In the early 1980s, the HIV epidemic spread rapidly throughout San Francisco, then the nation and the globe. It was a frightening time, and the doctors, researchers and students at UCSF desperately sought to understand the new disease that was swiftly decimating the community. UCSF faculty based at San Francisco General Hospital (SFGH) responded to the epidemic by immediately mobilizing to develop structures of care for infected individuals. And on January 1, 1983, in collaboration with other UCSF and San Francisco–based colleagues, Drs. Paul Volberding, Connie Wofsy and Donald Abrams opened Ward 86; so designated due to its placement on the 6th floor of Building 80 on the SFGH campus, it became the first dedicated HIV clinic in the country.
Over the past three decades, and under the leadership of HIV/AIDS Division Chief Dr. Diane Havlir beginning in 2002, Ward 86 has continued to meet the founders' vision as a center of clinical innovation for HIV care. Today, Ward 86 serves as the largest clinic in the San Francisco Health Network exclusively serving HIV-infected patients and a world-renowned center of HIV clinical expertise, teaching and research.
Ward 86 and the Division of HIV/AIDS have responded to the developing HIV epidemic with innovative programs, care and research in many ways over the past 30-plus years.
- The pioneering "San Francisco Model of HIV care" was established early on. It emphasizes interdisciplinary care with a team of doctors, nurses, social workers, case managers, psychiatrists, addiction specialists, nutritionists and so on; provision of an array of medical and social services in a single facility; close collaboration with community organizations and services; and a true focus on treating patients with compassion. This model of care has been disseminated throughout the country and the globe, and has provided an example for the management of other chronic diseases in outpatient medicine.
- A designated inpatient AIDS Consult Service was established at SFGH in 1985. Recognizing the need for a cohort of clinicians up-to-date on the rapidly moving field of HIV management and treatment of opportunistic infections, the new consult service was set up and staffed by HIV/AIDS Division faculty to provide expert consultation in HIV to multiple providers in the inpatient setting.
- HIV/AIDS Division faculty contributed substantively throughout the 1990s and 2000s to the development and testing of new antiretroviral agents to treat HIV infection, resulting in the conversion of HIV from an almost uniformly fatal condition to a manageable chronic disease.
- In 2010, leaders in the HIV/AIDS Division—Havlir and Dr. Brad Hare, medical director of Ward 86 at the time—worked with the San Francisco Department of Public Health (SFDPH) to establish a policy of universal antiretroviral treatment (ART) for HIV-infected individuals. Based on a growing body of emerging research, it was concluded that HIV-infected patients should be treated immediately upon diagnosis to help avert some of the chronic effects of the disease. This universal ART policy was established citywide a full two years ahead of national guidelines, which changed in 2012 to mirror the San Francisco policy. The World Health Organization endorsed the guidelines in 2015.
- A designated linkage-to-care team called PHAST (Positive Health Access to Services and Treatment) was established at SFGH. It employs, through Ryan White Care funding, nurses, social workers and nurse practitioners to help link HIV-infected patients in the hospital to outpatient care and retain them in care throughout critical periods.
- Drs. Havlir, Hare and Annie Luetkemeyer launched an initiative to eliminate Hepatitis C infection at Ward 86 with the use of new oral curative agents for HCV in 2012.
- Under the leadership of Dr. Havlir, a partnership between UCSF, community-based organizations, government officials and the SFDPH called "Getting to Zero" was established in 2014. Its goal is to make San Francisco the first city in the world to achieve zero new HIV infections, zero stigma and zero AIDS deaths. Featured in Time magazine in November 2014, the initiative has great potential, by using and expanding on existing treatment and prevention strategies, to eliminate the epidemic in our city.
- Drs. Havlir, Hyman Scott and new clinic Medical Director Monica Gandhi, in conjunction with the SFDPH, launched a pre-exposure prophylaxis (PrEP) clinic in 2015 with close ties to other DPH-funded clinics across the SF Health Network.
Dr. Monica Gandhi
Photo: Elena Zhukova