Departing head of SF AIDS legal agency reflects on tenure

When Bill Hirsh formally steps down as executive director of the AIDS Legal Referral Panel next month, he will leave the San Francisco-based nonprofit prepared for the future. ALRP, as it is known, has seen plenty of changes over Hirsh's 24-year tenure, but providing free or low-cost legal services to clients living with HIV/AIDS in the Bay Area remains at its core.

Over the years, leaders of HIV/AIDS nonprofits in the city have come and gone yet Hirsh, a gay man, has remained at the helm of ALRP. He is one of the longest-serving executive directors of an HIV/AIDS service organization in San Francisco. But that will soon end. Hirsh announced earlier this year that he is retiring and will depart in late December.

Hirsh, 62, said he had "mixed emotions" about leaving the agency, which this year marks its 40th anniversary.

"I'm proud of the work we've done here and I feel good about the work we've done to ensure a smooth transition," Hirsh, an attorney, said during a recent phone interview with the Bay Area Reporter. "When you've dedicated as much of your professional life as I have, there are strong emotions tied to work. Letting go is hard."

In late September, the agency announced that Matt Foreman, also a gay man and attorney, was appointed as ALRP's next leader. He started several weeks ago to provide a smooth transition and he and Hirsh are working together. Foreman is a previous executive director of the National LGBTQ Task Force and most recently led the LGBT Equality Program at the Evelyn and Walter Haas Jr. Fund. (The fund ended its LGBTQ grant program this year.)

Foreman said he is enjoying the transition.

"It's been quite a jolt — a good one — to move from the gilded world of philanthropy and come back to an organization providing direct services to people facing discrimination, poverty, and injustice," he stated in an email. "I feel incredibly fortunate to be overlapping with Bill through the end of the year — I frankly have no idea how he has been able to juggle so many responsibilities at the same time, but that's why our overhead is so low."

Foreman also outlined some immediate goals for 2024.

"For the new year, I see three priorities. First, I am looking forward to working with our board, staff, and stakeholders to develop a new strategic plan to guide us for the next three to five years," he explained. "Second, with Bill's help, ALRP and other organizations serving people with HIV are going to do everything possible to keep city funding from being slashed during the upcoming budget process. Finally, we need to help more people understand the often-overwhelming challenges so many of our older HIV+ neighbors face on a daily basis — I thought I was reasonably well-informed, but it turns out I was clueless."

ALRP's beginnings

Having done his undergraduate studies at the University of Pannsylvania, Hirsh moved to the Bay Area to attend Golden Gate University School of Law, from which he graduated in 1983. He held a series of jobs in the mental health and welfare fields. Before joining ALRP in March 2000, Hirsh directed the Mental Health Association of San Francisco, where he coordinated a broad-based public policy advocacy effort to increase affordable and supportive housing for people with mental health disabilities.

ALRP began as a project of Bay Area Lawyers for Individual Freedom, or BALIF. During the height of the AIDS crisis in the 1980s, LGBTQ attorneys gathered to see what they could do to help young gay men who were dying. They decided to help draft emergency wills for the sick men, and ALRP eventually became its own nonprofit. It continues to rely on the services of attorneys who volunteer their time (called panel attorneys) and also has its own staff of lawyers and legal professionals.

"There are more than 500 active attorneys who provide services in a broad array of civil legal matters — immigration, employment, credit, as well as estate planning and housing," Hirsh said of the panel lawyers.

In terms of current staff, Hirsh said that there are 13 attorneys when the organization is fully staffed; there are a couple of vacancies right now, he explained.

"We remain a very frugal operation, there's not a lot of administrative levels," he said, adding there is a volunteer coordinator, development director, office manager/bookkeeper, and the executive director in addition to the legal support staff.

Over the years, ALRP's services have evolved from drafting wills to fighting HIV/AIDS discrimination in housing, employment, and benefits. The shift to providing more direct services began in the late 1990s, Hirsh said. In a story 10 years ago on the occasion of ALRP's 30th anniversary, Hirsh said that housing was the No. 1 issue for clients.

It still is.

"Over time, our housing team has become even more robust," Hirsh said, adding that the need for in-house attorneys for housing matters is largely because those issues move through the courts faster.

He noted that the San Francisco ballot measure passed by voters in 2018 established a right to counsel for all residential tenants facing eviction. The ordinance went into effect in 2019, and provides funding. Prior to that, Hirsh said the agency had to fight every year for funding for its lawyers. The agency receives about $800,000 a year for tenant right to counsel services, Hirsh said.

"ALRP is an important part of that network of legal services organizations," Hirsh said, adding it handles cases for those living with HIV.

"We added a couple of attorneys, paralegal support, and social work support as well," he said.

