Lee urged to backfill AIDS cuts
by Seth Hemmelgarn
Advocates for people living with HIV and AIDS are increasing their calls for San Francisco Mayor Ed Lee to backfill federal funding for services they describe as lifesaving even as the city must close a steep budget shortfall.
For the fiscal year beginning July 1, there will be a reduction of $4.6 million in funds from the federal Ryan White HIV/AIDS Treatment Modernization Act. There will also be a $3.2 million drop in money from the Centers for Disease Control and Prevention, according to Supervisor Scott Wiener.
Wiener, who's on the Board of Supervisors Budget and Finance Committee, said that he and others want to get "as much of it restored as possible, hopefully 100 percent" when the mayor submits his budget proposal June 1.
If all of the money isn't restored, they'd work to backfill the federal cuts through the board process, said Wiener.
"This is my top priority in the budget process," said Wiener.
Restoring the money is important "because it'll save lives," he said.
"We have a responsibility in San Francisco to support those living with the disease and those at risk for the disease," Wiener said. "... We as a city made a commitment 30 years ago to do that, and we need to keep that commitment."
Wiener and his fellow LGBT supervisors, David Campos and Christiana Olague, held a news conference Wednesday in front of City Hall with HIV/AIDS providers and clients in which they called on Lee to backfill the federal dollars that will be lost.
Lee's spokespeople didn't respond to requests for comment Tuesday, May 15. Earlier this month, the mayor's office said that by June 1, he has to propose a citywide budget that closes a $170 million general fund shortfall in fiscal year 2012-13.
Mike Smith, president of the city's HIV/AIDS Provider Network, said the Ryan White award for 2012-13 is about $16 million. He estimated current CDC funding at $16 or $17 million.
Smith said that if the reduction is distributed proportionately and the expected Ryan White cut of 20 percent is not backfilled by the city, the agencies that would probably be hit hardest "are those that don't have large amounts of community resource to augment their Ryan White award."
Those organizations are often medical clinics, and agencies that provide mental health or substance abuse services, he said. At those agencies, reductions in Ryan White funding can mean fewer available appointments. Such changes "really can destabilize somebody who would otherwise have no detectible viral load," said Smith, who is the executive director of the AIDS Emergency Fund.
Michaela Hoffman, HIV services director at Mission Neighborhood Health Center, is one of the providers concerned about funding.
Almost all of the health center's funding comes from Ryan White. The center's budget is about $1.5 million, and the nonprofit receives approximately $1.3 million from the Ryan White program.
Hoffman said that the Ryan White reduction alone would result in a one-time cut of approximately 20 percent, or about $260,000, for medical care and supportive services. Most of the decreases would be in supportive services. The case management program, which helps link clients to housing, employment, and other services "would be substantially reduced," she said. She also said that they would probably lose the counselor who helps people adhere to their treatment regimens.
The reductions would add up to "less effective treatment," said Hoffman.
"The reason HIV care works right now is because of the comprehensive model," she said. "Cuts of this size start to chip away at that comprehensive model," and the decreases threaten to "whittle it down" so that only primary care is provided, said Hoffman.
"Primary care alone doesn't work," she said. "You have to have supportive services."
Hoffman acknowledged times are tough for the city.
"We know how many competing priorities are on the table," she said, but the cuts could have a "ripple effect," and HIV infections could increase again.
R. Lee Jewell, co-chairs the city's HIV Health Services Planning Council and uses Ryan White-funded programs, including dental care. He said he's already seen his ability to get dental services impacted, and he's worried about the impact further cuts would have.
Jewell said he told a mayoral staffer that he's concerned about "the most vulnerable" people, but there are also people like him who are doing "fairly well."
"If we start losing services we're going to start moving down to that bottom tier as well," said Jewell, and that's where places like emergency rooms will get "overwhelmed" because "there's nowhere else to go."
State deficit looms
On Monday, May 14, California Governor Jerry Brown released his May budget revisions that showed the state's budget gap has swollen to almost $16 billion. He has proposed $8.3 billion in cuts to state programs, including health care.
A statement Monday from the San Francisco AIDS Foundation said that the governor's latest budget calls for participants in the AIDS Drug Assistance Program to share costs. In some cases, monthly co-payments could reach nearly $400 for life-saving medications, according to the AIDS foundation.
"ADAP is an essential life-line to people who are already living on the margins and would not otherwise be able to access HIV medications," stated Courtney Mulhern-Pearson, SFAF's director of state and local affairs. "Forcing co-payments for AIDS drugs will ultimately result in people dropping out of the program altogether, putting their health and the greater community at risk. We now call on the legislature to make sure the governor's cuts are rejected."