>> sg&aerctionv, everyone. welcome to the san francisco board of supervisors budget and finance committee meeting for wednesday, may 7, 2014. my name is mark farrell. i'll be chairing this committee. i am joined by supervisor scott wiener and supervisor avalos and we'll be joined by london breed and eric mayor. want to thank the members of sfgov-tv covering this meeting

nona melkonian and jennifer low. victor young is the clerk for this meeting. are there any announcements? >> yes. [speaker not understood]. >> okay. thank you very much. just to let everyone know, in case you're sticking around for items 4 or number 6, we're going to continue both of those hearings to the june 4th budget and finance committee meeting. so, we won't be hearing from the hsa budget or dcyf budget or first five today. with that, mr. clerk, can you please call item number 1? >> item number 1, hearing to discuss funding proposals for hiv services in the upcoming fiscal year 2014-2015 budget, including expected federal budget cuts for hiv care and prevention services; san francisco has experienced huge hiv funding cuts from the federal government in recent years and the federal budget cuts for hiv care (ryan white care act) and prevention (centers for disease control and prevention) services in the upcoming fiscal year are estimated to amount to $2,700,000; including reports from the department of public health, the mayor's budget office, and community organizations on what the projected funding shortfalls will be for hiv services, what the impacts of these shortfalls will be, and how the city can work to fill them.

>> okay, thank you, mr. clerk. colleagues, this item was sponsored by supervisor wiener. want to thank you for sponsoring it, supervisor wiener. i will turn the hearing over to you. >> thank you very much, mr. chairman. i appreciate the opportunity to hold the hearing today. colleagues, today this hearing will address expected federal budget cuts to hiv services in san francisco for the upcoming fiscal year, specifically cuts around ryan white care act funding and prevention services funding from the centers for disease control and prevention. colleagues, we know that san francisco has -- we were, of course, at the epicenter of the epidemic for many years and epidemic took a huge toll on this city, both in the lgbt community and outside of the lgbt community.

san francisco has also always been at the cutting edge in terms of providing full care for those who are living with the disease and also providing very, very cutting edge services in terms of prevention and employing some of the most innovative approaches to prevention. and over the years we have been quite successful in getting people into care quickly and also in reducing infection rates in san francisco. in fact, we are truly a model for the world. and when you look at the success in term of the percentage of people who get into care, percentage of people who are getting into treatment and then becoming undetectable, we are so far ahead of the rest of the country. it's incredibly impressive and it really is a model and it's

important that we keep on track. we know that in the early days of hiv san francisco pretty much had to go it alone, as the federal government was nowhere to be found. we he had a president who would not even name the disease. and we did that, and we built -- we made significant local investments in fighting the hiv/aids epidemic and we also built incredibly strong network of community-based organizations who do this work and the partnership between the city, department of public health, other departments and our cbos has just been amazingly effective. the federal government eventually did begin to partner with us through ryan white, cdc and other programs. unfortunately, over the past number of years we've seen a

very unfortunate and short-sighted retreat by the federal government from funding hiv services in san francisco and elsewhere. there's was first a change to the formula that basically punished san francisco for having a large number of hiv positive people but for not being one of the highest -- an area with one of the higher rates of new infections. in other words, punishing san francisco for its success in preventing new infections. nancy pelosi, who is our champion on hiv funding for many years, was able to stave off some of those cuts, but eventually we were unable to do so. we then, of course, experienced the sequester which led to further cuts and unfortunately due to the really horrible atmosphere in washington, d.c., the sequester cuts secured will become part of the budget

baseline. since i took office, supervisor farrell and other colleagues in 2011, that's when the truly a down pour of federal cuts began. and in the last several cycles, budget cycles, we've experienced approximately $20 million of cuts from the federal government for hiv care and prevention services. to the credit of our city, to the credit of our mayor, to the credit of this board of supervisors, and to the credit of our partners in the community, we banded together and we have backfilled 100% of those budget cuts and that has been tremendous and that has saved lives. unfortunately, again this year we are going through what is an all too unfortunate ritual of again dealing with significant federal cuts to care -- hiv care and prevention services.

