Not Getting to Zero HIV Infections Among People Who Inject Drugs in San Francisco, California

We analyzed data from San Francisco's National HIV Behavioral Surveillance for 2018 and 2022 to assess progress towards getting to zero HIV infections among people who inject drugs (PWID). HIV prevalence showed little change from 2018 (10.9%) to 2022 (11.4%). UNAIDS 90-90-90 targets were not met during the four-year interval, accompanied by a drop in HIV testing in the last year (from 73.5 to 43.4%, X²(1) = 82.76, p < 0.001). We found no evidence that the HIV epidemic is heading towards zero among PWID. Our data are a wakeup call to revitalize our HIV epidemic response, especially for marginalized populations.