Bay Area Reporter - December 18, 2008
Seth Hemmelgarn, s.hemmelgarn@ebar.com

In one small bit of positive news, reductions to HIV prevention have been cut in half, to about $565,000, and other programs have also been spared some harm, at least for now.

On Tuesday, December 16, the Board of Supervisors' Government Audit and Oversight Committee continued an ordinance that includes proposals by Board of Supervisors President Aaron Peskin to divert money from the arts to other departments. Committee members expressed disdain at having to make cuts that would affect the city's most vulnerable residents.

At the Health Commission hearing later Tuesday, Jim Illig, the commission's openly gay president, encouraged the public to "keep up the conversation" with policymakers who will be making decisions on the cuts.

In order to address the projected shortfall for the 2009-10 fiscal year, like other departments, public health is being asked to propose a base budget with a 12.5 percent reduction in general fund, plus another 12.5 percent contingency reduction.

For the health department, that 25 percent will mean about $100 million in cuts, on top of the mid-year cuts. Budget submissions are due to the city controller February 20.

The Health Commission will hold a meeting on cuts Tuesday, January 6 at 4 p.m., at the department's office at 101 Grove Street.

Mayor Gavin Newsom's budget office had asked the department to cut almost $26.7 million from its budget this year. About $17.4 million in reductions had been identified, but Newsom rejected $3.23 million of that while approving $14.2 million. According to public health officials, the city's current budget gap is $90 million.

HIV prevention

Among the changes Newsom made was decreasing the cuts to HIV prevention by 50 percent, so that rather than $1.13 million, $565,000 will need to be cut.

Grant Colfax, the city's HIV prevention director, has said that needle exchange programs, which have been shown to be highly effective in preventing HIV transmission, will be held harmless, and programs providing prevention to men who have sex with women and women who have sex with men will be reduced to come into line with allocation recommendations from the HIV Prevention Planning Council, which is made up of community members and representatives from AIDS service organizations.

"Our goal is to continue to provide HIV prevention services to those most affected by the [San Francisco] epidemic: men who have sex with men, transgenders, and injectors," Colfax told the Bay Area Reporter.

At Tuesday's government audit and oversight committee meeting, Desmond Miller of Larkin Street Youth Services, which works with homeless youths, said the organization tests an average of about 45 to 60 youths every month, with one person testing positive every two months. Budget reductions, Miller said, means "effectively cutting off one of our hands to lend to these kids to help them get off the streets."

Holly Tedford Hayes, Larkin Street's director of development and grants, told the B.A.R. that the cut to her agency has been "changing almost daily."

But in an e-mail, she wrote that if the mid-year cuts go through as currently proposed, there would be an elimination of just about half of Larkin Street's HIV prevention contract, as well as more than half of the funding for the agency's Homeless Youth Substance Abuse Project.

"The proposed cut amounts have changed somewhat in either direction since they were first proposed," Tedford Hayes wrote, "but in every version of the planned budget cuts there have been significant impacts to these two programs on the list," as well as similar services provided to other populations by many other community-based organizations.

Jeff Hall, legislative affairs director for the San Francisco AIDS Foundation, wrote in an e-mail that the most recent information the foundation has received on cuts to its HIV prevention contracts is that the Stonewall Project, Magnet, Black Brothers Esteem and Speed Project programs each face an annual cut of approximately 4.9 percent.

Hall wrote the cuts would be applied to the last six months of the 2008-09 contract year - a 2.44 percent cut to the entire annual contract amount - and then to the full annual amount for the 2009-10 contract year.

"We have not yet determined how we will manage the budget cuts to our programs, and are unlikely to do so until we receive the final word from the city with regard to its contracts with us," he wrote.

Other cuts

The proposed reductions also include $155,000 to complementary therapies - services such as acupuncture that people with HIV/AIDS say help ease their pain, and $72,5000 to STD selective testing.

Mike Ward, who's on the board of the Immune Enhancement Project and also a patient, came to the Health Commission meeting Tuesday to speak against the proposed cuts.

