SF budget includes boost for HIV agencies, housing subsidies

  • by Matthew S. Bajko, Assistant Editor
  • Thursday July 20, 2023
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The new city budget includes a boost for HIV agencies and housing subsidies. Photo: Steven Underhill
The new city budget includes a boost for HIV agencies and housing subsidies. Photo: Steven Underhill

HIV advocates were unable to secure all of the $7 million funding ask they were seeking in San Francisco's budget this year. But they did score a few wins, including a small boost for service providers receiving federal funding, in the two-year budget the Board of Supervisors finalized at its July 18 meeting.

The $14.6 billion budgets covering fiscal years 2023-2024 and 2024-2025 addressed a $780 million deficit over that time span. The supervisors adopted the revised budget 10-1, with District 5 Supervisor Dean Preston opposed, and Mayor London Breed signed the fiscal documents July 26.

"There were some really bad things in the mayor's proposed budget so, to a great extent, the advocacy community was playing defense and trying to avoid some really bad cuts from happening," said AIDS Legal Referral Panel Executive Director Bill Hirsh, who co-leads the HIV/AIDS Provider Network, or HAPN. "I think we were largely successful at minimizing the impacts so that there won't be any service reductions for vulnerable communities."

Gay District 8 Supervisor Rafael Mandelman, a member of the board's budget committee this year, told the Bay Area Reporter that he was pleased, overall, with how the budget negotiations turned out considering the deficit city leaders had to address in order to come to a balanced two-year fiscal plan.

"This was not a great budget year, as you know, and my concern is next year is going to be worse," said Mandelman.

Specifics on HIV funding

As for the HIV funding asks the supervisors were able to include in the budget, there is $1,250,000 for housing subsidies that will be available for people living with HIV. It is less than the $3.6 million sought by HIV advocates, who noted the money is also earmarked for keeping seniors (60+) and adults with disabilities (18+) housed.

"Here is the rub with the housing subsidies. While we were able to get the $1.25 million for year one, there is only $500,000 in year two," said Hirsh, though he noted once people begin receiving the subsidies they have not been cut off by the city in future years. "We are in conversation as we speak with the mayor's office of housing to try and get this money into contract and do it in a way that allows for the subsidies to continue moving forward."

He also noted in an interview with the B.A.R. that the budget includes $8 million in rental assistance for people facing an eviction so they can pay their back rent and not lose their current housing.

"Given the affordable housing crisis we face, and given how expensive it is to build new permanent affordable housing, these housing subsidies are the best bang for the buck the city can utilize to address the crisis right now," said Hirsh.

The supervisors also included a $500,000 allocation to cover what is referred to in budget speak as the cost of doing business. The money is to help HIV agencies funded through the federal Ryan White HIV/AIDS Program cover rising expenses for staff salaries, benefits, and other costs that rise each year due to inflation or other reasons.

"We did fight for the Ryan White cost of doing business increase," noted Mandelman. "That is important for providers that are serving folks with HIV through the Ryan White act."

The funding is similar to the 3% increase for the cost of doing business for most service providers given city-funded contracts that Breed had included in her budget proposal that she submitted to the supervisors in the spring. The mayor also included an additional 1% for providers of services related to health and homelessness due to the high rate of staff vacancies such agencies experience.

But her proposal didn't include Ryan White funded agencies. The city's most recent allocation from the federal program was $16 million, with the city kicking in $24 million in local funds to maintain the full amount for Ryan White HIV services in the city at $40 million, noted Hirsh.

The cost of doing business allocation for Ryan White-funded agencies is the largest they have "ever gotten," he told the B.A.R. And it is the first time they have been able to secure such funds in a number of years, Hirsh added.

"It is rare that we have ever received one. I think we got one a couple years ago through the general fund process. I don't think we have ever gotten 3%," said Hirsh.

Nonetheless, he noted it is only in the fiscal year that began July 1 and not included in the budget for the fiscal year that begins next July 1 and runs through June 30, 2025.

"The challenge for us is the city budget process is a two-year budget cycle. We got that in year one of the two years and not in year two. We will fight again for it next year," said Hirsh, though he will do so as an advocate and not as a nonprofit executive, since he will be stepping down from leading ALRP in December.

While the budget approved by the supervisors also allocates $500,000 for the expansion of transgender health care services in the city, it doesn't include several other fiscal requests that HIV advocates had been demanding this year. Omitted was $500,000 they had sought to fund intensive case management for people living with HIV experiencing acute behavioral health challenges so that they remain in care.

Nor was another $500,000 they wanted to expand mental health services for long-term survivors of the HIV pandemic. The mayor did budget $973,000 for mental health services for people living with HIV, as the B.A.R. previously reported.

The HIV advocates had 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 that wasn't allocated in the budget. As the B.A.R. previously reported, Breed did include $18.9 million in her budget proposal 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," the mayor's budget document had specified. (City Attorney David Chiu has argued no city dollars can be spent on opening such a facility.)

As for $1.5 million the San Francisco AIDS Foundation was seeking for its Stonewall Project program that provides harm reduction services to drug users, Mandelman told the B.A.R. the supervisors and mayor's office worked out a deal to see the funding be appropriated. The city's Department of Public Health had cut the Stonewall funds in the budget it submitted to the mayor earlier this year.

"We felt keeping Stonewall going was pretty important," said Mandelman.

Breed's office had told the B.A.R. in June that the health department anticipated it could redirect $1.6 million in funding to Stonewall but doing so requires sign off from the city's health commission. The oversight body has yet to vote on the money, based on a review of its agendas.

Gay SFAF CEO Tyler TerMeer, Ph.D., told the B.A.R. his agency is "glad" that the health department will fill the program's funding gap and expressed appreciation for Mandelman's "persistence and focus" on the issue.

"Serving hundreds of community members every year, the Stonewall Project at SFAF provides individuals interested in changing their relationship to substances with comprehensive counseling, harm reduction, mental health, and group support," stated TerMeer in an emailed reply. "It is one of the few state-certified drug and alcohol treatment programs that specifically addresses the unique needs of gay, bisexual, queer, and trans men and other men who have sex with men, and serves as a vital resource for our community."

Hirsh praised District 1 Supervisor Connie Chan, the board's budget chair this year, and her staff for "doing an amazing job" under difficult circumstances. He also noted "it was great" to have assistance for the first time from three gay men on the board due to the elections last year of District 4 Supervisor Joel Engardio and District 6 Supervisor Matt Dorsey.

As for what next year holds, Hirsh predicted HIV advocates are likely to face an even tougher budgetary environment as they press their fiscal requests with city leaders.

"I feel like the city is facing some real challenges around revenue. I think in order to have a budget that truly reflects the values of San Francisco there need to be more robust conversations around how to address those needs," he said.

Updated, 7/26/23: This article was updated to indicate Mayor Breed signed the budget.

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