this year, a you'll hear, we anticipate approximately $2.7 million in federal cuts. while that is smaller than in the past few years, it is still a potentially devastating hit to our care and prevention services and it is critically important that we once again step up and backfill all of those cuts. and, so, we called for this hearing today so that we could discuss the cuts and talk about how we get those cuts backfilled. so, first i want to call up greg wagoner from department of public health who can give us an overview, and then we'll have some questions for the mayor's budget office after the dph presentation. mr. wagoner. >> thank you, supervisor wiener. good afternoon, supervisors. greg wagoner, chief financial officer, department of public health. supervisor wiener covered a lot of the context in those

introductory remarks, so, i won't belabor it, but i'll just go through a couple of numbers. the department of public health currently spends about $59 million per year on hiv health services, hiv prevention, and hiv epidemiology and research. as you can see from the table in front of you, those are variously funded through federal grants and local general fund as supervisor wiener mentioned that proportion has changed significantly over time, as the federal grants have been reduced to support those services and the city has stepped in. we are now at about 60% grant funded on hiv prevention and health services. a little history. this goes back much further than what we could fit on a

single powerpoint screen, but to illustrate the point of the annual discussion that supervisor wiener mentioned, we've had for each of the past many years had reductions in our grants to hiv funding services. in the current year we are -- current budget process we are projecting $2.7 million for [inaudible] -- they're reversed on this table, but $2.7 million for ryan white grants and $300,000 for hiv prevention for a total of about $3 million. those are projected and we'll know the final amounts very soon. effect of these cuts, very briefly. they would lead to a decrease in community-based hiv prevention programs that includes our testing, our

health education, outreach programs, condom distribution, all these programs that we put into place over the years to -- in many cases very successfully make progress towards limiting the spread of hiv. and much more broadly than that on the ryan white side of the equation, that reduction would turn into about $2.2 million of reductions to core services which are direct services to hiv clients. that would be about 17,900 units of service that would be affected. and in support services to those clients, which would be $386,000 which would be equivalent to service of 883 clients. where we are is we are still waiting our final awards, although we have a fairly good

sense of where that is going, we expect our final ryan white part a and part b awards to come in may and june. and when that happens, we'll do a final analysis of those amounts and have a process within our own departmental staff, and then also with the planning council to review those amounts and determine how the city would, would respond to them if we have limitations on our funding. so, that is all i have. i'm happy to answer questions if i can. >> thank you, mr. wagoner. i have a question for the mayor's budget office. so, i know this ha been annual conversation and i know i and others have spoken with the mayor about this year's anticipated cuts and mayor lee very much to his credit has been incredibly supportive

since he took office in terms of backfilling these cuts and has worked very collaboratively with the board to make sure they all get backfilled. and, so, if the budget office could comment on where mayor lee is in terms of backfilling these federal cuts in his proposed budget to be submitted later this month. >> yes, leo chi, deputy mayor for the budget office. as you know we are still working hard to balance the budget. this is an active effort and we're still finalizing. hour, the mayor, i'm pleased to say, has commit today backfilling these cuts so i'm excite that had we'll be able to move forward with that commitment. >> thank you. that would be for the 2.7 million approximately? >> yes, [speaker not understood]. >> thank you very much. and pleasepass along a big thank you to the mayor for that. >> thank you. >> thank you. okay, colleagues, if there are

no further comments, i'd like to first invite up for a brief presentation the hiv/aids provider network happen to make a brief presentation on behalf of the organizations that comprise that alliance. >> thank you, supervisor. i'm mike smith. i'm executive director at aids emergency fund and i'm president of the hiv/aids providers network. we're a consortium of about 30 agencies, grassroots community agencies that work closely with the department of public health for prevention and care services throughout the city. i did have a whole presentation that looks an awful lot like the dph presentation you just got. and in light of the fabulous news from the mayor's office and all the hard work that's been done on the supervisors' side related to this, on behalf of happen, we would just like to acknowledge your own -- all of your personal commitments to hiv funding in the city and i travel several times a year out of state for national meetings

with peer agencies and i hear horror stories about life in other cities. and i am very grateful on behalf of myself and happen and all of our clients that we live in a city that regularly makes hiv services and hiv prevention a priority, not just in word but indeed by applying funds each time the federal government steps back from this cause. thank you very much to the mayor's office and thank you to the board of supervisors for your work on this. and the fight will continue as long as people need our services. thank you. >> thank you, mr. smith. we'll now open up for public comments. public comment will be 2 minutes and i have a number of cards. kim gilgenberg steel. gabriel [speaker not understood]. kerry [speaker not understood]. mary lawrence hicks.

