some of those shifts in just a moment. another way to look at the aging of pop of people with hiv is to compare hiv surveillance age groups below 50 and above 50. the proportion of people in each group below 50 decreased between 2004 and 2013, while the proportion in each of the age groups 50 years old and older has grown in the same period with the largest growth in the 65 or older age group, which has grown by 282 percent since 2004. and there are differences in the demographic profile of older and younger people with hiv. african american and native american proportion of people living with hiv are about the same above and below 50, but there's been a substantial increase in the latino and asian pacific islander proportions below 50, latinos are 12 percent of people with hiv who are older than 50, but 21 percent of people younger than 50. asian

pacific islanders are 3 percent of people older than 50 and 7 percent of people younger than 50, while whites are nearly 70 percent of people over 50, but only 56 percent of people younger than 50. this change in the racial and ethnic profile has happened as people of color have begun to make up a majority of more recently diagnosed cases. differences in the ethnic and gender composition of the population, 50 and older and below 50, may have implications for the design of outreach and service delivery as the population continues to age and people with private insurance, private disability insurance, who have not used public services in the past turn to ryan white and other city services for the first time when their disability insurance expires. this is another way of looking at the changing racial and ethnic profile of people with hiv, showing the concentration

of whites, mostly men, mostly gay men, among older people living with hiv in blue, and the large proportion of people of color among younger people with hiv. again, white men have been the largest proportion in san francisco since the onset of the epidemic. they reflect an even larger number of people reflecting the large proportion of white men in the early stages of diagnosis. there are also differences in the demographic profile of the general population of people with hiv and people who receive ryan white services. ryan white funded services are generally available to people at or below 400 percent of poverty. it's our understanding that most people who receive ryan white services in san francisco are well under 400 percent of poverty guidelines. white men make up a small

percentage of clients in the ryan white program, which serves a greater number of people of color and women than are in the general population of people with hiv. again, these demographic differences might have implications for how programs are designed and how outreach is conducted for people who have not used public services in the past. as i mentioned, the insurance companies decline to provide information on the number of disability insurance policy holders and health care and other service providers generally don't collect this kind of information. so we've estimated the number of people with insurance, with disability insurance. we began by assuming that people who were diagnosed before antiretro viral therapy became available were more likely to be disabled and unable to work than people diagnosed after effective therapy became available in the

mid-90's. they end of 2014 there were 6,668 people in san francisco who had gone diagnosed from the beginning of the epidemic through 95, and we start by assuming that these people are more likely to have been disabled by hiv and stopped working and we base our estimates on the number of people with private disability insurance on this number. we used two local surveys of people 50 and older in san mateo, marin and san francisco to estimate the number of people in san francisco with private insurance. in 2010 the joint work group on hiv and aging, a project of the ryan white planning council and the mayor of long-term care coordinating council, conducted an online survey of people 50 and older in the three counties. this survey found 18.8 percent of respondents had

both social security disability insurance and private insurance and in 2013 researchers at san francisco state conducted an in person survey of people living with hiv at service agencies in the same three counties and found 6 percent of 160 people surveyed had private insurance. we applied these percentages to the number of people diagnosed through 1995, which gives a range of between 400 and 1254 people. we think the 1200 estimate is probably more accurate because the demographics of the people in the 2010 survey as far as race, ethnicity, gender and age more closely resembles the demographic profile of people with hiv in san francisco. one of the caveats we have to mention is that neither of these surveys saran dumb survey and they both relied on small

sample sizes. they are the only two surveys we could find that ask specifically about private disability insurance and we think these numbers give a reasonable order of magnitude estimate of the number of people with hiv in san francisco. we have made a high and lowest mat of people 50 and older with private insurance reaching retirement age and losing their insurance in the next 15 years. we used the percentage of people with private disability insurance and the age group distributions in the two surveys i just mentioned and we've broken this out in 5 year increments. in the first five years, 110 to 345 people reach retirement age and again in your 6 through 10 and in the last 5 years, 182-564 people reaching

retirement age and resumablely losing insurance. we were asked to estimate the service needs of people as they lose insurance at retirement and switch to social security or become completely dependent on social security income. since most lgbt seniors are renters, housing assistance in the form of rental subsidies allows people to stay in their homes, will probably be the greatest service need. here again we used the two surveys to come up with a high and lowest mat of the cost of new housing subsidies for people reaching retirement at 65 over the next 5 years in this case. these estimates assume renters receive a flat subsidy of $1,551 a month, which is the fair market rent standard for a one-bedroom apartment set by the capa program, the federal housing program for people with aids program. again we use the

