allocations for the aids program. where we are right now we're still awaiting information on our final awards from the coming year but the most recently estimate is we're likely to faces a $1.2 million for focus year 2013 and 15 and we're still awaiting information and that number didn't include the estimates of this sequester i'll get to later. as supervisor wiener referred we have quite a bit of history of

up and down predominantly downstairs as we've got federally funding down and replaced from representatives like our supervisors and last year, we had a significant reduction that was not replaced that reduction continues into the current year and will continue flo into 13 and fourteen and in terms of the rescues we've seen in the ryan white fund can you give just a general overview so people can see the dramatic you downturn >> i have on the next slide a history of our ryan white part a that's the bulk of our ryan

white funding. you can see the pattern of 2001 to the focus year at the beginning of 2000 our award was closed to $35 million that's declined over the last 12, 13 years and you can see where we're at a little over $20 million and this is the san francisco award if you look at the regional awards it will be higher. but you can see the up and down but a general downward trend over the last few years >> we have that one year 2007, 2008 which saw a big reduction

in the grant ward. was that made up by the city? >> that was made up from a general fund from the city that year there was a single large reduction the city stepped up on a one-time basis and the subsequent years our grant was increased to offset that reduction. so if you looked at the history of the general fund this matter put into the hiv, aids program you would there is was a general increase to partially offset that and do you have a graft to show what happens over the years? >> yes. i have the data - am i

able to use the overhead? actually, i don't need it i have it on a separate file here. it's not the visual format that would be ideal. >> maybe i have something - if it's too difficult to share it goes along with the presentation. >> but we'll provided that data to you, we certainly have it available. in addition to the ryan white reductions that we've seen over

the past two years we've also got reductions from our hiv prevention. in 2010 there was a relifetime that shifted funding away from certain geographical regionals that had success in parts of the country that were increasing and decreasing the effects of the epidemic. the impact is based on the new funding schedule san francisco will have used 40 percent of their grants for prevention between not that i'm aware of and 2016. at not that i'm aware of we're at $8 million but we're going to

decline further >> i assume you'll agree with this but the cdc cuts are punishing san francisco for reimbursing infections. >> we're losing funding as a result of our skwek the flip side is there's a great need and that's the driver. >> the solution would be to increase the funding to those parts of the country not to punish san francisco for reimbursing infections. has the cdc borlthd to do an analysis with the increase of infections they would - if

they're going to do an analysis they should show the number of people who would not contract hiv who are now going to contract it by taking money away from san francisco >> i don't know what the cdcs global prospective is on that but we do have studies of what the impact is in terms of impacts in the community and what that means in terms of prevented cases and we can certainly provide that. but there is slightly a trade-off in that shift >> of course, it's a trade-off of people's lives. and i would like that information. i'm sure it exists and you'll hear the frustration in my voice

because so much o so many of us have been working hard to let people know to be safe and to use the techniques and to lose this kind of funding and potential see the frustration >> it captures a lot of our feelings in the city. so just to continue we're projected as part of that prevention funding we're schedule to receive a reduction to continue in 2013 in addition to the $2.2 million reduction for the current year budget. and, of course, we're continuing to work with the community to

discuss what the implementations of this are. how those kits can best be accommodated and minute missed the impact. so just to give you a couple of tables that have a high-level summary in terms of funding. this is the serum of the reductions in the entrants to each of the two programs over the two focus years for the upcoming budget. we're up around $5. million and 4.8 for hiv prevention. and to take another look at the global outlook for the next 2 years. as you know in the 2013 budget process when he faced the

budgets to ryan white we worked closely with the mayor's office and the members of the board on the approach to that problem we're able to get general fund to restore those reductions for the years 2013 fully gu but in focus year 2014 there wasn't enough general fund dollars available and they were back filled at 50 with general fund. so you can see on this table we have total reductions on those programs of $10.5 million and the baseline dollars that have been reallocated and this is the

base budget for the two years coming up and that's $5.2 million in on a fourteen and that's spread through the programs >> and this will go up? >> so next slide we have the estimates on the sequester. there's a lot of uncertainty here so we've got on the spreadsheet in front of you are the initial estimates based on the percentage reductions are and what that would mean. the information is still changing and this is probably a negative impact, of course, it's

uncertain but it would especially show what would happen if we have the 16 percent reductions to ryan white and on top of those have another additional cuts to the funding. so it's about $900,000 to wrooin white and for a total of $1.3 million and again, i emphasis those are very preliminary as to how those reductions will be implemented. so lastly and getting a little bit to our question supervisor wiener you had asked for some numbers on impacts of what those

funding reductions are, of course, the actual impact of this would depend upon how the reductions are implemented locally and how we allocate those reductions across the program but it is to give you a sense of what we assumed it was spread evenly across the program the general approach in the past the impact from ryan white would be 17 hundred and duplicated clients are served and about 54 thousand units of serve across the various core and support programs provided under ryan white. in cdc to your question supervisor wiener with those

