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 this is like mission neighborhood and a i l wellness and the many crucial important programs in the jail and sir, ridge. we have ryan white cuts that be impacted over the whole program. as i can see this adds up to - that will result in great reductions in services for

clients. so in summary really the need for extra backfill and the current ryan white that we know about we're sure the sequestration cuts are coming and we're facing a larger budget cut across the board. it's not possible to hold the program harmless - we greatly appreciate this we're existing excited and anxious to work with the mayor's office and we'll be looking at the focus year on july one.

colleagues >> i have an initial of supervisor. actually i'll wait on my comments >> i have an initial list of public commenters and if he anyone has to go earlier we accommodate that. (calling names) >> good afternoon i'm lee i'm the hiv planning health council. we're here to prioritize those

who need this ryan white funding. provided by the agencies appearing here today thank you for let me speak today. i'm referring to those clients who are busy simply existing on the edge of life. so i'm advocating on their on behalf of. we all know that ryan white funding keeps it's most vulnerable citizens out of the hospital. we provided the best health care for our ryan white clients. i ask on behalf of our mostville initially please take this into

consideration >> i'm the medical director at the mission neighborhood health center. a year ago i spoke before this group. with our help we've been able to get more patients on medication and drastically reimbursing their spreading hiv to others. on monday, i saw my patient laura who was using heroin and over the last year with the help of her case manager is in the process of reunifying with her son.

she's achieved 96 likely to pass hiv to her sexual partner. and this is what success looks like and it didn't start or end with me writing a prescription and we know that changes are coming. this is not the time to change course on the hiv services. when in the; isn't that so we saw a surge of epidemics of tuberculous deaths. we can't afford to go backwards. i'm here asking you to keep those programs whole and sustain the services that protect our public health. i'll be here every year if i

need to be and remind you what the case of bad health looks like >> thank you. next speaker. >> i serve on the hiv prevention planning council and i'm here today on behalf of of the harvey milk. >> first of all, for being our champions on the programs. i feel that san francisco is the best we have to take care of our community and our residents. it, it's san francisco values at its finest. other people have spoken it's a

model for the world to follow. right now though we're faced with the dismanlt of this model and this is because of the failure of the federal government to respond to this epidemic as it should and come up with the funds obviously that comes in the context of our dismantling of our services. it's time for us to stand up for that people living with hiv and those at risk for hiv here. this is the results are significant in terms of what we can do so i ask the members of board of supervisors to work colons with the mayor to fill those cuts and take care of our

san francisco receipts. thank you very much >> i'm a physician and i'm the medical director of the hivs clinic. we take care of 13 thousand people living with hiv in san francisco. we work extensively with the members of the community. i want to focus on primary medical care. if we lose a portion of the ryan white services we scant continue and this will effect qualify. san francisco lead the way in saying that all people should be on treatment regardless of their cdc contact. so at our clinic with 3 thousand

patients we're able to prescribe medication and 82 percent of those patients are libel to pass hiv on. without ryan white or restoring those funds we won't be able to do that. and rapid assess engaging people at the time they first get a diagnosis is key to getting people on that undedeckably assess. i'm afraid that will change our care and we ask for your support >> thank you very much. next speaker >> good afternoon i'm a

community member and a student the san francisco university. i have been a person who has received treatment. i came here about 11 years ago this year serves that are affordable access to health care, affordable health care to testing and i think those services are really important for community members and for a vulnerable population about our supervisors. those services have been helpful to prevent diseases like hiv and just different diseases and there's other people out there that are benefiting from those services. i think it would be a ashamed to cut the services.