then what we will do is at the staff necessary for the supportive services. also, they also have a primary care component to them. they will be able to provide medical services on site to support of housing as well. we will incorporate some of the cost to that as well. >> the units are currently used by clients better in the substance abuse program. i understand he would not kick out anyone in the program right now, but i assume they have a waiting list. >> we have waiting lists throughout the system at any given time. to say this would not impact the community, i think there will be some capacity issues. when you look at the number of the people recycling through the programs over and over again because of the lack of housing, we think we can stop that by moving people more into supportive housing. there will be an impact in the

number of people that can impact residential care beds. supervisor kim: i just want to be careful if what i am understanding is we are eventually replacing patients that are in substance abuse programs currently listed these other high-need patients verses expanding it the resources. >> we are not in an expansive mode in this area right now. we're looking at areas of how we can stabilize the community overall. we totally believe in residential care programs, but we're trying to find initiatives that could solve a couple of problems at once. we also have an initiative to bring the substance abuse programs into the general mental-health program. we tried to create it -- be creative in the way we were

doing it. sup>> just to continue on, and we are near the end of the presentation. direct access to housing clients. this has been an initiative that has come up in the past, but essentially what the proposal is that there are two facilities that are leased by the department with the expiring leases coming up in the next fiscal year. those are two hotels, which are the camelot hotels. they have leases expiring, and as part of the normal pipeline of supportive housing, over the

coming year we anticipate having 200 + units of supportive housing coming on line. i am looking for the figure, but it did not have it at my bigger tips. the idea would be as the leases expire, that we could take the clients in the leased facilities and move them into the new units coming on line and would save on the lease cost and move the clients into facilities that are newer and higher-quality that would require people to move, which is potentially the negative aspect of this, but overall a still -- overall still a net increase to the number of units available in getting people into our own facilities. lastly on the list is a convergence of the program at

san francisco general, which is currently a community treatment facility to a level 14 group home. what this essentially means is it is changing the legal standing of the program so that it has a lower staffing threshold and other changes, but currently the program we would change is very unique. very few cities, only us and l.a. have the facilities that are operating at this height of a level of care that would be moving down to create staffing flexibility it would not be a net loss of capacity in the system, but it would be differently regulated so we can say funding by making that change.

we would work on implementation of that over the course of the first year. so that is all we have. after that, we just have the remaining ryan white slides. i am happy to answer any questions you have or take comments. supervisor chu: thank you very much, mr. wagner. just a question for you. i know there are a number of stakeholder meetings that will be occurring. the budget office is having a number of meetings as well. today's purpose of the meeting committed addition to the ryan white funds -- in addition to the ryan white funds come it is the board would have an opportunity to provide feedback. what is the best way to do that? what are your thoughts on providing feedback as to go forward? >> i have already had several meetings with some of you, and

we will continue to do that. we will set goes up again. i am sure after the presentations you may have questions we could answer. >supervisor campos: thank you. a question on the ryan white funding, we note the amount of a cut that the federal government has made, but one of the things i am wondering, do we have a sense of what the fiscal impact would be if the funding is not restored? in other words, what would be the impact if for some reason this funding was not restored and these services were not being provided to these patients, what is the impact on the system? i imagine if you will have an

increase cost anyway. >> we know testing is an important part of the prevention area. we know that needle exchange is an important part of our prevention. clearly we could have an increase of hepatitis c. -- impact on hepatitis c. we know if people are not regularly taking medications. in the department we would have a pretty difficult time with our primary care system that right now provides a lot of the care to clients. this is a chronic disease that is managed well. i think the mission neighborhood medical director has said it best in terms of the multi disciplined approach we have to

have. it is an important process, but i want to let you know we see the writing on the wall in terms of how health care reform will be the future for ryan white services, and i am working closely with providers to see what that means. that is why they are giving us the other dollars in getting ready for the advancement of 30,000 people throughout the city to will have more medical. that is something we're trying to prepare for in the expansion of the primary care center. just as we are stepping up, we have a step backwards. and we do know there will be an impact. community providers would be greatly impacted, because some are dependent on them for this fund. >supervisor campos: i appreciate that. there are costs involved for not

acting also. i think it is important to keep that in mind, and that long-term the inaction could be a lot more expensive, and maybe even short-term the impact can be pretty significant as well. >> we have a great deal of experience and was services in hiv. one of the initiatives we will take on its substance abuse and mental health. we are going to go back to those services to make sure, as this happens, because we will see a reduction in the future, it that we have a more integrated approach to our clients, so you also get hiv prevention activities as well. we're looking at that within the general fund application we have today. supervisor chu: given that, why don't we open up public comment.

