this issue. this would be an initial segment of public comment specific to this item. we will have a broader budget presentation and general public comment on the hiv issues or any other issues. i want to call up a handful of executive directors. public comment will be two minutes. i will ask that mike smith of the emergency fund come up first. i will probably be asking some questions. followed by laura thomas, kenneth hornsby.

mike? >> thank you very much, scott. thank you, supervisors, for your attention to this issue. i am president of the hiv aids provider's network. it is about 40 community-based agencies. i have a presentation. if we could switch the monitors, that would be great. i think he might have a copy of it. -- i think he might have a copy of it in front of you. although the dark ages of high death rates are behind us, it is important to remember that the total number of people living with hiv in san francisco still does go up every year. in the current year, there are more people living in san francisco with hiv than in the past year. people living with hiv who may

not know their status. this first draft -- graph is simple math. the number of new cases is low, but if you add new cases and people moving into the city with hiv, it is a larger figure than the total number of deaths. the pool of people requiring services continues to grow each year. in contrast, the funding to hiv services that has been coming from ryan white has been on a gradual downhill slide for more than a decade. this will give you some indication of the source of the revenue. this matches what greta was saying -- greg was saying earlier. the red bar sections is the

money that the speaker was able to put into place when she was the speaker. there has been additional state funding. supervisor chu: do you want to ask a question? if you could clarify the green and purple bars. >> i thought we were going to have an arrangement for me to have more time. supervisor chu: can you please elaborate on the use of the ryan white fund? >> there is information available in your package as far as what type of service is the funding is spent on. a variety of supported services

that keep people in care, keep them healthy, and keep them from needing emergency services. there is also a list provided of which agencies in particular will see how much of a reduction in their service delivery over the next few months. these numbers represent roughly 19% of the ryan white award. you may see the name of an agency that you are familiar with. this gives you an idea of what the impact will be for that agency. supervisor chu: it sounds like this is across the board same%. >> its is the formula that greg discussed. supervisor chu: the first 5%

going to core. >> in addition to the money that the department has control over, there is also a separate pot of unfs. -- funds. it does not necessarily a fact -- effect dph. they have rearrange their funding and their parties to move the money around the country. at least one of those contracts will be going away. the city will pit the losing an additional $500,000 in its system of care.

it is not necessarily money that flows through dph. it is important to take this into account because it will take money off the table that is used for services. this is the dcd shortfall, $3.1 million. it is important for you to understand that many prevention programs are targeted to hiv- positive people and provided in a medical setting or in a clinic setting. often, the same organizations that receive ryan white funding have other pieces that are prevention related. the impact of the $4.7 million shortfall plus the $500,000 will magnify the cuts.

it is one of those examples of how interlinked all of these are. supervisor chu: thank you. >> i will stop there and ask if there are questions. supervisor wiener: thank you very much, mike. if we did have the others that i named from the other organizations. >> [inaudible] supervisor wiener: lord thomit t have to be in that order. >> good morning. i am a resident of district 6.

we are the only committee funding body for hiv services where consumers have a real voice at the table. i am disabled with an aids diagnosis. my well-being is dependent on the care services. thank you for this opportunity. we are facing a press of this, our choice before you is to save hiv services. the planning council has spent the last 12 years shading cuts are around the edges. with a loss of the fund, we cannot do this anymore without having to eliminate service categories. there are no more options open to us. this is our d-day. you'll hear from a few represented clients about how they will be affected if these cuts are not restored. he will hear from some of our community partnered agencies on how they will be affected. at the beginning of the aids

crisis, san francisco had some very ford thinking community -- for rethinking community advocates. the san francisco model of care is recognized nationally. people come here from across the country seeking care. with increasing demand for services and diminishing resources, we are at the press of this now. we need to now more than ever. we need you to have the bravery to help those who are unable to be here. people with mental health, drug addiction, and homeless issues. i ask you to think about them now. we must care for our most vulnerable citizens of san francisco. i believe it is our collective duty. please help us care for them. thank you. supervisor chu: we have been joined by an additional supervisor.

