Issue:  Vol. 48 / No. 7 / 15 February 2018

City looks at $26 million in mid-year health cuts


Health Commission President Jim Illig. Photo: Jane Philomen Cleland
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The San Francisco Department of Public Health is facing $26.7 million in mid-year cuts that could affect areas including HIV prevention and substance abuse treatment. The city's health commission has been meeting to discuss the reductions, which would come at the request of Mayor Gavin Newsom's budget office.

Funding for HIV prevention and other areas had been kept off the table, but in October, the Health Commission decided to make that money open to cuts.

The reductions to the health department, many of which would take effect January 1, are part of an effort to close a citywide budget gap that's expected to be $90 million to $125 million. The city charter requires a balanced budget.

The department could also take hits from reductions in funding from the state, which is facing a possible deficit of billions of dollars.

Openly gay Health Commission President James Illig said the potential cuts, which he said are unprecedented for mid-year, are "crazy ... but that's the level of desperation we're at right now."

Illig said the $26 million figure is "just to reach the first target the mayor announced. That's what's scary – we don't know if this is the end."

Newsom's office did not respond to requests for comment.

Illig noted the cuts represent mid-year cuts, so when the value is doubled over a year, the reduction in services come to about $50 million. He said the commission is telling the mayor's office what the cuts would look like so he can make a decision.

The cuts include about $1.1 million for prevention, which would amount to about $2 million over a year.

Illig said the commission removed prevention and other sections from the "hold harmless" budget list because "we just wanted to make sure everything is put on the table. Nobody wants to cut prevention or housing ... but we couldn't exempt a whole, large service category like that." He said the commission is putting an emphasis on being able to provide direct services.

One agency that could be affected is the Stop AIDS Project, which works to prevent HIV transmission among gay and bisexual men in San Francisco.

Jason Riggs, Stop AIDS deputy director, said, "We're a pretty lean organization already, so every significant cut for us is a whole program."

He said the organization's budget this year is about $1.8 million.

Riggs said funding the agency gets from the city helps with programs that include Our Love, which focuses on black gay, bisexual, and transgender men.

He said one thing that worries him is that Stop AIDS would have to figure out how to avoid cutting services in a year when raising funds is difficult. The agency does not get federal money.

Rumor has circulated that Tenderloin Health is closing down, but Colm Hegarty, the agency's spokesman, said it's not true. Hegarty said the Human Services Agency cut funding for the organization's neighborhood resource center by 50 percent, but it will still operate.

However, he said, the health department has proposed cutting $179,000 from Tenderloin Health, which would eliminate the Prevention with Positives program. The program works with people who are HIV-positive to help them prevent the spread of HIV.

Mike Smith, executive director of the AIDS Emergency Fund and president of the HIV/AIDS Providers Network, said some prevention work is being spared from cuts, and the proposed cuts also don't affect AEF at the moment, but he said the situation is "awful."

"There's just no way to make cuts of this size without destabilizing just about every population, and it really seems from these cuts like almost everything is affected," said Smith.

"Even though AIDS services are not being cut, the programs that are being reduced still have an impact on people with AIDS," he said. There are deep cuts to mental health services, substance abuse, and crisis services, he said.

Funding from the Ryan White HIV/AIDS Modernization Act, which the city relies on for help, is usually not available until March, Smith said, but Monique Zmuda, deputy city controller, said that she will be speaking with health department officials to see what can be done to continue contracts.

Places for help

Smith said a city official arranged for Ryan White HIV/AIDS Modernization Act funding that is usually accessible in March to be available in January.

Only a few months ago, at the beginning of the summer, the health department faced millions in cuts, but most of those were restored by the Board of Supervisors. However, since these are mid-year cuts, they don't go to the board; the mayor has spending authority.

Supervisor Bevan Dufty said the mayor's office plans to discuss the cuts with board members, but that hasn't happened yet.

"At this point, I think things are a bit fluid, and I haven't gotten nervous," he said.

Dufty said one area of concern is Proposition T, which passed in November, requiring the city to provide enough free and low-cost substance abuse treatment services to meet demand and to maintain funding for those services. He said he would be meeting with the city's crystal meth task force and the city attorney to discuss how the cuts might intersect with Prop T.

Fearing the effects

Ann Harrison, executive director of New Leaf: Services for Our Community, said the agency would lose its meth program for gay and bisexual men in January if the program's annual funding of about $373,000 is cut. The program sees about 200 clients a year.

Harrison said she's "desperately hoping" the city's finance officials will look for other ways to make cuts "rather than decimating the Department of Public Health."

She said gay and bi male meth users are two to three times more likely to seroconvert in conjunction with meth use. More meth use also could mean more cost to the public in terms of emergency services.

Harrison said clients are encouraged to make use of Alcoholics Anonymous and Narcotics Anonymous, which are free, but the clients have co-occurring disorders, meaning they may have mental health issues as well as substance abuse problems, and they could also be HIV-positive.

Harrison said the anonymous programs are just one piece of what clients need, and New Leaf has the capacity to deal with mental health issues and can also provide substance abuse education, such as teaching about the effects drugs have on the brain, in addition to the group and individual therapy they provide.

David Stupplebeen at Asian and Pacific Islander Wellness said the agency's budget for outreach and prevention work, which is about $370,000, would suffer.

The cut would impact youth outreach services, transgender empowerment for male to female transgenders, and gay men over the age of 25.

Carlos Bermudez, API Wellness' director of health education, said the agency is the only one doing HIV prevention work in San Francisco that targets the Asian and Pacific Islander community, and the cuts would affect 2,000 unduplicated clients over the three programs.

Adam Chang, a gay 22-year-old man, has been participating in the youth outreach services group, Aqua, for about five years. He said it offers everything from HIV testing to information on safe-sex practices, and they've even had workshops on dancing.

"The fears that the API LGBT youth community have are very unique and very specific to us," said Chang. "API Wellness Center, through Aqua, is the only organization that fully meets our needs."

He said the comfort that comes from meeting with other youth who have shared fears and shared understanding might make people feel more secure to get tested.

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