Getting to Zero

It was at the 2011 United Nations World AIDS Day that the international Getting to Zero (GTZ) program was launched with the goal of achieving zero deaths, zero new infections, and zero stigma. In 2015, Supervisor Ken Yeager worked with the county’s Public Health Director Dr. Sara Cody and community stakeholders to explore how to start such a program in Santa Clara County.

Once it was known how to create a GTZ program that suited our needs, Yeager asked the Board of Supervisors in 2016 for funding and received approval for a $6 million budget spread over four years to 2020. Yeager stated at the time that it was one of his proudest moments as an elected official.

The program has four focus areas: and post-exposure prophylaxis (PEP) implementation, guideline-based sexually transmitted disease (STD) and HIV screening, initiation and retention of HIV care, and reducing stigma.

One of the main elements of reducing infection is pre-exposure prophylaxis (PrEP), an HIV prevention tool based on taking a daily medication designed to prevent HIV RNA from replicating itself in the body. Daily use of the drug can reduce the risk of getting HIV from sexual contact by virtually 100%.

PrEP is a remarkable tool in the fight against HIV/AIDS but has hurdles to implementation. Truvada, the only FDA-approved PrEP drug, costs as much as $2,000 a month. Much of the county dollars to cover the cost of the treatment for people who cannot afford it comes through Medi-Cal dollars and a federal program called 340B.

In 2017, the CDC announced that individuals with undetectable viral loads have essentially no risk of sexually transmitting HIV. This is a significant breakthrough that helps to reduce transmission.

Of the three goals of Getting to Zero, reducing stigma is the hardest to quantify and requires the most sustained effort and funding. Through collaboration with the county’s Office of LGBTQ Affairs, the GTZ initiative supported nine mini-grantees to conduct unique projects that reduced HIV-related stigma.

The county has sponsored two extensive marketing campaigns geared to inform young Hispanic/Latino men who have sex with men about the option of PrEP. Another PrEP awareness campaign was specific to African-American residents.

By 2018, the county was halfway through the four-year program and already had seen increases of more than 50% in PrEP prescriptions compared to the baseline before the County began Getting to Zero. The initiative set a new precedent for increased County STD clinic hours and staff, greater number of healthcare workers trained on PrEP/PEP, and other public health advancements that will continue after GTZ sunsets.

Santa Clara County has come far since the early dark days of AIDS. But much work still needs to be done. The goals of Getting to Zero are within our grasp, and we must remain committed to doing everything we can to ensure that we reach them. For everyone who has been involved in this pandemic, our hearts are full of both sadness and hope.

Provided by Getting to Zero staff with Supervisor Ken Yeager

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