With their roughly $7 million funding request not included in Mayor London Breed's budget proposal this year, HIV advocates and service providers are turning to the Board of Supervisors to find the money as it takes up this month the city's fiscal priorities for the next two years. The city is facing a $780 million deficit over that time span.
Roughly 40 people marched on City Hall Monday, June 5, for a rally on the steps of the building. Timed to coincide with HIV Long-Term Survivors Awareness Day, the activists then met with eight of the 11 supervisors to press their case for why they should allocate the additional funding for the various health services and programs for those living with HIV.
"It is a travesty we still need to do this," said Ms. Billie Cooper, 64, a Black transgender woman who has lived with HIV for close to four decades. "We shouldn't have to come out and beg for this."
As the Bay Area Reporter first reported last week, among the HIV advocates' priorities this year are $3.6 million to fund 200 additional housing subsidies for people living with HIV so they do not become homeless and $500,000 to expand mental health services for long-term survivors of the HIV pandemic. They have also sought $1 to $2 million to open a safe consumption site for drug users with the goal of preventing fatal overdoses and connecting them to services.
Another $500,000 is being sought to fund intensive case management for people living with HIV experiencing acute behavioral health challenges so that they remain in care. HIV organizations are also seeking $500,000 to cover their increased cost-of-doing-business for federally funded programs.
Unlike in years past, the HIV/AIDS Provider Network was not apprised by the mayor's budget office about what funding for HIV programs Breed included in her proposed $14.6 billion budgets covering fiscal years 2023-2024 and 2024-2025, said AIDS Legal Referral Panel Executive Director Bill Hirsh. He told the B.A.R. Monday that the coalition had yet to hear from the mayor's office or public health officials regarding this year's budget proposal.
"It used to be the mayor's budget office would meet with the community in advance," said Hirsh, as what was known as "the walk through" of the budget documents helped HAPN members with their conversations with the supervisors and other city officials during the annual budget negotiations each June.
The supervisors' budget and appropriations committee will take up the mayor's budget proposal and make revisions to it over the coming weeks. It is expected to vote on the proposed budget June 29, with the full board scheduled to cast its first vote on it July 11 and expected to finalize the budget July 18 in order to send it to Breed to sign by August 1.
"The cost of providing these services continues to go up each year," noted Hirsh during his comments at the rally.
He sounded a confident note that the supervisors would find the funding HAPN is seeking, telling the attendees "with your voice and with your support, we are going to make it happen."
Meeting with supervisors
The HIV advocates met with all of the supervisors except for District 3 Supervisor Aaron Peskin, the board's president, District 9 Supervisor Hillary Ronen, and District 11 Supervisor Ahsha Safaí, who is running for mayor against Breed in 2024. Gay Supervisors Matt Dorsey, who represents District 6 and has lived with HIV for two decades, and Rafael Mandelman, who represents District 8 and sits on the budget committee, also addressed the rally beforehand.
"The best and most important thing we can do," said Dorsey for long-term survivors of HIV, is to adhere to the San Francisco Principles, a document created to address their specific needs.
Dorsey also said the city needs to remain committed to its goal of getting to zero new HIV cases in a given year. The projected number of new HIV diagnoses this fiscal year is 158, according to the mayor's budget proposal, with 80% of people virally suppressed within one year of being diagnosed.
The city's target for new HIV diagnoses in the fiscal year that begins July 1 is 128, decreasing to 106 in the following fiscal year. Its target for viral suppression is 85% each year.
Mandelman said he looks "forward to working with all of you to ensure we do right by the long-term survivors."
He added that adopting a budget that only ensures no cuts to HIV services "is not enough."
Conflicting information
The mayor's office has provided conflicting responses to the B.A.R. when asked which of the specific funding asks from the HIV service providers were included in Breed's spending plan.
Saying at first it needed more time to dive into the 362-page budget document released May 31, Breed's press secretary Parisa Safarzadeh emailed the B.A.R. June 2 to note that the budget continued and maintained "financial and programming investments" of concern to the LGBTQ community, including "HIV education, prevention and treatment programs."
"I want to be clear that the mayor's proposed two-year budget avoided any cuts to HIV funding and services, and previously launched LGBTQ initiatives, despite facing a significant budget deficit," wrote Safarzadeh, noting in particular the new drag laureate position and specific programs for transgender individuals.
One new area of funding the mayor is seeking is $350,000 for LGBTQ nonprofits to improve the safety measures at their offices due to an increase in threats some have received of late. Safarzadeh noted Breed included the funding in her proposed budget for the Mayor's Office of Housing and Community Development.
The San Francisco AIDS Foundation is separately seeking $1.5 million for its Stonewall Project program that provides harm reduction services to drug users. The funding had been cut from the budget submitted to the mayor by the city's Department of Public Health.
According to Safarzadeh, the city's Department of Public Health "anticipates being able to fulfill this request at $1.6M. This is contingent on health commission approval."
When asked to clarify if the other specific HIV funding asks from the coalition of service providers were funded, Safarzadeh had replied, "Yes — and it's important to note all of the asks will be continued and maintained, not reduced."
But on Monday, mayoral LGBTQ policy adviser Victor Ruiz-Cornejo told the B.A.R. that none of the $7 million additional HIV funding request was included in the mayor's budget proposal. He, too, stressed that the mayor did not cut any of the HIV funding the city has been providing "despite this massive deficit."
"The mayor's budget includes a lot of funding for these investments already," said Ruiz-Cornejo.
He noted that more than $10 million has already been allocated for housing subsidies for people living with HIV. The mayor made no cut to the $973,000 for mental health services for people living with HIV, including long-term survivors, added Ruiz-Cornejo.
While the mayor did propose a 3% increase for the cost of doing business for most service providers given city-funded contracts — Breed also proposed an additional 1% for providers of services related to health and homelessness due to the high rate of staff vacancies such agencies experience — it does not include those agencies funded through the federal Ryan White HIV/AIDS Program. According to Hirsh, the city is expected to absorb a nearly $60,000 decrease in its Ryan White allocation this year.
As the B.A.R. noted last week, Breed proposed $18.9 million to open up to three Wellness Hubs over the two budget years "to improve the health and well-being of people who use drugs, including those experiencing homelessness, and reduce public drug use." But any safe consumption site "would be funded by private entities," specifies the budget document. (City Attorney David Chiu has argued no city dollars can be spent on opening such a facility.)
"We are still pushing for safer injection services. The mayor says she supports them. We just want to see it happen," said Hirsh.
Paul Aguilar, a long-term survivor community liaison with the San Francisco AIDS Foundation's Aging Services department, said during the rally that housing and access to mental health services are critically needed for the city's residents living with HIV. According to the agency, one in six people living with HIV is unhoused or at risk of losing their housing.
"San Francisco, you once set the standard of care for people dying from HIV and AIDS. Why can't you do that for those of us living with it?" asked Aguilar, who was diagnosed as being HIV-positive in 1988.
Help keep the Bay Area Reporter going in these tough times. To support local, independent, LGBTQ journalism, consider becoming a BAR member.