I. Call to Order
II. Roll Call
Please see attached.
III. Review and Approval of Agenda
Item number 9 was presented before item number 8. Item number 10 will be skipped
since the Council addressed it before March 22, 2004.
The agenda was approved.
IV. Review and Approval of Minutes- February 23, 2003
CM Sanders will provide a couple of grammatical changes to the minutes. There
was also a minor content change made to the ADAP/Medical Update section.
The minutes of February 23, 2003 were approved.
V. General Announcements
Leah Crask announced that all Council members interested in attending the Title
I Consumer Training should contact Council Support as soon as tonight’s
meeting concludes.
VI. Public Comment
Patrick Monette-Shaw submitted written comment: The HIV Prevention Planning
Council is sponsoring a Late Night Breakfast Buffet providing refreshments
and $30 so-called “incentives” to crystal methamphetamine users.
As this Council knows, it is widely understood in the national research community
that offering incentives skews the data collected. SF DPH conducts far too
many so-called “scientific” studies that issue cash, and other
forms of, incentives, calling into question just how valid data collected
in San Francisco is. I am heartened to learn from Steven Tierney, DPH’s
director of HIV Prevention, that the HIV Prevention Planning Council is considering
a policy to potentially ban use of incentives. To preserve data integrity,
I urge this Council to develop a similar Resolution banning the use of incentives
for all HIV/AIDS healthcare studies, outreach, needs assessments, focus groups,
and community forums conducted by the CARE Council.
Several members of the public representing the San Francisco Latino Community
affected by HIV and AIDS pointed out the impact of CARE funding cutbacks on
the only bilingual legal assistance program (specifically serving the HIV+
Latino community in San Francisco) that will close at the end of May. CM Guillen
served as a translator.
Ana Mantano, AIDS Legal Referral Panel Immigration Attorney spoke on behalf
of her Latino clients who were cut from the program.
Another Spanish speaking public, Roberto requested a translator.
VII. Update from the Mayor’s Office
Jimmy Loyce presented an update from the Mayor’s Office regarding city-funding
issues.
The 15 billion dollar Bond Initiative has little impact on San Francisco in
terms of its deficit.
If the Bond initiative failed, there would have been an additional deficit,
not a decrease in the deficit. The deficit is based on the numbers originally
forecasted somewhere between 299 and 350. The budget will lead the Health Department
after the Health Commission vote tomorrow. They will vote to either send it
the way it is or vote to make some alterations before sending it to the Mayor’s
Office. It will be in the Mayor’s Office until June 1, 2004. The real
struggle with the budget begins June 1, when the board has hearings, and begins
to determine how to allocate city and county revenues, and to the Departments
of Public Health. The budget analyst will do his analysis. He will make comments
about each department and how money is spent. A decision will be made whether
to add money or delete. Last year, the San Francisco DPH was to put forth $16
million in cuts. The board of supervisors added back approximately $13 million
dollars to the whole department, not to any portion of it. The money was added
back based on police prior overtimes and other kinds of monies that were found.
Jimmy Loyce does not know whether they will be able to add back funds in this
next go round. All that he knows is that the deficit must be addressed. In
the DPH, there is no formalized contingency budget at this time: however, a
formalized contingency budget is expected by April 6, 2004, after the Health
Commission. Jimmy Loyce does not have the authority to put out the DPH’s
budget or its contingency budget. That comes from the Director of Health and
from the CFO.
The HIV AIDS Bureau said that they allocated all of the money that is in Ryan
White so that even if our appeal were successful, there is no money to give
back to San Francisco. As a result, of the letter being created for the Mayor,
a four-year request is being made again. Senator Feinstein will be writing
the letter as a representative of the State of California. The state of California
took an 8.4 million dollar cut in its total Title I and supplemental awards.
Public Comment:
Patrick Monette-Shaw submitted written comment: It’s disturbing Mayor
Newsom, instead of working closely with this Council by heeding your recommendation
to appoint an AIDS czar, appears to be working with Jim Illig, who advised
Newsom not to appoint a czar. Illig appears to carry more influence than you.
Newsom’s rationale the City can’t afford an AIDS czar to provide
oversight is specious. Chopping one IS manager paid $165,000 between salary
and fringe benefits could fund an AIDS czar $75,000, plus $18,750 in benefits,
leaving $71,250 to rescue other. Jimmy Llocye just stated the Board of Supervisors “added
back $13 million” to DPH for the current FY. This is untrue; Ordinance
191-03 raided the LHH rebuild fund by $25 million earmarked only for DPH. Included
in Mayor Brown’s budget submission; it was not an add-back. If only $13
million went to DPH, this Council should be keenly interested in what happened
to the remaining $12 million.
