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. they are working really hard on 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.