Millions sought from CA, SF for sexual health services
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With budget negotiations set to heat up in the coming weeks, advocates for sexual health services are seeking millions of dollars from California and San Francisco officials this spring. Their demands come as both the city and state are currently flush with cash as the economy continues to improve as the COVID pandemic ebbs.
There are warnings, though, that the financial picture will not be so rosy in coming years. Nevertheless, advocates and providers of care and prevention for HIV and sexually transmitted infections, along with substance-use treatment, are hopeful of seeing their budget asks be funded this year.
"STI rates have reached historic highs and continue to climb in California and across the country. The COVID-19 pandemic has only reminded us that we must be vigilant and responsive when it comes to public health," stated Amy Moy, chief external affairs officer of Essential Access Health. "Although the state has recently increased investments in STI prevention activities, additional resources are needed to ensure access to STI services for youth, and low-income, uninsured, LGBTQ+ Californians who face disproportionately high rates as a result of structural and systemic inequities."
State leaders are expecting a $68 billion surplus in the budget this year, leading to suggestions residents could see $200 rebate checks. Governor Gavin Newsom is set to release his budget revision by May 15.
In March, San Francisco budget officials projected a $74.7 million surplus for the upcoming two fiscal years. But that was $33.4 million less than the surplus of $108.1 million that had been projected in January, and the cumulative deficit projection stood at $156.2 million by FY 2025-26.
As covered by the Bay Area Reporter last year, state lawmakers boosted by $13 million the funding for implementing a plan to end the combined epidemics of HIV, hepatitis C, and STIs. It was less than the $19 million that health advocates had sought and state legislators had initially added to the budget.
This year, a coalition of nonprofit service providers is seeking $105 million not only for addressing sexually transmitted diseases but also to tackle the overdose epidemic among intravenous drug users. Newsom is once again expected not to include the funds in his budget, leaving it to state lawmakers for a second year in a row to add the funding into the budget they adopt.
Gay Assemblymember Evan Low (D-Campbell), chair of the California Legislative LGBTQ Caucus, has pledged to champion the budget request in the Legislature.
"With a historic budget surplus, the governor and Legislature have a critical opportunity to improve the health of the most vulnerable and underserved Californians and reinvigorate the state's efforts to address HIV, STIs, viral hepatitis, and overdose as we begin recovering from the pandemic," stated Low. "I applaud the governor for proposing unprecedented new investments to rebuild the state's depleted public health infrastructure, increase access to behavioral health services and substance use disorder treatment, and expand access to health care for all Californians regardless of immigration status. At the same time, however, targeted public health funding remains essential to ensuring that adequate resources are allocated to tackle these growing public health crises that disproportionately impact LGBTQ+, BIPOC, and other vulnerable communities."
Craig Pulsipher, the associate director of government affairs for APLA Health in Los Angeles, told the B.A.R. he is "optimistic" about seeing the funding be included in this year's budget, especially since the LGBTQ caucus has thrown its support behind the ask.
"The coalition continues to have strong support from legislative leadership and budget committee leaders. I am very optimistic," said Pulsipher. "As you know well, we have seen some really concerning increases in overdoses and STI rates, especially over the last couple of years of the pandemic. All of these requests are certainly justified and needed in the community. We have had a positive reception from the meetings we have had thus far."
With syphilis cases continuing to spike across the state, the coalition is seeking $49 million in one-time funding for a syphilis and congenital syphilis strategy to address the issue. It also wants $8 million in one-time funding for Hepatitis B outreach, screening, and linking patients to care.
Another $20 million in ongoing funds would go toward improving the capacity of local health departments and community organizations to provide Hepatitis C outreach, testing, and linkage to care and treatment services. The coalition would also like $750,000 in ongoing funding to make free condoms available in public high schools, middle schools, and school-based health centers that opt in to the program.
An additional $7 million in ongoing funding is sought to support the expansion of access to STI testing and treatment services for low-income, uninsured LGBTQ+ individuals through the state's Family PACT program. The same funding ask was made last year but was not included in the budget.
With overdose deaths up 45% in California since June 2020, $20 million in ongoing funding is being sought for syringe services programs and overdose prevention programs. Most of it would go toward continuing a pilot program called the California Harm Reduction Initiative that was funded at roughly $15 million over several years and is set to expire June 30, 2023.
"National Harm Reduction Coalition has surveyed participants of harm reduction programs across the state and found that stigma remains the number one barrier to accessing treatment, which is one of the reasons it is essential that we fund harm reduction at a commensurate level as other tools to ensure the health and wellbeing of people who use drugs regardless of the cessation of drug use," stated Jenna Haywood, the group's associate director of community mobilization. "Our approach to substance use disorder, overdose, and other drug related harms needs to be multifaceted, this means parity of investment between prevention, treatment, harm reduction and recovery."
The Legislature has to pass its budget by June 15.
SF funding sought
San Francisco officials allocated an additional $2.6 million for local HIV programs over two years in the fiscal budget adopted by the Board of Supervisors last July. In March, people living with HIV and AIDS advocates staged a "die-in" in front of City Hall to demand a stronger local response this year to addressing their needs and reaching the city's goal of ending new HIV cases.
A coalition of advocates and service providers is now seeking upward of $10.5 million in city funding this year for its HIV Community Budget Proposal. It also wants a renewed commitment from city leaders that they will backfill any cuts to San Francisco's allocation in its Ryan White Federal CARE grant to fund HIV services, currently at about $15 million.
