I've just wrapped up my first six months as executive director at the AIDS Legal Referral Panel, which has been providing free legal service to people living with HIV/AIDS for over four decades. Having been a "gay for pay" (i.e., a professional LGBTQ advocate) for the preceding 34 years (with 15 of them in San Francisco), I thought I was relatively well informed about HIV/AIDS. Not at all.
I will never forget my first experience with an ALRP client. I hadn't actually started working at ALRP but came in to meet with our outgoing leader, the legendary Bill Hirsh. Though the office was closed for a court holiday, there was a knock on the door and Hirsh answered it. A thin, frail man, probably in his mid-50s, explained that he had just been discharged from the hospital after a three-week stay and, when he got home, he found eviction papers taped to the door of his apartment. The sheriff was due to come in a few days to remove him and all of his belongings from his longtime home. Hirsh jumped into action. While he scanned the eviction paperwork and called one of our staff attorneys to prepare an emergency motion to stay the eviction, I had a few minutes to speak with the gentleman.
He'd been in the hospital because of a kidney infection — infections were a recurring problem because his extremely low T-cell count made him vulnerable to viruses and bacteria that a functioning immune system would fight off. He lived alone and had lost almost all of his friends to HIV disease. He then asked to use the restroom, pulling up his pant leg to show a catheter drainage bag that was full of urine — that's how he'd been sent home.
Hirsh came back and said we'd be in court for him the next day and that he was confident we could stop the eviction (we did!). I told the client how badly I felt for him and his situation. He looked me in the eye and said, "I've had HIV for more than 30 years and I've been through a lot worse. Don't worry, I'll get through this too."
That day, and since then, I've learned so many things, both challenging and uplifting. I will start with the challenges:
Over half of HIV-positive San Franciscans — over 8,000 individuals — have late-stage HIV disease — AIDS — which means their health is always precarious.
More than three-quarters of HIV-positive people here are over 50, and 25% are over 60.
The vast majority of older HIV-positive people are living alone, with tiny or nonexistent networks of friends or family.
Most older HIV-positive people cannot work and are forced to live on paltry government benefits. In fact, 80% of our 1,315 clients last year had an annual income of less than $30,000 to live in one of the most expensive cities in the country.
Due to all of these circumstances, there is no such thing as a "small" legal issue for older, HIV-positive people. If not addressed quickly, one small thing can quickly lead to a cascading spiral of negative consequences.
The reason that San Francisco contracts out so many vital social services to nonprofits is because we are much less expensive than having city employees do the work. Deputy city attorneys, for example, start at more than $145,000 per year, nearly double the entry salary for legal aid lawyers. This same kind of pay disparity exists across almost all job titles. And people wonder why staff turnover among city-contracted nonprofits is such a challenge?
On the positive front, I've learned:
In spite of everything, almost all of our clients are extraordinarily resilient and determined to fight for their rights. Like the first client I met, far from being "victims," they are true survivors.
Having a lawyer makes a world of difference. Our attorneys, for example, successfully resolve 85% of the eviction cases they handle. It's similarly remarkable how often insurance companies, banks, and service providers back down once they know an attorney is involved.
While frayed and stretched, San Francisco has the nation's most robust network of organizations focused on helping people with HIV, and it's surprisingly non-competitive and mutually supportive.
In San Francisco, we have elected and appointed officials who actually care about people with HIV and remain committed to ending the epidemic. Over the last couple of months, we met with every member of the San Francisco Board of Supervisors and key people in the mayor's budget office. Without exception, none needed any education on HIV and each seemed genuinely supportive. This played itself out during the most recent (and largely opaque) budget negotiations: the Board of Supervisors and the mayor's department heads ensured that there would be no cuts in HIV services. This was accomplished through both the final budget bill and city departments' commitments to find the money to backfill reductions in federal HIV funding. Special thanks go to Supervisors Rafael Mandelman, a gay man who represents the Castro, and Connie Chan, who chaired the budget committee, for their leadership.
And finally, even with low salaries and less than optimal working conditions (putting it mildly), there are so many people — ALRP's staff especially — who are dedicating their lives to advancing and protecting the rights, dignity, and health of people living with HIV/AIDS. I'm so proud to be on this journey with them.
Matt Foreman, a gay man, is the executive director of the AIDS Legal Referral Panel (alrp.org). Previously, he held leadership positions in local, statewide, and national LGBTQ organizations and in a foundation that was a leading funder of the freedom to marry movement.
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