i would like to now open it up. i would like to thank everyone who came and sat patiently through the presentations. i am going to call the names fromm cards. if you a dirty spoken, please ignore that. every individual will have two minutes. sara avilas, alex asmara, lee jewel, charles suro, felicia houston. come on up. >> thank you. good afternoon, supervisors.

i of the medical peer advocate at the black hills foundation. thank you, supervisor wiener. i ever resident of district 8. -- i am a resident of district 8. we work with hiv-positive african americans with disabling hiv to our entire risk of transmitting hiv to others. our work is to provide mental health and substance abuse counseling and a wide variety of support systems to ensure they say engaged. the new policy is what we do. being and medical care reduces the hiv-positive tittity of a vl load. a 20% cut to the black hills center of excellence would have a significant negative impact on the capacity of clients. we will lose between 25-35 hours

of staff time per week and need to stop or reduce services to approximately 20 or more of our clients. 20 may not sound like a large number, but let me describe one client who represents many others just like him. this is a case study. jerome is a 32-year-old hiv -- a black man who just tested positive for hiv. he rarely uses condoms. he distrusts doctors and has avoided contact with the health- care system. he talked to me months ago and agreed to a test. he tested positive. i connected him with medical care as infants as the general hospital, and now i help him get to his medical appointments. we combine motivational interview techniques and

counseling and substance-abuse counseling to help him in disclosing to his wife his status and to get the partners tested. supervisor chu: thank you. mix speaker, please. -- next speaker, please. >> my name is michael scott jarvis. i live at care facility for people with aids. budget cuts will see -- will impact the level of services needed. i know about my treatment because they used to be a volunteer their. medical staff and support has made things easier for me to recover more quickly than the doctors and dissipated after my recent surgery. my knowledge of one care in physical distressing live beyond normal nursing care. if i were not there, i would

only have option of going through an sro. as a person with aids, i ask you to please put the money in the budget to support this during the time of ryan white funding cuts. supervisor chu: thank you. >> hi. my name is michael smith. i am the executive director of passionate care. we are a 24 hour residential care facility. some of our residents were formerly homeless and many lack medical support before arriving. we have served over 1000 in our 25 years. most of those residents

experience it as their final home. we have always had a waiting list. i mention this to emphasize that the demand continues. in recent years, residents have represented approximately 10% of the aids deaths in the city of san francisco. we are a vital safety net for the city. we currently serves 45, more residents a year, with ryan white been our primary funding source. we would have no choice but to reduce admissions and leave some of our beds empty. we would be receiving the funding for 30 residents a year. ten or more would likely end up suffering and or the dying

alone. the reality is that most of those individuals would end up visiting san francisco at general repeatedly. we are -- are administrative expense ratio is well under the 20% industry standard. thank you for your consideration. supervisor chu: thank you. >> good afternoon. i am a health services manager at larkin street youth services. i work as a part of the team that serves 45 youth who are living with hiv and aids. teen-agers and young adults are different from beyond our children and older adults. they are working on autonomy, and they are impulsive and

fearless. it is an exciting and dangerous time. the proposed ryan white cuts will impact our ability to provide a youth-specific counseling to young people. i fear we will be left with increased numbers of young people in the bay area who are hiv-positive and not even know it. i fear our community load will increase substantially. many young people do not feel comfortable or save engaging in adult services. the most significant relationships are with peers. the role of the peer advocates is to support them and connecting with providers, go with him to appointments. it is crucial in getting youth

engaged. our young people deserve the support funded through part d. thank you. supervisor chu: thank you. next speaker, please. >> i am happy to have a chance to speak with you today. i heard about this meeting from my case manager at larkin street. i meet with them every wednesday. it is an example of the services that i use. i have been using it for a year. i came to san francisco because i could not find anything to help me out as a homeless youth. san francisco was the place i came and i found stability and structure and housing and support. i do not know where i would be right now if i had not been there this past year.

all of my peers, this is unimportant place for me to meet other people like me. -- this is an important place for me to meet other people like me. without that, i feel like i am lost in this universe. these services are vital. i urge you to find some way to make it happen. people are depending on you and they may not even realize it. it is going to hurt when it is gone. thank you for listening. supervisor chu: thank you. >> good afternoon, supervisors. i became a client of larkin street in 2007. as a homeless youth, i have gone through a lot of things in my childhood. larkin street was the one that provided.

