SF nonprofits on frontlines of HIV in Latino community

Instituto Familiar de la Raza is one of the organizations on the frontlines of HIV prevention and care. Last year the city awarded the Mission neighborhood-based organization a $2 million request for proposal to run a Latina/o/x Access Point at 1663 Mission Street, in partnership with the San Francisco AIDS Foundation and the Mission Neighborhood Health Center.

"We receive different types of clients here," said Jeremias Rivera, a gay man who is the program manager of Sí a la Vida-Integrated HIV Services at IFR. "What we do is connect them to linkage to gain access to services."

The AIDS foundation also has its own separate and long-running Programa Latino/Latine.


Meanwhile, over at AGUILAS, a longtime HIV/AIDS nonprofit catering to the Latino community, financial woes may force the agency to scale back services even more than it already has.

Such is the state of HIV services geared toward the city's Latino population.

The priority, those whose HIV prevention and education work targets the city's Hispanic and Latino communities say, is that they need more funding and culturally competent services now as the population sees higher numbers of diagnoses even as other groups see declines.

AGUILAS
One of those programs facing issues with funding stability is AGUILAS, which these days is tucked away in a fourth floor office at the San Francisco LGBT Community Center. (AGUILAS stands for Asamblea Gay Unida Impactando Latinos A Superarse, or in English, Assembly of Gays United Impacting Latinos to Supersede.)

The organization's gay longtime Executive Director Eduardo Morales, Ph.D., said funding from the city went from $426,621 for Fiscal Year 2022-23 through the San Francisco Department of Public Health, to less than $200,000 for Fiscal Year 2023-24 through the Mayor's Office of Housing and Community Development.

Asked how AGUILAS will get funding from the city in fiscal year 2024-25, Morales said, "We don't know."

"We got funding through June 30," Morales said. "We're hoping they will continue funding us, but we don't know what the situation is going to be."

The mayor's housing office did not return a request for comment.

Morales told the B.A.R. that AGUILAS was originally going to lose all of its city funding. The cut came after DPH decided to award the money to IFR, he said.

A last-minute add-back in June 2023 from the San Francisco Board of Supervisors, after conversations with gay District 8 Supervisor Rafael Mandelman and District 9 Supervisor Hillary Ronen, prevented elimination of city funding, Morales said.

This is the 30th year AGUILAS has been in the HIV/AIDS prevention field, Morales said. (He added that the organization was founded in 1991, but the first three years were focused on political activities.) The organization had to cut staff and services.

"The services have been reduced," Morales said. "We can't do $400,000 [worth] of services with only $200,000. It just doesn't cut it. So we had to let go of staff — we went from 11 to six and all of us are part time. ... What we had to knock out were the monthly social events, our major way of recruiting people and building community ... and providing HIV testing when we had our grant with the health department.

"We also had a grant with the [state] AIDS office — $250,000 for three years — which also ended in June 2023, and we still have a grant with ViiV Healthcare to do leadership development," he added.

That leadership development grant totals $91,000 per year but ends May 9, Morales said, though he added ViiV just sent a call for proposal requests at the end of January for the next four years. Gustavo Ordonez, a gay man who is a program manager with AGUILAS, told the B.A.R. that the money funds on-site testing and training programs.

Bithiah Lafontant, MPH, the director of corporate communications for ViiV, stated to the B.A.R., "We are proud to have been able to provide funding to AGUILAS as part of ViiV Healthcare's Positive Action for Latinx Men grant program, an initiative designed to support organizations across the U.S. and Puerto Rico in creating solutions to address HIV for Latinx bisexual, gay, and trans men."

"The ViiV Healthcare award supports AGUILAS' leadership development program for Latinx gay, bisexual, and trans men through local advocacy training and networking in English, Spanish, and Portuguese," she continued. "Topics vary from sexual health to general skill building such as preparing taxes or how to develop a business. AGUILAS' work is critical as they address the broad social determinants that impact health and HIV, including ensuring that immigrants have access to vital resources to promote their health."

Ordonez said the grant funds "our HIV and STI projects, which besides providing HIV and STI testing, also we provide a training program so our members are prepared for the outside world."

Ordonez said that over the past three decades there've been over 1,000 members of AGUILAS; there are "about 250" as of now.

People interested in participating in the training programs — which cover basic financial knowledge, efficient communication tools, legal awareness, and advocacy strategies — can sign up on its website (https://www.sfaguilas.org/la-academia).

AGUILAS' most recent IRS Form 990, for the 2022 calendar year, shows it took in $793,764 in 2022 and spent $907,249, for a deficit of $113,485. In 2021, it took in $759,800 and spent $890,517, for a deficit of $130,717. Morales made $156,034 in reportable compensation, plus $30,456 in "other compensation from the organization and related organizations."

