talented and innovative arts and our city, keeping us vibrant. all of these commissions -- we have some 14 commissions are being appointed today. each and everyone of them are extremely important in terms of the quality of life for the city and the promises that we will fulfill to all of you. i am excited about your appointments. as we swear you in, i will ask and take the time that i know the rest of the city family wants to see -- i want you to come up come as you raise your hand, named a commission that you will be on. we are proud of these appointments, we are proud of the time that you will spend, the quality of life that you will improve. i want you to do that for me as we swear you in. looking at all of you, knowing where you will be, the hours you will be spending, you have to

understand, you reflect a tremendous diversity in the city, one that i have the privilege of representing myself in an historic fashion. i know that all of the communities in san francisco will be so proud of your leadership and your vision, but also, i think, most importantly, we are proud of the spirit in which you take on this responsibility. because it is personal sacrifice. sometimes, for us, we can get tired of the complaints, but at the end of the day, when you know, it if you listen to everybody, you do the balloting required, you make the decisions, and you keep your heart focused on improving people's lives in every possible way, whether in it is in entertainment, planning, all of the things that are represented here today, you will feel really

good about the city. i just want to welcome all of you to the official city family and do my best to let you know that i will help as much as i can from the mayor's office. we have a great job to do, and it will be fun, exciting, enriching, and rewarding for everybody. thank you for being here today. [applause] i know time is of the essence. we need to get to those agendas. if i may, i would like to have all of the candidates please stand up. please raise your right hand. as i begin, i will go through and ask you to announce your

name in the boldest way you can and simply to name the commission that you will be sworn into. please repeat. >> [inaudible]

>> and do solemnly swear that i will not supplant -- support and defend the constitution of the united states and constitution of the state of california against all enemies, foreign and domestic, that i will bear true

faith and allegiance to the constitution of the united states and the constitution of the state of california, that i take this obligation freely without any mental reservation or purpose of evasion, and i will well and faithfully discharge the duties upon which i am about to enter during such time as level the office of -- for the city and county of san francisco. congratulations. thank you very much for your service. [applause]

ladies and gentlemen, please welcome all of our newest 31 commissioners for the city and county of san francisco. thank you.

>> welcome to the regular meeting of the budget and finance committee. my name this carmen chu. the agendas -- if an additional member does come to the meeting, we will be a meeting of six. i just wanted to make that comment. do we have any announcements

today? >> yes. please silence all cell phones and electronic devices. items will appear on the march 13 board of supervisors agenda unless otherwise stated. item #one -- fiscal impact of the cuts, the impact on those living with and at risk for hiv aids and san francisco's options in response. item number two, urine to receive updates on the department of public health's budget. supervisor chu: thank you very much. given that today, we have a

request from supervisor wiener to have a hearing on ryan white funding cuts. what i would like to do is to turn it over to supervisor wiener. what we do is to do a hearing on the ryan white funding. we will hear from the department of public health some of the challenges and issues that are facing. before we did that, let me turn it over to supervisor wiener. supervisor wiener: thank you, madam chair. i called this hearing today said that we can have a frank and public discussion about the challenges we are facing, the significant challenges in terms of finding hiv services and keeping our longstanding commitment to those living with hiv and those at risk for the disease.

over 30 years ago, when the hiv aids epidemic began, san francisco was incredibly hard hit. at the time, we had to take care of ourselves. we came together and we made a commitment that we were going to take care of our community. we did not have any help from the federal government. we have little or no help from the state government and we did it ourselves. both as a city government and as a safety net, community-based nonprofit that formed to take care of those who were sick and dying and that risk in our community. over time, our federal government became engaged with the creation of the ryan white care act. our state government became engaged. we could count on our state and

federal government to keep their commitment. unfortunately, because of right wing recalcitrance and destructive behavior in washington, d.c., and sacramento, we are now facing a situation it yet again where our federal government and our state government are retreating from their responsibilities to those living with and that respect for the disease. we will keep working with the federal and state government and try to support the efforts of those heroes and others who are absolutely committed to this issue and to have moved mountains. i want to particularly thank nancy pelosi for doing heroic work for so many years for this

community. we are now in a position again where we are losing significant federal funding. we need to figure out how we are going to compensate and address that situation. when we first learned that this is happening, we quickly came together and and sponsored a supplemental appropriation. i wanted thank my colleagues for unanimously supporting that supplemental, and archer for making sure that it moved to the process -- and our chair for making sure it moved to the process quickly. there are two aspects. there are the ryan white cuts,

$4.7 million. in addition, and separately, there are prevention cuts from the cdc as several million dollars as well. these together comprise a significant hit to our ability to address the disease. it is also important to review them separately because they do place separate roles. ryan white focuses on care of those living with the disease. the cdc prevention funds are our way of making sure that new infections do not occur. both are extremely important. i want to start out hearing from the department. i know we will hear more broadly about the department budget. but we are done, we are here -- we will hear from some of the community-based organizations, and then public comment.

