally, although population estimates for transgender people are not reliable, we can see that transgender women accounted for 6% of new diagnoses. This is an extraordinarily high burden of new HIV diagnosis in what is likely a small population in San Francisco. Although we have had an incredible success in improving the HIV pre-exposure prophylaxis (PrEP) care continuum among transgender women clients at our clinic Magnet, it’s clear that the trans community must continue to be prioritized in the HIV response.

People living with HIV

We know it’s optimal for people living with HIV (PLWH) to be quickly linked to ongoing HIV antiretroviral therapy—it’s best for an individual’s health, and ends the possibility of transmission when the person becomes and stays undetectable (U=U). These two reasons are why we pay close attention to what we call “the HIV care continuum.” The HIV care continuum allows us to see milestones such as knowledge of status, linkage to HIV care, and evidence of viral suppression—which are all important measures for the population of PLWH.

Among people diagnosed with HIV in 2023, those with a history of or current injection drug use and those who were unhoused were less likely to be virally suppressed within a year of initial diagnosis than the overall population of PLWH.

Among the approximately 9,000 PLWH living in San Francisco in 2024 who had a viral load lab test that year, 94% were virally suppressed. PLWH who were unhoused, part of the Black community, transgender women, and people with a history of or current injection drug use had lower levels of viral suppression. These populations likely intersect – for example, PLWH who inject drugs are more likely to be unhoused – comprising the most vulnerable in our community and requiring the greatest support to achieve viral suppression.

Of course, for many people in this population, HIV cannot be one’s greatest concern. This highlights that many PLWH require comprehensive psychosocial support services, such as behavioral health, substance use treatment, and housing support. Such services are provided by SFAF’s community programs including Stonewall, Black Health, Latine Health, Housing & Financial Benefits, and Syringe Access Services.

Mortality among PLWH

Thanks to remarkable advances in HIV treatments, PLWH with access to care have similar life expectancy to HIV-negative people. As of 2024, 75% of PLWH in San Francisco are 50 or older, presenting the City with a largely aging population of PLWH. As such, chronic health conditions that are common in the general population over 50 – including heart diseases, cancers, and diabetes – have become more common causes of death among PLWH.

While the share of deaths among PLWH in San Francisco that list HIV as an underlying cause has nearly halved from 40% in the mid-10s to 24% in the early-20s, accidental drug overdose has nearly doubled from 10% to 20% in the same period. Among transgender women living with HIV who passed away between 2020 and 2023, nearly half (46%) included drug overdose as an underlying cause. The overdose crisis in San Francisco impacts PLWH, particularly the most vulnerable in our community.

Conclusions & takeaways

SFAF’s services are designed to prevent HIV in our community and help PLWH lead healthy lives. The rate of new diagnoses among Latine cisgender men, Black cisgender men and women, and transgender women encourage us to find creative, responsive ways to tailor our comprehensive HIV testing and linkage-to-care services to these populations. Ongoing care disparities among people who inject drugs and those living unhoused highlight the continued need for our community programs that serve these populations.

While we are encouraged by high levels of community viral suppression overall and by sustained decreases in the City’s HIV diagnosis rate, we must continue to advocate for and serve the most vulnerable people vulnerable to and living with HIV in San Francisco.