Cultural competence
A common refrain from HIV prevention workers and advocates was the need for cultural competence, which they said may be a reason messages about available services aren't getting through.

Ordonez said that "just because you translate a program into a language doesn't mean it's focused on that community."

In other words, several people interviewed for this story said materials should be translated in a more culturally appropriate way, not just translated directly from English to Spanish.

"Most of our community members don't feel the programs are made for them," Ordonez said. "They are just translated into a language. You have to talk like them and talk to them, so they are not afraid."

Jorge Zepeda, a straight ally who has been the Latino services manager with the AIDS foundation since 1999, told the B.A.R. that "we need better work with community-based organizations and the city in setting up services and creating an environment for the most vulnerable."

He also agreed on the need for funding, especially for "community-based organizations where we have the key" to success, he said.

The AIDS foundation is the city's largest HIV/AIDS service organization.

Tyler TerMeer, Ph.D., a gay Black man living with HIV, is the AIDS foundation's CEO.

He stated to the B.A.R. that it has a budget of $48 million and it serves 27,000 people.

"SFAF has been providing services to the Latinx community for over 40 years through El Grupo, our Programa Latino/Latine Health Team, and services offered at Strut," he stated, referring to the health center in the LGBTQ Castro neighborhood.

"We partner with the SF Latino Task Force, a collaboration of 40 agencies, to ensure a community network of access and referral. Additionally, through the SFDPH-funded Latinx Health Access Point we partner with IFR and Mission Neighborhood Health Center to extend services to this same community," he added.

Representatives from the Latino Task Force did not respond to a request for comment.

Asked if the AIDS foundation can pick up the slack if AGUILAS closes, TerMeer stated, "SFAF will work with AGUILAS and our network of community partners to inform clients about what services are available and to ensure that clients are connected to existing organizations providing support to the Latinx community."

Zepeda said that the AIDS foundation offers services in English, Spanish, and Tagalog. It also runs its Programa Latino/Latine Individual Services, which is available regardless of immigration status and has drop-in hours at Strut.

This will be moving soon, however, as the foundation will relocate its Market Street headquarters to 940 Howard Street in the city's South of Market neighborhood, as the B.A.R. previously reported.

"We are halfway done with our tenant improvements in the new Howard Street space and remain on track to open programs and services in that space this spring," TerMeer stated February 16.

Programa Latino/Latine has been long-running — its progenitor, El Grupo, was started 42 years ago by Fernando Castillo.

Zepeda said that even at the Magnet sexual health clinic at Strut, "we have a robust team of bilingual professionals."

"We have everything set up for bilingual and monolingual community members — HIV, substance use, counseling, PrEP," he said. "With Strut, 25% of the participants are Latine."

In Latin America, "Latine" has been lifted up as an alternative to "Latinx" as a gender-neutral alternative to Latino. "Latinx" has been criticized in part because the Spanish language does not have an "x" suffix.

PrEP refers to the use of antiviral drugs to prevent people exposed to HIV from becoming infected. The pill Truvada was first approved for PrEP use in 2012 by the U.S. Food and Drug Administration; since then the FDA has also approved the pill Descovy for some groups, and the drug Apretude as an injectable treatment. Studies have consistently shown disparities of PrEP use among people of color, as the B.A.R. has reported.

IFR
IFR received $2,180,171 for the health access point, or HAP, about half of which went to its contract supporting partners, which are the Mission health center and the AIDS foundation, stated Esperanza Macias, a Latina lesbian who is IFR's development and strategic communications director.

Health access points were started by the city in 2022 as a means to address health disparities. The San Francisco Community Health Center has an access point at Trans Thrive, 1460 Pine Street, focusing on trans women, and the AIDS foundation has one at Magnet at the Strut building, 470 Castro Street. An access point for youth is at the LYRIC site at 566 Castro Street.

When asked about the Latino community and HIV prevention, IFR's Rivera said, "I would say the need the Latino community has is not just HIV; it is related to HIV. They come because they need linkage, legal support, different services; because the needs are high."

Rivera stated to the B.A.R. that his Sí a la Vida program is one of seven at the institute.

"Sí a la Vida has continued to support the Latinx community, including providing diverse and evolving education and outreach on prevention strategies throughout the years," he stated. "We provide direct services to approximately 500 individuals per year."

These services include therapy, counseling, and clinical case management. IFR also provides testing for both HIV and hepatitis C.

"One of Sí a la Vida's greatest contributions to HIV prevention is to address this issue in a way that mainstream services cannot," Rivera stated. "Sí a la Vida also has a strong prevention and wellness team that provides support groups, individual risk and reduction counseling, case management services, and health education services.