Roughly $500,000 of the specific dollar amount ask would go toward covering the cost of doing business for those service providers with Ryan White-funded contracts. Between $2 to $3 million is being sought to maintain current HIV prevention services in the city.
Housing subsidies for people living with HIV would receive $3 million, while $2 million is being sought to be evenly split between providing mental health for long-term survivors of HIV and AIDS and intensive case management services for those living with HIV.
Between $1 to $2 million is sought for safer consumption sites where drug users could access services to help them become clean and prevent them from overdosing. The city purchased a site in the Tenderloin to potentially use as a supervised drug consumption facility, but it has yet to open. A linkage center opened in the Tenderloin earlier this year to help drug users access services and get tested for HIV, STDs, and COVID.
At a May 4 hearing before the Board of Supervisors' Budget & Appropriations Committee Paul Aguilar, a gay man and chair of the Harvey Milk LGBTQ Democratic Club's HIV Caucus, stressed the need for the city to fund the various services that will assist long-term survivors of AIDS and HIV like himself. Aguilar, who helped stage the die-in action, has been living with HIV for 34 years.
"We are shoved to the side while prevention methods such as PrEP and syringe access get everyone's attention and focus and funding," said Aguilar. "We insist these prevention efforts not drain resources for caring for those of us living with HIV for 30 and in some cases 42 years."
The city spends $28.7 million on HIV prevention. As with the statewide focus on the three overlapping epidemics, local health officials are also taking a multipronged approach to how they provide services. They are also developing central access points geared to specific communities, such as gay and bisexual men or transgender individuals, and will be announcing this month new funding allocations based on that model of care.
"The goal is to develop locations with a welcoming environment for people in that group," explained Tracey Packer, director of the health, population health division at the San Francisco Department of Public San Francisco, during the hearing.
But a number of longstanding HIV service providers have expressed concerns about the health department's new approach and how it will severely impact their already strained budgets and ability to continue providing services. Eduardo Morales, Ph.D., executive director of AGUILAS: El Ambiente had laid out his concerns about the pending impact to his agency and its ability to continue providing culturally relevant services to the city's LGBTQ Latinx community in a letter sent to the supervisors in March.
"As you know the Latinx community is overrepresented in HIV/AIDS and COVID-19 cases in SF. AGUILAS looks forward to your continued support that is central to our ability to attract new funding and provide HIV/AIDS prevention services to the Latinx gay and bisexual community especially during this COVID-19 pandemic. Without the continued partnership with SFDPH, our ability to execute the newly acquired funding sources for services that AGUILAS has received recently will be impeded," wrote Morales, who did not speak during Wednesday's hearing.
Committee chair District 9 Supervisor Hillary Ronen, who called for the hearing along with gay District 8 Supervisor Rafael Mandelman, although he was unable to attend, asked Packer about the pending funding cut to AGUILAS and other agencies.
"What happens to those organizations that all of a sudden have significant budget holes and cannot continue to work with individuals they have gained a reputation for serving?" asked Ronen. "It doesn't appear obvious to me or people in the community if the new organizations that are going to be funded with all that money set to be diverted have that same history and level of engagement and work with the communities they are serving."
Packer did not directly answer Ronen's question specific to the impact on AGUILAS. She noted that the decision on which service providers are to receive the $8 million in contracts this year has yet to be officially announced.
It could be revealed as soon as next week. The decisions will be based on input the health department received from an independent review panel that scored the requests for proposals it received.
"The RFP process is not over. I can tell you the health access point for Latinx services will be provided by Latinx service providers," said Packer, who acknowledged it is a "challenging process" that "is difficult for all of us."
Several leaders of other HIV service providers, including the San Francisco AIDS Foundation, also expressed concerns about the new approach the health department is taking this year in doling out the HIV contracts. AIDS Legal Referral Panel Executive Director Bill Hirsh, who co-chairs the city's HIV/AIDS Provider Network, also expressed misgivings about the plans.
"While I appreciate the work of our partners at the Department of Public Health and the thoughtfulness that they have put into some of the decisions that they are putting forward, I fear that there are some unintended consequences, which will have the net impact of destabilizing the system of care that we have come to rely upon," said Hirsh.
Committee member District 11 Supervisor Ahsha Safaí pledged his support for the budget request put forward by the HIV advocates and service providers. In particular, he said it was imperative that the city support long-term survivors of HIV and AIDS.
"These long-term survivors need our focus, need our support and attention to ensure their health and wellbeing," he said.
Ronen added, "We will keep our eye on this issue throughout the entire budget process."
At the supervisor's May 10 meeting Mandelman introduced a resolution calling on the mayor to include the HIV advocates' funding request in her budget and the health department to not "destabilize the city's HIV/AIDS testing and treatment safety net by cutting millions of dollars in funding to legacy organizations providing lifesaving services to thousands of residents."
During the hearing, in response to questions about the city covering any federal HIV funding cut this year, it was revealed by Ashley Groffenberger, Mayor London Breed's budget director, that no reduction is expected this year. Should there be then the city would look at backfilling the money with local funds, she pledged, as part of the budget the mayor needs to release June 1.
Ronen made a point to say doing so is a "huge priority" for her as budget chair.
"I am assuming the mayor will act as consistently as she always has and any cuts will be backfilled," she said.
UPDATED 5/10/22 with information about Supervisor Rafael Mandelman's resolution in support of the local funding request.
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