>> just one second. i think we are ready to go. >> good afternoon, supervisors. how supervisor wiener said, we have two pieces to this presentation. we have a little bit on our overall budget and some focus on the hiv aids reductions. do you have a preference on how you would like us to approach this? supervisor chu: supervisor

wiener? supervisor wiener: it would be great if you could start with the hiv programs. >> ok. supervisor wiener gave him an encapsulation of the big picture. as he said, we have two major issues that are confronting us for the coming year. the first is on the ryan white funding. as of earlier the sure, there is a piece of our funding that has been in danger on multiple occasions of being reduced. over the past several years, we have always, with the help of our benefactors, have been able to make it through without those reductions. we learned earlier this year that that was no longer going to be the case.

our funding associated with a ryan white would be going away. we have a supplemental appropriations approved to get tested the end of this fiscal year. -- to get us through the end of this fiscal year. but we have $4.7 million gap. i will just make a note that there are still some adjustments that could come to that figure. we are waiting on some final information on some of our awards that number could change a little bit as we get more information. but that is pretty close to where we are. that funding gap will continue into the future. the other major piece of the equation is the hiv prevention funding. we have been notified that our funding for hiv prevention is going to be reduced over the next several years, the biggest

reductions coming over the two years of our upcoming two-year budget. we are anticipating production, and this is based on the way the federal government is allocating funds across the country, the new funding formulas no longer favored san francisco for a variety of reasons. that funding will be reallocated. we are looking at a reduction of $3.1 million in fiscal year 2013. the total loss of funding is about 7.8 in the first year of the budget and almost $10 million in the second year. supervisor chu: in terms of the cdc, is that because they are sifting the type of focus of what they want programs to look like? is it something different? >> we have our program folks

here, too, who can talk about this. it is more geographically focused. there has been a policy decision to shift funding to areas where the growth and incidence of hiv is increasing. that tends to be away from the coast and towards the south. the shift in funding, if there has been a policy to shift funding. supervisor wiener: we have been punished for our success. we have very robust prevention programs here. but a large population living with the disease. >> that is a good point. we are a victim of our success on the funding formulas in front of us. a couple of other things i want to point out. there are other reductions that

are happening to providers in the city that did not go to the apartment of the debate -- the department of public health's budget. we are trying to coordinate and making sure that we have all the same information. lastly, there is another piece that has been factored into the deficit for next year. it is a change in how ryan white costs are treated. certain patients that were formerly treated under ryan white are now being moved on toward lower income health program. the biggest impact of that is the cost of drugs. those will now be on our low- income health program, which is partially a general fund did.

that is creating a financial strain on the low-income health program. there will be a cost to the city associated with that. supervisor chu: is this related to medication that is no longer covered by ryan white? >> the changes are now defined as the provider of glass resort. anybody who is eligible for the low-income health program, the drugs they need will have to be covered. we will have a 50% share of those costs. just to put these reductions in context, we have $37 million budgeted in the current year for health and support services. $24.8 million of that is ryan white funding. $4.7 million reduction is about 19% of the ryan white award.

that is a significant portion of our funding. that could have some impact on the total numbers in front of us. the way that the reductions would be handled is that the hiv help services planning council, which is graded under the federal legislation, that provide speak ryan white -- that provides the ryan white funding, the first 5% of any reduction would be applied to course services. beyond that amount, it would be split between core and support services. it is distributed across the providers. this is a combination of community services, dph, city

services, $1.1 million that comes directly to find city provided services. on hiv prevention, we have about $17 million in total budgeted funds for fiscal year 11-12. productions that we are expecting to experienced over the next -- reductions that we are expecting to experience over the next five years, we expect to have a reduction of about 37% of the total funds. that is a significant part of our funding. we are in the process right now over the next several weeks, we will be having some stakeholder processes to talk through any plan to implement the reductions would look like.

we now have details on what that would look like -- we do not have details on what that would look like, but we will as a move to the budget process. in terms of how this looks in our budget, the funding reductions are revenue lost and expenditures reduced that we have submitted. the reason for that is there a larger policy discussion, obviously, that has to happen with the city about how we will treat this. in the budget we have submitted to the mayor's office, these program reductions are not back filled, we have not made reductions to redirect findings. they are standing has presented to us by the federal government. any questions before we turn it

over? supervisor chu: on the two slides that you show what is budgeted, on the hiv production side, the total budgeted amount is $37 million for health and support services. the $17 million is on top of the $37 million? >> that is correct. supervisor chu: this is where that cdc component will hit? >> exactly. supervisor chu: you have any questions for the department? we will go back to the general department of public health hearing. supervisor wiener: that would be terrific. we do have several providers here today.