ALRP currently operates on a budget of $2.1 million, Hirsh said.

The agency assists about 2,300 clients annually; about 800 are helped with housing issues, according to Hirsh.

"I'm really proud of the work we do around housing and to keep people stably housed," he added.

In terms of employment discrimination cases, Hirsh said there hasn't been an uptick, though ALRP continues to see those issues.

"But we just got a case where an employer disclosed [an employee's] HIV status," he noted. "There are still many nasty things that happen and still great stigma associated with HIV."

One of the goals of San Francisco's Getting to Zero program is to reduce stigma, in addition to dramatically reducing new HIV transmissions and HIV deaths by 90% by 2025. In 2021, the most recent year available, San Francisco had 160 new HIV transmission cases, according to the Department of Public Health.

Other health issues

These days, many of ALRP's clients are dealing with mental health and substance use issues, in addition to HIV/AIDS, Hirsh said. There is also the aging of the HIV population, as treatment advances have led many people to live fairly normal lives. In other words, HIV/AIDS is no longer the death sentence it was back in the 1980s and early 1990s.

"Cognitive impairments related to aging are exacerbated by HIV," Hirsh pointed out.

Jesus Guillen is a client of ALRP. An HIV and aging independent consultant, Guillen is also the founder and director of the HIV Long Term Survivors International Network Group.

"To speak about Bill Hirsh, for me, is to speak about one of the most balanced and important voices in the Bay Area HIV community, but even more simply, and in a greater way, the human community," Guillen wrote in an email.

"For many of us HIV long-term survivors, we know without a doubt the importance of leadership and allies, and Bill has been doing that for a long time," Guillen added. "And for people like me aging for the first time with HIV, the feelings of invisibility, isolation, and loneliness are very present every day. So, doing a job that implies protection and safety for a community that had suffered so much, from the beginning of everyday deaths to the present of many of us who carry those deaths in our souls and spirits, has been a monumental journey."

Hirsh pointed out areas of need for long-term survivors include mental health care and food security. Additionally, training support for front line staff and housing subsidies are critical, he said.

Other clients may need assistance in different areas.

"They may want accommodations in both employment and housing due to disability status," Hirsh said.

HIV/AIDS Provider Network

In addition to serving as the head of ALRP, Hirsh has for many years been co-chair of the city's HIV/AIDS Provider Network, a group of nonprofits that work together on things like getting HIV/AIDS funding in the city budget. Hirsh was asked how long he has co-led the group.

"In my mind, forever," he quipped. "I'm not 100% sure.

"After Mike Smith left, Lance Toma and I stepped in as co-chairs. That was five to 10 years ago," Hirsh said, referring to the former executive director of the AIDS Emergency Fund and the current CEO of the San Francisco Community Health Center, respectively. (Smith retired when AEF merged with PRC in 2016.)

In an email, Toma, a gay man who has long led the community health center, praised his colleague.

"It has been a privilege to co-chair the San Francisco HIV/AIDS Provider Network with Bill since 2015," Toma wrote. "He is one of the most passionate and dogged HIV advocates with a laser focus on housing. I have such deep admiration and adoration for Bill. The HIV community of San Francisco is as strong and vibrant as it is because of Bill's tireless work at ALRP and with HAPN."

Hirsh said that Laura Thomas, director of harm reduction policy for the San Francisco AIDS Foundation, would be joining Toma as co-chair of the provider network.

Thomas did not respond to a request for comment.

As the B.A.R. reported this summer, San Francisco's budget includes $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," Hirsh said at the time, referring to the city's two-year budget for fiscal years 2023-2024 and 2024-2025.

Hirsh said in the interview that San Francisco is unique because it's a city and a county. And he cited a longtime city policy that when cuts are made by the federal government to the Ryan White CARE Act, the program that provides grants to local jurisdictions for HIV/AIDS treatment and services, the city backfills the shortfall using general fund dollars.

"Advocates were able to get that commitment from local government," Hirsh said.

He talked about the different strategies in how the city approaches cuts. And he pointed out people involved in advocacy work often have a broader, longer view as the city's financial picture has gone up and down over the years.

"So you need the view of advocates who share with decision makers" the lessons of mistakes from the past, he added.

Hirsh also warned that next year the HIV/AIDS Provider Network likely will be focused on fighting cuts, as the city's budget woes continue.

"Next year the city is facing a particularly tough budget year," he said.

Already, Mayor London Breed in October ordered city departments to cut 3% from their budgets in view of the grim budget outlook. City officials have noted the structural budget deficit could reach $500 million by the 2025-2026 fiscal year, the San Francisco Chronicle reported. The city's current budget is $14.6 billion annually.

"Often community assets are at risk if cuts are deep enough," Hirsh said.