>> my name is laura thomas. i am a resident of district 10. we have had the privilege of being able to meet with many of you and talk more in depth about the services and programs in your district. from a citywide perspective, those of us to sit on the hiv planning council, we are responsible for assessing and understanding the needs of people living with hiv in the city. trying to allocate the available resources that we have to meet those needs. it is not that different from the board -- from what the board of supervisors does. part of what i need to say is there is no way to cut 20% out of these funds without losing services that are keeping people alive in san francisco. we need to go back to the times

when san francisco stepped up to take care of our most needy folks who were not able to access resources elsewhere. we looked every year at the needs of people living with hiv and every single year, there are significant unmappet needs. we are hearing over and over again that their needs are not being met. the existing resources we have are not enough. facing 20% will leave more people without the services that are keeping them alive. we pledge to work with the mayor and the board of supervisors and the health department to figure out how we can come up with the funds to avoid these cuts. thank you.

supervisor chu: thank you. >> i'm the director of the hiv help services planning council. it has been mentioned that the ryan white funds are the pair of last resort. how the council looks at it, these are funds that are dedicated to the most challenged individuals and communities. these are funds that are dedicated to individuals who are homeless, folks who are tripoli it diagnosed with substance abuse or mental health issues. this money is dedicated to communities of color. these funds are dedicated to our senior population, which is a continually growing population in san francisco. these funds are the primary funder of the centers of excellence. it provides integrated care.

cuts to these communities will be devastating. it is a 20% cut and is not small. i urge the supervisors [inaudible] thank you. >> good afternoon, supervisors. thank you for the opportunity to speak with you today. i am a member of the hiv aids planning council. i am the consumer. i have had hiv aids now for 32 years. without these services, i would not be here today. any cuts would impact me and many others harshly. i will not give you any sob story. i will give you numbers and facts. my monthly income is $844 a

month. to under% below the poverty line. my rent is 3180 a year. utilities are 360 a year. laundry is 420 a year. cleaning supplies, $360. over-the-counter medications, at $250. clothes, $600. leaving a balance of $279 a month for emergency expenses. this does not allow us to go to movies, go to dinner, at any recreational activities. i hope this gives you a better understanding of how these cuts would do a lot of harm.

thank you for your time. supervisor chu: thank you. >> good afternoon. i am here to film the story about the cuts that could impact women, children, and fans in san francisco. -- infants in san francisco. at this point, we know there will be a $500,000 reduction in those funds. most of those funds will hit larkin street. that represents almost half of our budget. we do comprehensive services, medical care, food, mental health and substance abuse support. we have a comprehensive center of excellence. we will lose about half of that

funding what could happen there will be an additional $500,000 loss. that will eliminate all the dollars for women, infants, and children. that would be in addition to the loss of the 20% this decimates the continuum of services for people who are hiv-positive and for young people. we serve about 100 young people each year. it would be a significant loss. thank you. supervisor chu: thank you. >> good afternoon. thank you, supervisors, for your leadership. i am the director of the aids legal referral in san francisco. we provide legal services to

those living with hiv and aids. it is nice to have a couple of attorneys on the board. not everyone appreciates legal services. when you are sick and you get that eviction notice in the mail or you get that denial from your insurance company, getting access to a good attorney quickly becomes your top priority. we are aware that to the extent people have been able to manage this horrible disease, it is only when they have affordable housing. we try to prevent homelessness by people keeping -- keeping people in their homes. the cuts proposed will eliminate a full staff attorney, limiting access of hundreds of those in san francisco who need legal services. this would be at a time when demand for our services has increased by 50% in the last few years. we know there are many competing needs that you were trying to balance.

these are tough times for the city. the cuts being proposed to hiv aids services are of a destabilizing nature. we need your assistance to step and to provide that support. thank you. supervisor chu: thank you. >> i am the hiv services director. i am joined by my colleague providers and a client. thank you so much for having us today. i represent mission neighborhood health center. we have been providing services to underserved hiv-positive members of the community. i want to thank the members of the board of supervisors on the mayor for their decisive response to the federal ryan white cuts. we would have faced devastating reductions.

unfortunately, this action has only -- without continued support from the city, ryan white program so face as much as a 20% reduction. i prepared a contingency budget for you. i wanted to get a feel for what these actual numbers look like. how many clients will be impacted by these cuts and what it will mean for their lives. we do our best to protect medical services. these are a must have for hiv care. the real pain would be seen in the supportive services. in the end, at least half of are hiv-positive clients would be directly impacted by the cuts. it is essential to understand that the cops would have the same -- the cuts would have the same outcome and would lead to the negative side will that you

see on the back of the handout. more people will seek care and it will find none. in these economic times, $7.8 million is a significant amount of money. everyone is doing more with less. thank you for your time and consideration. supervisor chu: thank you. >> i and the medical director for hiv services admission neighborhood health service -- help center. i am committed to stopping the spread of hiv. i cannot do that by just writing a prescription. you are familiar with san francisco's model. for that model to work, we need a multi disciplinary carotene. -- team.