jeff sheehy. [speaker not understood]. [speaker not understood]. jorge [speaker not understood]. [speaker not understood]. [speaker not understood]. and armando hernandez. you don't have to testify in the same exact order that i -- and i'm sorry, before we go, i apologize. carolyn from supervisor campos's office is here and supervisor campos did co-sponsor this hearing request with me. >> thank you so much. and thank you, everyone. supervisor campos what unable to be here, but he asked me to scum and just communicate his support for main tabing san francisco's model of care and [speaker not understood]. it is critical that we the city step up and make sure these services are funded. we are very gratified to hear the mayor plans to include this in his budget and look forward to working with you all. thank you. >> thank you very much. okay, now we'll go to public comment. good afternoon, my name is kim castillo. [speaker not understood] asian

pacific islander center in the tenderloin. firstly, i'd like to thank the board of supervisors and the mayor for your unwaivering support of hiv services, especially to those providing care for the residents that are in most need. the tenderloin neighborhood has one of the highest community viral load weights in the city and also the lowest rates of individuals seeking care. currently at api we help patients that are most likely to fall out of care due to chronic homelessness, untreated mental health and substance use issues. despite these challenges our unique hiv care model outperforms not only the city but also the nation. i am proud to say that 70% of our clients have a suppressed viral load and at 60% of those are undetectable. we can do this because we understand that when people are hungry, homeless and struggling with depression, tion ts --, anxiety, or psychosis, going to the doctor and taking medicines is not a priority. having a doctor is not enough to keep people in care because hiv is more than a medical

issue. for example, last week an hiv positive homeless transgender latino woman came to our agency seeking housing. our case manager assessed her other needs and she complained of foot pain. our case manager hooked her up with medical that same afternoon. we discovered she had advanced [speaker not understood] sarcoma and through seeking housing we were able to detect and treat this potentially life-threatening [speaker not understood] condition, a condition i haven't seen since the 1990s. left undetect this had patient would have wound up in the er or more likely would have died on the street. this is how san francisco helps to lower community viral load and this is what you have helped to preserve. we hope that we can continue to count on your continuing support this year. thank you. >> next speaker.

good afternoon, members. city council. and office of the mayor. my name is [speaker not understood]. i am an advocate for latino community and also a planning councilmember, hiv planning councilmember. in light of the wonderful news we just received, i want to thank the office of budget of the mayor and of the city supervisors. my reason for being here is that we must not forget the prevention amongst the latino community is still very critical. we need the focus more with the latino community as far as prevention and we're looking forward to see with this budget, new arrangement that would benefit from it. my second reason for being here is that about a year and a half

ago i was made aware that there was going to be a housing availability for the lgbt transgender latino women in the mission district and i believe that it was -- i don't know if it was sheltered or tabled or whatever, but the importance of having a housing availability for the latino transgender women and the lgbt latinos is very important, especially for the transgender women. they are in danger when they are put -- placed in the general public and oftentimes are threatened and put in a very precarious dangerous position. thank you. >> next speaker, please. i'm laura thomas. i'm the co-president of the harvey milk lgbt democratic club and i want to thank the members of the budget committee

for holding this hearing and thank the members of the board of supervisors and the mayor for coming up with the funds to maintain the system of care. you know we have more people living with hiv and aids here in san francisco now than we ever have. i would love to see a greater investment in our system of care. and thank you for helping to maintain it [speaker not understood]. thank you. >> thank you. next speaker. good afternoon, supervisor. i'm john weather man, speaking in support for the shanti project life program which offers direct services, education, and support to men and women with hiv/aids. at 71 years and 30 plus years paused, i am a thankful resip yetv of these services for the last eight years. ~ recipient the live pr