Should voters return former President Donald Trump to the White House and hand control of Congress to Republicans on November 5, it is very likely federal HIV and AIDS programs will be targeted for cuts or wholesale elimination in their budget proposals. In the summer, GOP members of the U.S. House tried to push through a $419 million cut in federal funding for HIV and AIDS services.
In San Francisco, due to a funding formula used by federal health agencies that penalizes jurisdictions that have been able to reduce HIV transmission, local leaders routinely have to contend with cuts to the city's allocation in the Ryan White HIV/AIDS Program. In the fiscal year budget for 2024-2025, local leaders used local revenues to backfill the $197,850 reduction San Francisco received this year in its Ryan White Part A funding.
And as the Bay Area Reporter noted in 2023, San Francisco's allocation from the federal Ryan White 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 in the fiscal year 2023-2024 budget.
While the GOP-backed Project 2025 policy guideline for a second Trump term doesn't call for a total ending of the Ryan White program in its 54-page plan for the U.S. Department of Health and Human Services, it does target funding in it supportive of gender-affirming care.
"Withdraw Ryan White guidance allowing funds to pay for cross-sex transition support. HRSA should withdraw all guidance encouraging Ryan White HIV/AIDS Program service providers to provide controversial 'gender transition' procedures or 'gender-affirming care,' which cause irreversible physical and mental harm to those who receive them," states the plan, referring to the Health Services and Resources Administration, an agency within HHS.
With federal HIV funding a perennial issue at City Hall, the B.A.R. asked this year's mayoral contenders if they would commit to backfilling future federal HIV/AIDS budget cuts if elected in November to lead San Francisco. Of the top five candidates, the four elected officials have routinely done so while serving either as mayor or supervisor.
Thus, it wasn't that surprising to see District 11 Supervisor Ahsha Safaí provide the briefest reply to the question. He simply answered, "Yes."
In the spring, when asked by the B.A.R. about the expected Ryan White federal funding cut, Mayor London Breed had been uncommitted to backfilling it as she prepared her budget proposal to deal with an estimated deficit of $789 million over the next two fiscal years. But in late May, her office informed the B.A.R. that she would use local revenues to plug the roughly $200,000 hole from the feds.
As for her questionnaire response, it notably didn't use the word "yes." Breed took a more nuanced approach with her answer.
"Sustaining HIV/AIDS funding is a high priority. In addition to backfilling federal dollars in this space, I also enhanced provider funding by way of a 2.5% cost of doing business increase," wrote Breed. "Preserving this funding will continue to be of utmost importance. I'm also proud to have invested an additional $3M to support our goal of getting to zero, and was the first mayor in 12 years to create new rental subsidies for people living with HIV."
In comparison, board President Aaron Peskin was unequivocal with his response.
"Yes, I commit to backfilling future federal HIV/AIDs budget cuts. The current proposals to cut this funding are disastrous for the LGBTQ community, many of whom rely heavily on these services," wrote Peskin, who represents District 3. "And my record shows that throughout the 17 years that I have been a member of the Board of Supervisors and the 6 years I have served as president of the board I have always backfilled any and all federal cuts with local dollars and have grown HIV/AIDS services at every opportunity."
Former mayor Mark Farrell, who represented supervisorial District 2 and is a venture capitalist, also began his reply with a simple, "Yes." He added that, "as mayor and budget chair, I prioritized backfilling the cuts every year and I pledge to do so again because our communities rely on it and deserve it."
When he launched his mayoral bid last year, Daniel Lurie, an heir to the Levi's fortune who later became founder and CEO of the nonprofit Tipping Point Community aimed at addressing the Bay Area's homelessness epidemic, had initially told the B.A.R. that he would support a backfill of hundreds of thousands of dollars but wouldn't commit in perpetuity if, for example, Republicans in Congress are able to push through cuts to HIV funds in the hundreds of millions of dollars.
But he has since dropped talk of a cap when asked about the issue by the B.A.R. this year. In May, Lurie had noted, "Every San Francisco mayor has backfilled Republican-driven cuts to federal HIV funding, and we cannot stop now."
He took a similar stance with his questionnaire response to the issue.
"I commit to backfilling federal funding cuts to maintain San Francisco's HIV safety net," wrote Lurie. "Access to culturally-competent health care is a fundamental right. This includes robust funding for HIV/AIDS prevention and treatment. As mayor, I will continue to backfill any federal funding cuts driven by Republican agendas and invest in our City Clinic's modernization and relocation to better serve our community."
A Lurie administration, he added, "also will require that throughout our public health system decisions about gender-affirming care are made between patients and their doctors to uphold the well-being and dignity of all."
Gay Castro resident Keith Freedman was relatively succinct in his response.
"Yes! These funds save lives," wrote Freedman, who owns a short-term rental management company. "I am on PrEP and am a beneficiary of these funds as are many in our community."
Of the seven candidates who returned the B.A.R.'s questionnaire, transit engineer Shahram Shariati was the only one to give a somewhat equivocal answer to the question. Although he did not commit to fully backing federal HIV cuts, he did tell the B.A.R. he would redirect the savings from his proposal to use secondhand cruise ships to completely eliminate homelessness in the city to shore up the budget for HIV services.
"I have already reduced the homeless budget by $400 million per year with my cruise ship plan, which can free up funds for essential programs like this," wrote Shariati, who also works as a residential property manager.
Keep abreast of the latest LGBTQ political news by following the Political Notebook on Threads @ https://www.threads.net/@matthewbajko.
Got a tip on LGBTQ politics? Call Matthew S. Bajko at (415) 829-8836 or email [email protected]
Never miss a story! Keep up to date on the latest news, arts, politics, entertainment, and nightlife.
Sign up for the Bay Area Reporter's free weekday email newsletter. You'll receive our newsletters and special offers from our community partners.
Support California's largest LGBTQ newsroom. Your one-time, monthly, or annual contribution advocates for LGBTQ communities. Amplify a trusted voice providing news, information, and cultural coverage to all members of our community, regardless of their ability to pay -- Donate today!