2010 survey for high estimate of 2,300 people reaching retirement over the next 5 years and the lowest number of 110 people. capa and ryan white have decreased as all care act funding has decreased over the last several years, and we are presenting these estimates of 6,019,000 as general fund costs. housing will probably be the most urgent need for people losing insurance but we were also asked to look at other service needs. again we have made two projections for increased service costs for other services in the next year and we base this on ryan white funding in the 2013 ryan white fiscal year. again, a lowest mat of people reaching retirement age in years 1 through 5 of 22 people and a

high with 69 people and we've estimated core services and support service costs ranging from 35,000 to $112,000. we've excluded medical costs from this estimate because people will be eligible for medicare and medical when they reach retirement. so without the cooperation of insurance companies, we can't know the exact number of people with private insurance, but what information is available indicates the size of the population is somewhere between several hundred and approximately 1200 people. we know that few people with private insurance make regular use of services intended for people with hiv with private disability insurance, which will have to -- i'm sorry --

and this will have to be taken into account when designing services for this population. the overall effect of the drop in income that will occur as people lose their insurance is difficult to predict conclusively because some people have other resources including home ownership, but what evidence is available indicates that for many people the lost income will make it impossible to afford san francisco's median rent and housing assistance is a most likely need that most people have when they reach retirement. i'll be glad to answer any questions. >> thank you very much for the presentation, also for the analysis that you did. i know it was very challenging. this is not an issue that has been really studied before and i think you did i think really good work given the data limitations, so i appreciate the creative thinking.

one question i have. if you go to slide 11 where if you look at the high estimate, estimates the housing rental subsidy needs over the next 5 years starting at 1.3 million, approximately, next year, escalating to about 6 1/2 million five years out, that obviously continued past year 5. and i guess the question is do you have a sense for what is the total time frame of this issue? it's obviously not a permanent issue because from more recent infectiouses people are less likely to be on disability to begin with, so if you could just give us a sense of some of the long-term beyond year 5? >> that would be determined by

the number of people 50 or older perhaps who are reaching retirement. we know there are approximately a thousand people aged 50 through 65 who are receiving social security disability insurance who have hiv. so i'm assuming that the long-term effect -- i can't do the math in my head, i'm trying to find the number --. >> so this 6 1/2 million, would you expect that to continue at that level? >> it will probably decrease after the bulk of people who are approaching retirement age now retire. >> supervisor wiener, i think one of the things we looked at, if you look at slide 10, you

look at how we saw the increments of these 1200 people coming on to services. over the next 15 years we did see some increase in services. now, one of the things that we couldn't calculate would be the morbidity. some people might actually leave the city or die or something else and they would no longer require services but our estimate went out 15 years. we just wanted to focus on the first five. >> and of course our hope is that as they turn 65 they have another 30 or 40 years ahead of them, but of course we're also learning a lot about what it means to be hiv positive in 70, 89, a lot of this is slightly uncharted territory so i know there's a lot of speculation involved. great. thank you very much for your presentation. next i'd like to ask bill hersch and john sesky from the

aids legal referral panel to speak and i want to thank the first person was bill who said let's look at the report and let's talk about it so i want to thank you for raising the issue. >> good morning, supervisors, i want to thank you for taking the time to look at this issue in more depth and certainly, supervisor wiener, i want to thank you for your leadership in calling your attention to this issue. i'm bill hersch, i'm the director of the aids legal panel and now the co-chair of the aids provider network. lrp provides services assisting people with hiv and aids around a broad array of insurance matters and i'm proud to have our insurance attorney here to talk about the work he does with clients. you've heard some of the good news and the bad news this morning so the good news is