i would like to tell you about one of our patients, david. david had been living with aids for many years, but had been off medication for almost a year. he struggled with hepatitis c, bipolar disorder, and addictions to drugs and alcohol. over the last few months, david has made amazing progress. he was admitted to a treatment program and is now clean and sober. he will be able to get permanent housing when he finishes the program. he will see our on-site psychiatrist to get the medications that help his bipolar disorder. he was able to regain the weight he had lost. when he looks in the mirror, he does not recognize himself because he looks so much better. he was ready to work with educators to learn about hiv and to start the medications. he is 96% less likely to pass

hiv to his partner. he will also not good admitted to the hospital with an expense of infection. and his life is better. this is what success looks like. this is an ongoing process, but it is worth it. i am asking you, do not make me do this alone, because it will not work. you and i both know that. thank you. >> i am a recipient at the mission neighborhood health center. i have been a client there almost three months. i did not have the care to get the medication. i had a medicare, but what are you going to do? through the clinic, that they helped me and now i have a place

to take my medication. tried to in power -- we are not done yet comment we have a long way to go. -- we are not done yet, we have a long way to go. we will have to inspire each other. this is my first time at a meeting like this. i am glad to be here. supervisor chu: thank you. >> good afternoon, supervisors. i am one of the case managers at mission neighborhood. i have been there for six years. i work directly with my clients to see them from being homeless, out of care, to becoming

steadily -- housed. this is never an overnight process. this is a complicated system through housing applications', psychiatric referrals, and request to replace critical documentation. it is oftentimes lost due to mental health or substance abuse issues. all these items are time- consuming. our clients have a multitude of barriers to care which required case management to help navigate assistance. the homeless, the mentally ill, or recent immigrants. these people are vulnerable to more complicated medical problems that without proper engagement, result in expensive

emergency room visits. i am proud of might work. -- my work. that is what success looks like. you guys can help us achieve that. supervisor chu: thank you. >> good afternoon, supervisors. i am on the executive committee of the hiv aids providers are not work. we provide coverage for the api community. we provide a continuum of care for the entire transgendered population of eight san francisco. -- of san francisco. all these programs and services are funded by federal hiv dollars. san francisco has been a national leader with respect to our response to the hiv epidemic. this has included medical

intervention, a research, treatment, testing, educational and prevention efforts. this comprehensive and integrated approach to hiv is resulting in a stronger and healthier city and a city where new hiv infections are fewer. just as we are about to reinvent our health care system, along with the department of public health, and as we look ahead to 2014, just as we are seeing success with the potential end of the hiv epidemic, cuts at the $7.8 million level will mean a dismantling of hiv prevention and care services. it will be devastating for all clients that we serve. $7.8 million worth of cuts will translate into whole groups of clients who are the most of the honorable and fragile, who will be lost to care. there will be last testing. he will seamark -- there will be less testing and we will see

more infections. we must find solutions together for the long term. in the short term, we need your help and commitment to support these programs. supervisor chu: thank you. >> good afternoon. i am here on behalf of the executive committee of the hiv provider networks. we really appreciate you holding this hearing today to address the cuts we are facing. i want to specifically speak to the hiv prevention cuts. we are being punished for our outstanding hiv prevention at system here in san francisco. the challenge of prevention is that it is often hard to see. as fewer people acquire hiv, we might assume that we no longer to fund initiatives at the same levels. however, when reduced funding --

when we reduce funding, it translates. if we reduce funding now, we will have a harder time preventing new infections in the future. the total number of people living with hiv would continue to grow. each new infection has a price tag. conservative estimates are that the lifetime cost of hiv care is $240,000. if we're able to prevent 100 new infections, the cost savings would be in the range of $25 million. these cuts come at a time when we see the end of new hiv infections in our sights. we are asking for your support to continue to do what we know works. to continue to be the model in the nation and the world for hiv prevention. thank you.

>> good afternoon, supervisors. i am on the -- as you have been hearing, the cuts we are talking about will destabilize our system of care for people with hiv. i was hoping to be joined by a longtime client and volunteer. unfortunate, he is having health issues. he sent me his remarks and he asked me to read them to you. because of time constraints, i read just the part that captures the importance of our services. when i was sick, i mean it really sick, constant hospitalizations, at not being able to get out of bed and wondering if i was nearing the end of the road, it was volunteers that were always there for me. there are hospitalizations that my family's and closest friends do not know about.