advocacy -- peer advocacy and support. also therapy. it was where i went for my services. tomorrow is my birthday. i am 25 tomorrow. but i am looking towards -- what is going to provide people would support that i have gotten? i think that is very important. thank you. supervisor chu: happy early birthday. thank you. next speaker. >> good afternoon, supervisors. i am a person living with aids and die and volunteering on the planning council for the last 12 years -- and i am volunteering on the planning council for the last 12 years. but planning council has been advocating locally, state, and

nationally, for the past 10 years. we have been working hard for people living with aids, documented and undocumented. one more thing that i want to share with you is that the city of san francisco -- it is a sanctuary city. it has been the compassion and has a diverse citizens in this county. the model of the health care system would be devastated with a 20% cut. when i started, i had nowhere to go. i had no family. without having a partner that is a nurse, i did not know what to do. it will not only affect the

u.youth, the older age population, latinos, chinese, dad -- japanese, all of us. i urge you to be advocates for people and the citizens of san francisco. thank you. supervisor chu: thank you. >> good afternoon. i am here representing -- as a member of the transgendered community, i've always understood the importance of taking an interest in my personal health and awareness around hiv prevention. i too big this awareness to all the supportive services i received -- i attribute this awareness to all the supportive services are received growing up. i can say that the work being done around prevention and care

has been beneficial to myself and to the community. whether it is on the rise in attendance and participation and our education group, larger numbers of people interested in maintaining and updating its chevy statuses, or more people engaging in support of case management -- updating hiv status is, or more people engaging in support of case management, these services are changing lives. it is important that we continue to raise awareness. we to keep the hiv care network here in san francisco. thank you. supervisor chu: thank you. >> good afternoon. i have been receiving hiv care services and i am also the co- chair of the agency's consumer advisory board. i am doing my best to represent the clients. i have a good relationship with

my doctor and my health has been improving. i have been receiving -- in addition to my medical care, i received case management, hiv treatment and education and mental health services. i am able to speak my native language. it is because of these programs and i am able to maintain my health and well-being. a 20% reduction could mean the full hiv care staff could be eliminated. that would mean the specific language could be eliminated. an entire group of clients would not receive competent care. please do not let this large spending cuts happen. keep supporting the hiv care community. thank you. supervisor chu: thank you.

i or read a few more cards as well. -- i will read a few more cards as well. >> thank you for this opportunity. sorry about that, i am a little short. catholic charities has three programs that receive ryan white funds. we provide 135 beds. a licensed care facilities to the chronically ill. we need to have 24 hours care for our residents. ryan white cuts would mean a decrease in certified nursing assistants. as mentioned, the major savings

and expenditure reductions -- the idea was that they would transition clients to the community programs so that they can move into the community. we are the beds. we hope this is recognized when you are discussing ryan white cuts. thank you for the opportunity to speak. supervisor chu: thank you. >> i am a resident of district 9. i am a client, a volunteer, and board member of project open hand. 7 -- food is a basic need.

as a board member, i know we currently have the largest deficit ever. we cannot make up these cuts. it is a trickle down effect for myself, clients, and people for hiv. 75 percent and never doctors say that food is essential to their treatment plant. -- 75% of their doctor said that food is essential to their treatment plan. >> we need your continued support. i am here today to talk about the drop-in center located on 13th street. in the proposed budget, and received a 25% cut in funding.

it's = $193,000, which would equate to 6 staff. dph and a director have said that no program would be eliminated from their budget. with the reduction of that staff, that dollar number, the hours would have to be reduced. it is the only 24 hour drop-in center for women and families. last month, we served about 120 single adult women and 50 families. we provided them case management, we linked families to substance abuse treatment, mental health services and permanent housing. i would have to say we started

doing this on december 27. i go in the morning and women say thank you. i would like to think they are thinking me personally as the director. but i know my job is to get and keep money. they are thinking before a back door, that room to sit in. without it, you will have one in -- you will have women back on the streets under the overpasses. thank you. supervisor chu: thank you. >> good afternoon. thank you for giving me the opportunity to speak. i speak to you today as a person living with hiv. i first received services as a client from the aids legal referral panel. i've been volunteered with t