"This grouping of services offers a continuum of support that allows our team to implement a harm reduction and trauma-informed approach within a culturally and queer-friendly approach," he added.

While the city's 2022 HIV report is disappointing, Rivera is not surprised.

"We know there has been an influx of Latinx immigrants into San Francisco, and with limited access to health information, our numbers are not at all surprising," he stated.

"We are currently working on a project with our collaborative partners with the support of SFDPH to create a linkage-to-care hub that will support all psychological, sexual and health needs of the participants. The clients will receive rapid syphilis, Hep C, HIV, and STI testing," he stated, referring to sexually transmitted infections.

"They would also receive linkage to gain access to health insurance, harm reduction counseling, health education, and referrals for mental health, all in one place, which would be in the Latino Wellness Center," he continued, referring to IFR's space at 1663 Mission Street, where the health access point is also located.

Claudia Cabrera, program director of the access point for IFR and program director of Sí a la Vida, stated to the B.A.R. that "our work is not yet done."

"The increase in HIV cases among Latinxs is the consequence of many psychosocial factors that afflict the Latinx LGBTQ community, including stigma, poverty, lack of mental health services, anti-immigration sentiments, and barriers associated with systemic oppression," Cabrera stated. "HIV prevention efforts won't be good enough if those factors are not addressed together."

When asked how many clients the access point has seen, Macias stated, "It's a complex question to answer."

"There are #s of people tested for HIV, #s of people who receive clinical case management, mental health support, linkages and referrals, support groups, etc.," Macias wrote in an email.

Rivera explained that IFR is aware that sexual health pertains to all communities.

"Which is why we are currently focusing on the entire Latinx community to promote sexual health awareness and education as well as reduce the stigma that has been long standing in our communities," he stated. "We hope that this project will succeed and that the prevention and wellness portion of this project supports us in the reduction of HIV+ statuses."

According to its most recent publicly available IRS Form 990, IFR had a total revenue of $15.4 million in 2022 and expenses of $14.3 million.

DPH responds
DPH stated via a spokesperson that its decision to have a model based on health access points was "the result of an extensive stakeholder engagement process."

"The Latinx HAP, located at the Latino Wellness Center, is led by the Instituto Familiar de la Raza, along with the Mission Neighborhood Health Center and SF AIDS Foundation. Staff at the Latinx HAP are diverse, bilingual and bicultural. All Latinx HAP program activities are delivered in Spanish and the educational materials they produce are created with the maximum intent to reach the affected population. The FY 23-24 Latinx HAP funding is $2.1 million," the spokesperson stated.

"In addition to the HAPs, we are focused on strengthening our relationships with community-based organizations. For example, we are partnering with the Latino Task Force and UCSF on their efforts to provide HIV and STI screening, integrated with other health care, at the Unidos En Salud 24th and Capp community site."

Asked about the cultural competence matter, the spokesperson stated DPH is "part of a cross-bay effort to bring together Spanish-speaking front-line workers who serve the Latinx communities to provide support for their activities."

The department noted its involvement with Getting to Zero San Francisco, a consortium of over 300 members working to eliminate new HIV infections, preventable deaths among people living with HIV, and HIV-related stigma and discrimination.

"A key priority of Getting to Zero San Francisco is to scale-up efforts in providing access to HIV pre- and post-exposure prophylaxis to Latinx, and Black/African American communities, as well as to people experiencing homelessness and people who use drugs," the SFDPH spokesperson stated. "We are working to reach our Getting to Zero goals through innovative approaches to providing low-barrier, and judgment free, services such as injectable PrEP and testing."


Editor's note: This story is one of two focusing on HIV prevention efforts in San Francisco's Latino community in the aftermath of the city's annual HIV report for 2022.



Resources for the Latino community
AGUILAS is located at the San Francisco LGBT Community Center, 1800 Market Street, fourth floor. Hours are 1 to 5:30 p.m., Monday through Friday. For more information, go to sfaguilas.org/la-academia.

Instituto Familiar de la Raza is located at 1663 Mission Street. It has a support group on Thursdays from 3 to 5 p.m. For more information and other programs, visit ifrsf.org.

The Latino Access Center is located at 1663 Mission Street, Suite No. 603. Hours are Mondays and Wednesdays from 10 a.m. to 8 p.m., and Tuesdays, Thursdays, and Fridays from 10 a.m. to 6 p.m.

San Francisco AIDS Foundation's Programa Latino Individual Services is available regardless of immigration status and has drop-in hours for new members Monday through Friday from 2:30 p.m. to 4:30 p.m. at Strut, 470 Castro Street. For more information about SFAF's programs, go to sfaf.org.

SFAF's El Grupo program meets at 3 p.m. Thursdays at the foundation's headquarters at 1035 Market Street. (Will move to 940 Howard Street this spring.)