funding reductions we're looking at 17 thousand reimbursed contacts as a result of those reductions and we do have estimates so we can and will share what that translates to in terms of numbers reimbursed new cases of hiv. so i will leave it at that unless there are additional questions? >> colleagues any questions? >> and before we go any further. >> i apologize that i have to step out thought he meeting but there was a problem with the way this was calendared normally this committee allows for another supervisor to set in that allows a quorum and

something happened here so that didn't happen. i also want to thank the chair of the committee for giving me the opportunity to say a few words about this. again, it's my pleasure to work with supervisor wiener. but i think we have an obligation to make sure we protect the safety net and there are different degrees of vulnerability and when he look at the kinds of funding we're talking about some of the most vulnerable people in our city and we have an obligation to restore as much of that funding we can. i think there's also a financial and quite frankly a moral cost

to not doing this. if you don't allow the folks to be impacted by those services to continue to get the life service they need it could cost the city money and you can have people who will die if those services are not provided. we do what we do extremely well, and given the number of cuts that have taken place in the last few years they're doing the most they can with very the money. i know there are efficiency here a lot of collaboration and coordination so i think the challenge we're talking about an amount of money that i think unfortunately has to be

replaced. i don't think we can afford financially from a health care prospective and noting morally not to do that. i know we have worked with the mayor to make it possible. and consistent with this idea i continue to encourage the hiv and aid providers to continue to be involved in the budget process. he hopefully, we'll resolve this issue shortly but i hope once the issue is resolved you'll continue to advocate for other population it's not just the hiv and aids community we're talking about here. there are many other vulnerable groups that needs our

protection. with that thank you very much. >> so we are now going to hear from the hiv, aids network happen. and so i want to call up mick smith and two other people to do is a joint presentation after which we will open the floor for public comment. and you have a power point there? >> yes, we do. >> it's broadcast now. >> thank you very much. supervisors, good afternoon i'm courtney i'm here on behalf of the hiv provider network. i want to thank supervisor wiener and another representative for calling this

meeting. i'm going to giving a few words about contacts and talk about funding. as we've heard there's about 16 thousand residents and in addition, there are a lot of folks who don't know their positive and dizzying those folks. this means about 1 in every 35 thousand in san francisco are positive. our funding the number of people living with aids in san francisco has increased over 40 percent but we've seen a drastic decrease in our funding over the same period of time.

as we've also heard the department of the public health hiv services provides care for those 17 thousand annual and about 16 thousand receive funding for the ryan white dollars. and in addition to gay men african-americans and the homeless are impacted by this epidemic and folks over the age of 50 comprises over 50 of people living with hiv. also want to set the instantly in terms of health care reform. as you know we're facing a huge transition. the hiv provider network was worked together with the department of public health and the planning consonantal to form a fairly unique and is only one

i know of in the country task force to address this issue. we are persecuted a funding grant and the transition for most vulnerable populations and to adjust to a new insurance environment. we have a huge challenge in front of us. we anticipate that ryan white - although there will be a significant change we know that ryan white will not go away. and finally, there this the the slide that highlights the drop in ryan white funding from 3

million to $18 million down. and the dark blew it the general cities general tuition and this is the amount of money we were able to get through governing pelo pelosis money but it went away last year. and then also want to highlight the drop in cdc funding so this represents the funding moving forward. thank you and good afternoon supervisors thank you so much for having us here on behalf of the hiv centers. hiv continues to test us so the funding has gone down dramatically over the last dozen

years and ultimately it is impacting the clients at risk living with hiv and aids. and yet i want to talk about the silver lining because as we are in partnership with the elected leaders in san francisco we've continued to create some innovative protection and prevention. i want to tell me this is called the garden cascade otherwise known as the garden can say candy. almost a million folks are living with hiv. and you continue to go down less and less phone calls are engaged

in care and those are the folks that at that point hiv transition reduces dramatically. what's pretty incredible is that we've tested will 8 hundred and 62 folks and found them positive for hiv and 50 percent of those have reached an undetectable environmental load because they've had the comprehensive services our community is providing. we're leader and we must continue to lead. what we know is we've been in deep dialog. we've been our mother to as

worked because we've targeted hiv testing programs that reach the people that are the hardest to reach. they target the most eventually visually communities. our models work because we're in partnerships and many other embedded in organization that provide wrap around care and prevention programs. if you see this this see inclusive of legal and housing and hospice care assistance. on the hiv prevention side what you see here is we're providing a wide array of sir, ridge

assess and target our high-risk folks in san francisco. if this careful prevention if year after year we can't afford to dismantle the programs and services. and the services have the convention of taking us backward we can actually see in san francisco an aids free generation and we know folks everyone who is hiv positive we reach them and they get to that environmental load of undetectable. and then our transition rate b will go to zero. we share this kind of success with states like massachusetts.

this is exactly the kind of continued investments it's a moment to do this so we can realize the long term health benefits that you will see. thank you very much >> i'm mike smith i'm president of the hiv providers network. my job is to bring the bad news of the funding. we feel that the provider community we're facing the perfect storm this year there are so many types of cuts being thrown at us. i think this next certain really is the 18 months of funding that was add into the mayor's budget last year, it does mean that 50

percent of those programs are only funded 50 percent in the next cycle. the ryan white programs have become 50 percent percent this

means a decrease in condoms and syringes and