Ward, who's been living with HIV for 27 years and has also had cancer, said the side effects from HIV medications are "devastating."

Another proposed reduction is $104,759 for primary care.

Teri McGinnis, executive director of Lyon-Martin Health Services, said a proposed mid-year cut of about $38,000 for her agency would directly affect 132 people making a total of 345 visits.

"Unless we can find some other funding source to cover those costs, we could be forced to turn folks away," McGinnis said.

She said almost one-third of the agency's clients are transgender.

"What our clinic is most uniquely known for is culturally competent care for [LGBT] folks," McGinnis said. "We're transgender specialists ... Lyon-Martin provides a safe environment. Being turned away to another provider who has no experience in transgender healthcare would be an almost unbearable barrier to care for them."

Besides reducing proposed cuts to HIV prevention, Newsom also rejected a proposed $405,000 cut to the health at home program, where people with serious illnesses such as AIDS receive care at home. A possible cut to behavioral-health related contracts was reduced from $4.78 million to $3.89 million, to lessen the impact to substance abuse services.

In a memo to the Health Commission, Gregg Sass, the health department's chief financial officer, wrote that the department will no longer be required to submit more cuts to reach $26.7 million.

"However," he wrote, "as the controller continues to update financial projections, and as efforts by the state to balance the current year budget become more clear, it is possible that we will be asked to identify additional mid-year cuts." At the commission meeting Tuesday, he said that could happen in January or February.

The city charter requires a balanced budget.

Nathan Ballard, a spokesman for Newsom, wrote in an e-mail to the B.A.R. in late November that "We are in a very serious situation that will require cuts to the health department. Wherever possible, the mayor will act to protect vital services. But significant cuts must be made."

The mid-year reductions also include $148,828 to the SRO Collaborative, which includes four groups that operate in neighborhoods from Chinatown to the Mission, working to assist residents of single-room occupancy hotels - buildings notorious for bedbugs, rats, mold, drugs, and violence - to get linked up with services from mental health, fire prevention, and better housing.

LGBTs and people living with AIDS, as well as families with young children, are among those living in the hotels. The overall budget for the collaborative is already slim: $1.1 million for the whole year.

On Thursday, December 11, about two-dozen tombstones were laid out across from City Hall representing several programs facing cuts.

Standing nearby was Matthias Mormino, project coordinator for SRO Families United Collaborative - one of the four groups in the broader collaborative - who said, "We go into the buildings, the hotels the Department of Building Inspection won't go into," providing vital links to the hotels' residents that would be lost if the cuts go through.

Mormino said there's been a "dramatic increase" in the number of families moving into the hotels, which are "the last bastion of housing for many people."

Tommi Avicolli Mecca, a longtime advocate for queer and housing rights who's a member of the San Francisco Coalition to Save Public Health, said, "A lot of members of our community, especially people with AIDS, are ending up in SROs because of the high cost of renting." Without services like those offered by the collaborative, he said, many SRO residents would be very sick, and even homeless.

The Board of Supervisors isn't required to offer input on the mid-year cuts, and Newsom could make them unilaterally. But at Tuesday's Board of Supervisors committee hearing, Peskin said although the board could do nothing, "we need to lessen the blows" from the mid-year cuts.

After the hearing, Nani Coloretti, Newsom's budget director, said the $575 million gap for 2009-10 (before the annualized mid-year cuts are accounted for) is almost half the city's discretionary general fund.

"We need to make cuts now, otherwise we're not being proactive enough to address a very large and looming shortcut next year," Coloretti said. The $575 million figure could grow if the state's budget deficit continues to go unresolved.

About 400 city employees have been laid off but are expected to stay on the job until February.

Many people have bemoaned city official salaries that top $150,000 or more.

At Tuesday's committee hearing, Supervisor Chris Daly, who's not on the committee, noted a "signifcant growth" in upper-level management positions across departments.

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