that people living with hiv and aitsds are living much longer. the bad news is that people have been living for decades in poverty and with disability and many folks never planned for a retirement because they didn't think they were going to be around. so we've seen this issue coming for a while. we were very pleased to work with the task force to help them identify this issue. what we want to avoid is a large number of people coming to lrp's offices with eviction notices. we want to try and educate the community about this issue and come up with some practical solutions that will avoid a mass of people living with hiv and aids from being evicted from this city, from losing the very services that have sustained them over the years. before we do any outreach and

education about this issue, we want to make sure a we have some solutions to offer our folks. some of the solutions may involve helping people return to work and supplement their income so that they are able to afford their rent. but for many folks, that won't be an option and last year the homeless emergency service providers association worked through the board to get additional funding around homelessness prevention. some of that money is finally going into contract effective today and some of those subsidies will be readily available for people with just this situation that we're describing this morning. but it's only 61 slots. those slots will be gone within 3 months. this issue is bigger than that and i think the city has a commitment that it needs to ensure continues to help people living with hiv and aids

maintain the system of care that they depend on for their lives. so i hope that the board will increase funding for homelessness preconvenience. we know we can't build ourselves out of the affordable housing crisis. this may seem like a significant commitment on the part of the city to provide on-going operating of cities for people, but i think it is a smart way for the city to make sure this vulnerable population maintains the affordable housing they now have. thank you again for the opportunity to present and i look forward to working with you on this issue. >> good morning and thank you for this hearing. it's very important and timely. my name is john sisky, i am

the hiv/aids insurance protection project staff attorney at the aids legal referral panel, representing clients living with hiv/aids, the majority of whom are long-term survivors growing older, like me. to retain their private long-term disability insurance. while many of these individuals have lived with hiv/aids for decades they access private disability policies through their employers or individually during a time when, as many will recall, we were advised that surviving aids was not possible. it was not an option. fortunately the introduction of new hiv/aids medications in the late 1990's has in many cases improved and extended the lives of people living with

hiv, people who thought that planning for a longer life was not necessary. although there seems to be no clear answer as to the life expectancy of us long-term survivors, it is clear that as my clients grow older they face loss of their private ltd policy, ltd standing for long-term disability, at age 65 and increased scrutiny which i'm seeing more often by the social security administration just prior to the ssa's set retirement ages at age 62, 66 and age 70. s a individuals living with hiv/aids lich longer lives, there will be more clients coming to hrp for representation in navigating these insurance programs and consequently many who will be

at risk for losing their housing when their income drops suddenly. it is a fact that stable housing is essential to living well with hiv and aids. in 2014 the city funded housing subsidies to help long-term survivors to remain in their current housing. while i agree with my wonderful executive director, this is a great start, but the city must do more. preventing homelessness for all individuals living and aging with hiv/aids is really the best strategy in our current housing crisis. i am here to pledge right there with bill, pledge my support of immediate subsidized financial assistance to more individuals living with hiv/aids who are facing imminent and dramatic loss of income resulting from the loss of their private ltd income. thank you.

>> thank you very much. okay, colleagues, at this point we will move to public comment. mr. chairman, may we do that? >> yes, let's open public comment. >> i have a few public comment cards. public comment will be two minutes. paul followed by richard goldman, newton butler, momte hill and ryan basinger. >> thank you, supervisors, for this opportunity to speak on this issue and for everybody who has done so much work in bringing it to our attention. i am a long-term survivor, i was diagnosed in 1986. for me actually -- before i make a couple specific suggestions i want to be clear about the idea that everybody -- there's

implication anyway that everybody is doing really well since the cocktails came out. the fact is many of us have struggled even with the cocktails with quality of life issues and side effects from medications that have been on-going for most of us. as bill i think mentioned, the opportunity for some of us to go back to work is not an option as we reached retirement age. for me in my situation my income will decrease by almost 50 percent when i reach retirement age. and arizona i think of some of the services that i've taken advantage of and that i would like to see increased are, other than more money for housing that -- i'm not sure if this is the venue for this suggestion or not, but additional legislation be passed to protect this

