Issue:  Vol. 48 / No. 3 / 18 January 2018

New prevention plan likely to shuffle money for AIDS orgs


HIV prevention director Dr. Grant Colfax. Photo: Rick Gerharter
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Several HIV/AIDS agencies in San Francisco are worried about their funding as the city's HIV Prevention Services office begins talks with organizations. Many say there will be cuts to programs.

Part of the concern is an increased emphasis on testing over other areas, such as health education and risk reduction. People are also worried about what HIV prevention services in the city will look like come July, when the new fiscal year starts.

The shift, which is tied to the 2010 HIV prevention plan, has been in the works for more than a year, and there have been numerous meetings, but some wonder how conclusions on which agencies to fund were reached.

San Francisco health researchers estimate that there are 736 new HIV infections each year in the city, though the number could be as low as 621. A decade ago, there were more than 1,000 new infections a year. The city's goal is to reduce new HIV infections by 50 percent by 2017. Objectives include cutting new HIV infections among gay and bi-sexual men and eliminating new infections among injection drugs users.

Dr. Grant Colfax, the city's HIV prevention director, said at a meeting last year that HIV is endemic in San Francisco, so "If we don't do things differently, we'll continue in this state."

Rebecca Rolfe, executive director of the San Francisco LGBT Community Center, invited representatives of several agencies to a meeting last week to talk about their concerns. The center receives about $150,000 in city prevention funding for its SNAP program, but was not invited back for the next fiscal year.

The Bay Area Reporter was denied access to the March 18 meeting. Just before the gathering, Rolfe explained attendees "strongly" wanted to keep the meeting closed because they wanted to have "an honest conversation" about what the changes mean.

In an interview later, Rolfe said, "We spent 30 years building a set of services we feel work well and really reach the needs of the diverse communities that we serve, and I think there's concern about what's going to happen as we move forward, and how do we make sure our clients really receive the best possible services."

Colfax said in an interview this week that no funding decisions have been made. He said that because the city's in the process of negotiating with providers, he was limited in what he could say.

However, he said, "As part of the process, what we look at is potential gaps, and we make efforts to fill those gaps whenever possible." He said he was committed to ensuring that "all clients' needs will be met as we move forward."


RFP process

The request for proposals was published last November, and proposals were due in February. Agencies that made the initial cut then received invitations to negotiate earlier this month.

The RFPs included eight categories, including testing, prevention with positives, addressing HIV-related health disparities among black gay and bisexual men, and syringe exchange. About $6.7 million in awards are available. More than one agency can receive funding in most categories.

The process also consisted of review panels that scored agencies' proposals on subcategories that addressed a range of factors, such as whether their programs would contribute significantly to the city's goals.

San Francisco AIDS Foundation has fared well, receiving invitations to negotiate in all five categories in which it submitted proposals.

Bob Rybicki, vice president of programs and policy for the foundation, said one of the reasons the foundation did so well is that it "put together some really solid collaborations with other organizations," including the Stop AIDS Project, which was part of its proposal for working on disparities among gay and bisexual black men.

Separately, Stop AIDS received an invitation to negotiate for prevention with positives work, which looks at reducing opportunities for HIV transmission, among other areas. Stop AIDS also submitted proposals for two other categories but didn't receive invitations in those.

Kyriell Noon, Stop AIDS executive director, said his agency is looking at "a fairly significant decrease" in funding from the city. He didn't know exactly what the reduction would be, but the current budget is about $1.8 million, and approximately $1 million comes from the prevention office, he said.

Noon said what's at risk for his agency are health education and risk reduction programs such as the Scene, which is geared toward gay, bi, and transgender men in their 20s to mid-30s. Stop AIDS is trying to determine whether the Scene will survive.

Many are aware that the city is having budget troubles of its own and it has gotten harder for the prevention office to provide support.

Asked about the need for agencies to merge, Noon said the health department "has made it clear they wanted agencies to start thinking about more strategic ways of restructuring," whether that's through mergers, sharing finance and administration staff, or other means.

He said Stop AIDS is "currently looking at a number of options" along those lines, but couldn't share specifics.


More disappointment

The Black Coalition on AIDS submitted a proposal for addressing disparities among black gay and bi men, but the invitation to negotiate in that category went to SFAF instead.

Perry Lang, the coalition's interim executive director, said it's as if the prevention office is "dismantling" the city's HIV prevention network, "and the potential effect it's having on the black community is painful."

"I'm concerned that prevention dollars seem to be going to the best proposal writers, and not necessarily those that have the expertise and the cultural competency necessary to reach the population in a way that affirms prevention messages and cultural values," said Lang. He declined to specify whom he was referring to as "the best proposal writers."

Terry Smith, who works at AIDS Project Los Angeles and was a panelist in the category in which the coalition submitted its proposal, said that "clearly" officials will go with groups that are most responsive to the RFP.

Smith, an African American gay man, said that panelists ranked proposals individually, then submitted information to the health department, which made the selections.

Lang estimated the reduction from the city would mean a loss of $300,000 to his agency, and he said almost 200 clients could be affected. In addition, said Lang, probably four staff would have to be cut.

Officials at Shanti, which offers support to people with life-threatening illnesses, including HIV/AIDS, and has received high marks from the city for its work, are also dismayed.

Using the acronym for Learning Immune Function Enhancement, Shanti Executive Director Kaushik Roy said, "We are very disappointed, because the decision is to de-fund Shanti's LIFE program." Shanti received $624,000 from the HIV prevention office this year.

Chip Supanich, who was diagnosed with AIDS in 1995 and is a graduate of the LIFE program, said the service reminded him of the benefits of meditation, among other things.

Supanich, now a Shanti board member, said LIFE programs in other cities would continue, and Shanti will look for funding to continue the program in San Francisco "at a diminished level."

He sees a shift toward a medical model of care and away from the "San Francisco model," which includes medical care, but also services in areas such as alternative therapies and housing. Supanich said before he received housing subsidies, he was homeless.

"I'm standing up for the model of care that has nurtured me for 16 years," said Supanich.

No one on the review panel for the prevention with positives category, which Shanti had submitted its LIFE-related proposal in, responded to interview requests. All of them work in other parts of the country.

Mark Molnar, director of HIV programs at Shanti, said, "We're not necessarily taking issue with the quality of the reviewers," but he noted none of them is seen as representing agencies that solely provide support services.

Colfax, the city's HIV prevention director, said that in addition to diversity and other considerations, "We sought out people who were experts in the field and had no conflicts of interest" and panelists went through "intensive training" about the epidemic in San Francisco and the prevention plan.

Despite all the concerns, Colfax said the health department is "building on the success of the San Francisco model" and would keep working with others "to continue to do the innovative and comprehensive work San Francisco has always done."

He also said he's committed to having "open and transparent" dialogue with providers and community members.

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