Back in March city leaders learned that San Francisco would face cuts from the federal Ryan White HIV/AIDS Treatment Modernization Act and the Centers for Disease Control and Prevention. The cuts, about $4.7 million from Ryan White and approximately $3.1 million from the CDC, will significantly impact the HIV/AIDS service organizations that provide treatment and services (Ryan White) and prevention (CDC). Additionally, there's another $500,000 in Ryan White Part D money that may also be at risk. These are funds that agencies apply for themselves, unlike the main Ryan White money that is allocated to the health department, which then disburses it to contracted agencies. All of these cuts go into effect July 1.
The $4.7 million Ryan White cut looks to be a onetime adjustment that resulted from special funding that Nancy Pelosi was able to secure when she was speaker of the House, AIDS advocates said. But this decrease is much larger than previous Ryan White cuts, which have been in the .5 percent to 5 percent range. Combined, the Ryan White and CDC decreases represent a 20 percent cut to San Francisco.
Federal decreases to AIDS funding have happened before, and in the past, the city, through the mayor and the Board of Supervisors, have backfilled the cuts with general fund dollars. However, with the 2012 decreases larger than ever, combined with the sluggish economy and the dismal news from Sacramento concerning the state's $15.7 billion budget gap, we call on Mayor Ed Lee to close the shortfall of federal dollars in the city's budget he is expected to unveil June 1.
San Francisco has done extraordinary work in combatting the AIDS epidemic for more than 30 years. But AIDS is far from over. Prevention efforts have been successful in lowering the number of new HIV infections to about 900 per year. Ideally, these 900 people would immediately begin treatment upon learning they are HIV-positive, with the goal of reducing their viral load to zero, thus greatly increasing the likelihood of preventing new infections. But even with the existing funding for care and prevention, people fall out of care and do not maintain their medication regimen.
Real harm
The human cost of a 20 percent reduction in federal HIV/AIDS funds would be dramatic – for community-based service providers, the city's health clinics, and programs at UCSF. AIDS advocates fear that programs could be destabilized. There will be fewer services, longer waiting lists, and fewer resources for clients. And keep in mind that Ryan White dollars provide services to those who are uninsured and low-income – in other words, people who need help the most.
For example, the Ryan White cuts would mean the likelihood of a nurse practitioner and physician's assistant losing their jobs at Mission Neighborhood Health Center, reducing available appointment slots by 20 percent. Tightening of eligibility guidelines at AIDS Emergency Fund would curtail services for 200 clients needing short-term financial assistance to move off the street and into an SRO. Project Open Hand – already facing a deficit and a new tiered structure of services beginning July 1 – may have to distribute fewer meals and smaller grocery bags. (Tenderloin Health, of course, closed its doors last month.) All of these services are designed to keep people healthy enough to avoid emergency room care (a huge drain on the city's budget) and to keep their viral loads low enough to avoid transmission of the virus to others.
And we must say a few words about the critical importance of housing for people living with HIV/AIDS. It is the most important factor in getting someone who is on treatment to maintain that regimen.
As soon as the federal decreases were announced a few months ago, Supervisors Scott Wiener, David Campos, and Christina Olague began working on plans to replace the money. The board can't supply the entire amount in its budget; the leadership must come from the mayor and his spending plan.
We know that devising the budget is difficult this year. And we know that no one wants service cuts. But the significant funding decreases for HIV/AIDS services will affect hundreds of people in San Francisco. They will have a devastating impact on people living with HIV/AIDS, people at risk for becoming infected, and the service providers who are already trying to do more with less.
Mayor Lee and his budget director must find a way to fill the gap and restore the $7.8 million that San Francisco will soon lose.