Another member of the public spoke in Spanish about health services that were cut to the HIV/AIDS Latino community. It was explained to this speaker that public comment must relate to the specific agenda item addressed. Clarification on this topic was done in Spanish.
VIII. Epidemiology of HIV/AIDS in San Francisco County
HIV Statistics & Epidemiology Section – SFDPH
The epidemiology of HIV/AIDS in San Francisco County was presented to the Council.
Sandy Schwartz gave a presentation on the status of the HIV/AIDS Epidemic in
San Francisco. Please refer to the handout containing the PowerPoint slides.
The Planning Committee facilitated questions and discussion about the data
after the presentation.
CM Chung asked about statistics on the transgender HIV/AIDS population. Sandy
Schwartz explained that all AIDS cases are declining and all new AIDS cases
are declining, including all groups. She is looking at what is happening with
new HIV infections. There is no current updated data about the incidents in
transgender people. She assumes that the transmission AIDS cases among the
transgender population has declined, but lacks the current data to show it.
CM Guillen asked if the AIDS case definition is the same throughout the world.
Sandy Schwartz responded that the AIDS case definition is the same throughout
the United States. In Europe, they use the same opportunistic illnesses. In
Africa and much of the developing world, there is an HIV option as well. CM
Allgaier mentioned insurance status at the time of diagnosis. He asked if there
was any data about the change of ones insurance status throughout the course
of the illness. Sandy Schwartz has no data on this topic. CM Perez asked about
data on mortality rates and trends. Sandy Schwartz says that mortality is declining
and survival is improving. An existing analysis looks at causes of death to
see whether causes of death were changing because of people living longer.
Some people with AIDS now are dying from other diseases instead of dying from
AIDS. What we found is that mostly, people who have HIV and AIDS are dying
from HIV and AIDS. CM Thomas asked when the next annual Epidemiology Report
would be published. According to Sandy Schwartz, the next one will be available
in May or June. CM Conley commented that the statistics in the presentation
were only in San Francisco, not from the EMA. He pointed out the fact that
the demographic information in San Jose and Marin are different.
CM Ortiz mentioned the age difference between people with HIV and AIDS. Sandy
Schwartz said that in general, the people with diagnosed with HIV are younger
than those diagnosed with AIDS due to a time lag.
Public Comment on this item:
A member of the public said that he wanted to see statistics on people living
with AIDS and what they are doing with their lives.
Bill heard an estimation stating that there are twice as many people with HIV
than with AIDS. Sandy Schwartz’s incomplete data showed that there are
twice as many people with AIDS than with HIV. He finds this interesting and
felt the need to point it out.
Patrick Monette-Shaw submitted written comment: Michelle Long Dixon indicated that the majority of the $500,000 add back the Board of Supervisor’s awarded to backfill lost CARE Act funding two years has been used for methadone maintenance rather than to restore CARE Act funded services. The Board of Supervisor’s had expressly noted that it was adding the $500K back to restore lost CARE funding, but DPH made the decision how to spend it. This Council should work very closely with the Board of Supervisors to develop Ordinance governing when the Supervisor’s earmark funds lost from CARE Act cuts, that the Council prioritizes how the addback is to be spent rather than DPH. If the intent is to restore lost CARE funding you, not DPH should decide how it is allocated. In the unlikely event the Supervisors addback $4 million to replace CARE funds just lost, you should have this Ordinance place before DPH grabs the money.
IX. HIV Health Services Report
Michelle Long Dixon/ HIV gave a HIV Health Services monthly report and update.
Michelle Long Dixon did not bring the Quarterly Report. She discussed the actions
taken towards addressing the funding deficit. Please refer to the Reductions
for CARE Title I FY-04/05 handout. It includes a list of eliminated programs.
She notified the agencies and services listed, that they must prepare to close
out their programs. When notification of the grant award was received, the
programs were sent termination letters with exact steps for closeout and a
preliminary estimate of how much money they would have to close out their programs.
They were sent another letter, stating that they could not depend on the dollar
amount for closeout, but they were still in the category of programs to be
terminated. In order to come up with a balanced budget, she looked at the base
budget for 2003/2004 and determined how much of a contract reduction should
be made in order to balance the budget and determined a reduction of approximately
3.5 million. There were interruptions from the Council. She had a previous
track record of doing reduction protocol. The Council did not tell her this
year was what to do with regard to program extensions for eliminated programs.
