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. when i visited by my volunteer. when i was home into sick to move, they would just sit with me. we did not even really talk, because i was too tired and weak to talk, but she would stay with

me and i knew i was not alone. with the greatest respect i would suggest that unless you have in this bill yourself, or at least taken care of some of this bill come it is hard to really imagine the excruciating pain, and i do not mean just the physical. i cannot imagine what i would have done without my volunteer. i know there are new clients that find themselves in situations similar to mine. i urge you to acts of it will have the support they need. for me was the difference between getting better or not. thank you. thank you, supervisors. supervisor kim: we registering providers at the moment. i want to offer a supervisor campos a chance to state -- to say a few words. >> think supervisor campos: thau

for hearing this matter and putting this request on the agenda. i want to thank the entire provider community of the entire community that has been working on this for quite some time. i want to say a couple of things. i know on a more personal note, i did have someone very close to me here recently passed away because of aids-related complications, and i think many of you knew that individual, and as a gay man, i think we do not fully appreciate the impact some of the devastating impact of aids and hiv has had and continue to have on our community.

the fact is people to this day are dying of this disease, and a crisis hot that people will often talk about or think about is in the 80s or 90s, but the reality is and this year, 2012, this remains a big issue. i think that we need to be very mindful of the fact that dealing with aids and hiv is difficult enough as it is, even if you are having all of the treatment and medications that you can have, but when you deprive a community of that some of the problem is compounded so many times, and we just had a meeting that we have a on a regular basis around budget issues.

with the issue of ryan white came up, it is incredible when you think about how connected all of the services we're trying to protect our to what we're talking about here. the elimination of this funded when not only have a devastating impact on the communities and individuals directly affected by this come up but there are so many organizations that are doing a lot of other work that if the funding goes away, their challenges will be quadrupled, because that means the clients they are serving will have even greater needs, and we simply do not have the ability to deal with that. i do not know that we can really overestimate how critical the funding is. it literally has been saving and will be saving the lives. i am very appreciative that the mayor's office has been so responsive in a very short amount of time, we as a city

collectively as the board in with the vader restore the funding for the current fiscal year. my hope is that we do the same for the upcoming fiscal year, because if we did not do that, i do not know what will happen to this community, and what will happen to the rest of the city which will be dramatically impacted by it. i hope it is something that we make a top priority, and i know it is not an easy thing to do, because there are so many things we want to protect, but this is something that is so basic and fundamental to the quality of life of so many communities, and i can tell you as a gay man of color, i know there are communities that are proportionally impacted by this. if you look at the devastating

affect that this disease has been african-american community and latino community, we need to do something, so i look forward to working with the mayor's office and making this a priority. i know the work of this committee is very difficult. you'll have to make very difficult choices between now and june, and i want to thank you for listening, and i think if anyone can get this done, the city and county of san francisco can get this done superviso. supervisor chu: thank you. why don't we continue to the department of health presentation. >> good afternoon, supervisors. barbara garcia, director of health.

i wanted to acknowledge the providers and advocates today. planning council's work hand in hand with us on the issue of prioritizing services. having been on the planning council, i can tell you from my experience planning councils of local government and not always see eye to eye and the planning process. part of the process is using the planning community, particularly when we look at the budget process in engaging with community and providers. if we take a step back in terms of looking at the department overall budget, and many of you know what the mission is to promote the health of all san franciscans, and the services we provide. we have two major hospitals. differences good general was one of the main providers of

servicing the hiv epidemic in continues to be. not only that, but we're seeing worldwide some of the most knowledgeable researchers in the field. we do have the advantage of having a very educated community about hiv and aids. in the overall department we have community-oriented partners and public health services. along with this, we have almost $200 million of contract of services to providers. our overall budget is 1.6 billion come including $363 million of general fund. as you heard today, not only do we have the fiscal challenge of several federal departments changing their funding sources, we also are 23% on general fund. primarily those funds are used to draw down other federal

funds. with that, we still have significant structural challenges in the budget, and we have had losses of major state in ventral spending. -- in federal spending. we have also been facing federal funding reductions. there is still a state issue whether they will continue to cut the budget. we continue to have increases in operating costs, including regulatory requirements. we still have cost-related health services. if you look at ussf, they are the decision group and provide an incredible amount of services, and we have to take care of some of the needs through our budget process is over the years. in the next following year you

of heard a little bit about health care reform. the federal requirements will be pretty steep. they will require us to invest more money in our department. while we see the reductions in looking at the reductions, we are required to invest more dollars for milestones to meet some of the federal health-care obligations. it represent order to $25 billion in new revenue that the federal government has given us, but that represents 80 million, because we leverage those dollars to medical. almost 80 million is required for the performance milestone. we have come in you will see will will be increasing the primary care area in the specialty service area, because those of the requirements we have to meet. one of the other requirements we have to meet is moving into the 21st century in electronic

medical records, and $5.4 million in additional investments are required to do that. we have to achieve levels of meaningful youth. one of those is we have an electronic health record. there will be porter's -- portals for consumers to be able to get into the electronic health records. those are about a couple of years away. as many of you know, we are in the middle of building a new hospital, and part of the bond up for the hospital covers the structure of the hospital, but we will be needing a couple of fiscal years, an additional $170 million to provide the furniture and equipment for the next four fiscal years. supervisor chu: in terms of the requirement of the program helped reform, what is the timeline that some of the milestones need to be that, and what are the milestones? >> some of them include can we

open during the night and weekends? other milestones include timing access that we have to be able to get people appointments within 10 days in 60 days within specialty services. i did we have three more years in that waiver. there are about 60 milestones we have to meet, including medical milestones. supervisor chu: is on for the milestones are spaced out over time basically? to go right. we have organized milestones and have put expenses against the milestones. supervisor chu: for the electronic records, is there a time goes up to be complete? >> some of them are within the next two-three years for the waiver. we have a very detailed timeline

on that. we can certainly give the background information to you. the department has embraced a pretty significant process to ensure we have stickle their input. we have set of meetings with community groups to receive input on the budget process. this year we had three town hall meetings with staff to receive input, and we have already had to help commission meetings to propose public comment. in some of the meetings with the community groups we tried to look at ways to increase revenue to be able to reduce duplication of services, and also, we did think about how to prioritize our revenue to the extent possible that can draw down matching funds. one of the areas we're looking at is services relied generally on the heavy -- on the general

fund. substance abuse services we have to be diagnosed individuals. many of them have mental health issues. what we have to do it in order to drop down meticadical is make sure they are delete the eight most fundamental health. we have engaged with community groups and have assessments in working with the substance abuse providers to see if we can move them into the program to be able to draw down general funds. we think that will create more revenue. i do not know if we will be able to do that fast enough. you will see that not that there was total consensus, but one of the ways of the budget was to look at non-match general funds. for every dollar we would cut, that would be $2, making a

larger significance of the reduction. over the past four-five years we have promoted service delivery integration. given a lot of work around primary-care and health care. we try to prioritize non-service efficiencies. i am trying to look at programs to consolidate some of building consolidations. we look at redirecting those for new service needs. i will leave this and allow the new cfo to go through this. one new note to see at the very bottom of this is that although