population from evictions. also increase funding for rent subsidy programs provided by the sf aids foundation and increase monthly amount of money available to us from the aids emergency fund and an end to the lifetime cap. thank you very much. >> thank you very much. next speaker. >> good morning, supervisors, hi, my name is richard goldman, i am 66 years old. i work at project open hand currently and i was on ltd for 25 years. i am one of the lucky ones. i survived when i didn't expect to and with the help of the aids legal referral panel and the positive resource center, i had navigated through the maze of benefits and was able to stay on ltd for all those years. the catch-22 is that you can't work at all part-time if you are on ltd you can't earn any

money, you can't save any money, and i want to also say that the idea of transitioning to retirement is a fallacy. people on ltd are already on social security disability and when you reach age 66, as i have, that just becomes social security retirement and a 60 percent reduction. with the help of alrp and prc, i was one of the few lucky ones and able to return to work and supplement my social security so i am able to survive, but i just want to thank supervisor wiener and this committee for addressing this important issue and increasing funding so that people do not face homelessness and that other support services are included in this proposal as well. thank you. >> thank you very much. next

speaker. >> good morning, my name is newton butler, thank you for making time to hear about this important issue and for those who spoke before for their excellent presentations. i have been positive with hiv for about 34 years, been on disability for 13. 85 percent of my income, which is made up of ssdi and also long-term disability, is paid to rent here in san francisco and for the balance i am gradually plowing through what i had amassed as savings. in three and a half years, i am 61, i will turn 65, my long-term disability will turn out and i will accelerate through the process of exhausting my supply of funds. i am very helpful

for project open hand and for the food banks which make living frugally more a reality in this excellent city but it will be a bigger squeeze so when i find myself actually beting against myself, i find myself almost having to hope i do expire before age 71 or so, which is when my bookkeeper friend estimates i will have run out of money to pay rent. so i am hoping that something can be done in the form of perhaps just structures or wherever we live we pay a third or even half of our income as opposed to 85 percent of our income for rent, which would be a more tolerable scenario than paying 85 percent and after the loss of long-term disability payments at age 65 it will be much higher. thank you again for being here and i hope something wonderful can be done. >> thank you very much. next speaker. >> hello, supervisors, brian basinger, the director of aids

housing here. as bill mentioned, we are getting approved right about now to release for the funding for those 61 permanent needs based rental subsidies. we've dwot 12 agencies who are part of our collaborative referring into the system. we have an online screening and referral data base for people and our hopes are that we can actually start modeling out when these individuals will be aging off of their ltd's and start needing the rental assistance so that as we continue to ask for additional funding we can actually capture people right when they are most at risk. and as you all know, aids housing lines has probably one of the most comprehensive eviction prevention services in san francisco so we can provide the back rent, the move in

deposits and these other forms of assistance. the model that we worked out, we can provide up to $800 a month in rental approach. so when individuals have a rent burden that is excessive they aren't disqualifid, we have time to apply for affordable housing and help them move to places of greater affordability so they can maintain their housing and thank you all again for bringing up this important issue and we look forward to talking to you soon. >> hello, my name is monte hill. i moved to san francisco in 1978 and i moved to the east bay a few years ago, actually about 28 years ago, and was making the most money i had

ever made in the food and beverage industry and bought a house with a spouse, we were together for 21 years, and he left 4 years ago and i've been in that house living rent free in east bay but he was a train wreck with his financeses and we had to sell the house and recently we did. he's honored a vow we had, i did a quick claim did when i almost died to turn my property over to him, but he's going to be sharing the equity with me. so i'm back in san francisco now with a modest nest egg, but finding a place to live here now, that nest egg could evaporate instantly. and while i might look older than the rest of the people speaking, i'm only 55 so i can go back to work. i'm on ssi, not ssdi, because i somehow waited too long, i didn't even know what happened back then when i was sick and i retired from the work force 18 hours a day, 7 days a week, so

i'm making $640 a month from ssi i recently took a letter to social security to tell them i was living here and i no longer had subsidized rent and they wanted to know how i was renting a room in san francisco on $600 a month and i said i sold my possessions when i moved and i said you had to report that. it became this thing where they didn't want to take the letter because there was no way out of that rock and a hard place. so i'm beting on san francisco that in the next 10 years i can go back into the work force somehow, but clearly it's a brutal market out there for housing and that's a really important thing to address for seniors. >>