In the past, she has given extensions to programs that have been eliminated.
She was trying to be conservative, recognizing that the longer programs had
to extend, before closeout, the higher to cut up into the service category
the more programs to defund. She started with the base of a month for every
program that would be eliminated. Program staff consulted with the agency staff
to see what they thought. Some programs said that they could close out in three
weeks and others said that they needed six months. It was decided that everyone
would have a month except a few special cases that could extend for up to eight
weeks. The amount of money for the extensions is $400,000. Next, a source had
to be found for this extension money. It was obtained from three different
areas: residual money from outpatient substance abuse, residential mental health,
and money from general funds. There was an executive decision made to restore
the Methadone Maintenance Program at the DPH. Tomorrow she will fax letters
to the programs that are being eliminated, and will tell them how much of an
extension they will have. She is also awaiting notification about Title II
Award. The letter from the State instructs her to budget up to 95% of the amount
from last year. Michelle Long Dixon answered questions from the Council. CM
Booker requested a spreadsheet with the budget. CM Hume asked about the $500,000
that was given to the Methadone Maintenance Program. CM Pearce asked why the
Executive decision was made to give the funds to the Methadone. Michelle Long
Dixon explained that the decision was consistent with the department’s
general funds budget priority to expand the Maintenance Program, rather than
another program. CM Chung asked about the demographics of the clients affected
by the budget cuts. CM Shea commented that it seems odd that when a program
is cut and then restored- the department’s priorities are different from
the Council’s priorities. CM Shea expressed that the Council’s
priorities were not factored in and there needs to be a process between the
Council and the DPH. Michelle Long Dixon distributed and reviewed the Ryan
White CARE Act Title I Program FY 2004 Objective Review Committee Summary Report
and Ryan White CARE Act Title I Program FY 2004 Objective Review Committee
Summary Report “Strengths and Weaknesses” Russ Handout gave an
update on HHS Solicitations for FY 03-04 March 22, 2004.
Public Comment:
One speaker commented on cuts to immigrant services. The speaker favors supporting
treatment education and legal assistance for immigrants.
Another speaker from the Latino community was helped by the agency that was
cut. He expressed his concern for the other consumers that were part of the
program.
Estela of Instituto Familiar commented that the cuts affect women of color
and youth. Her 80 clients will need HIV services and she has nowhere to send
them.
Patrick Monette-Shaw submitted written comment: Sandy Schwartz indicated during her presentation that there can be a lag of upwards of three months in AIDS case reporting. If it only takes three months, then why did I discover during the CARE Act Re-authorization 2000 process that DPH had moved at least 723 AIDS cases around on its quarterly surveillance reports fully eight years after first reporting data? By comparing Table 5 across the March 1998 to March 2000 quarterly surveillance reports, I discovered that 511 of 765 gay and bisexual AIDS were moved from “first diagnosed in 1991 and 1992” to the “pre-1990” category; the remainder of the cases were reclassified to other risk categories. Why had those cases been reported for fully eight years as having been diagnosed in a given year and suddenly they were reclassified? Is DPH’s lag in reporting so severe that it takes eight years to straighten out its data sets?
X. Dinner Break
XI. Memorandum of Understanding - VOTE
The Infrastructure and Policy Committee presented a change to the Conflict
Resolution Model portion of the MOU for a vote to approve the change. There
was no public comment on this item. The Council voted unanimously in favor
of the change.
XII. Membership –VOTE (CM Sanders/ CM Rodriguez)
The Membership Committee recommended Council Member William Blum for membership
term renewal (May 2, 2004). The entire Council voted in favor.
XIII. Update on Provider/ Consumer Input
John Golenski presented a brief update on the current plans for incorporating
Provider and Consumer input into the prioritization process.
XIV. Exercise to Review Decision Making Methodology
John Golenski facilitated an exercise developing a new decision making model
for the Council. This exercise was intended to assist with understanding
the application of operating health and social values to decisions regarding
budget allocations. The purpose is the identification and clarification of
operating values. Please refer to the following handout: Values-Directed
Allocation First Exercise—Operating Values Clarification
Values Ranking Matrix and Results
Utilitarianism (“Greatest Good for the Greatest Number”) 45
Fairness (“Similar Cases Treated in Similar Fashion”) 3
Retributive Justice (“Making Up for Past Inequities”) 3
Distributive Justice (“Working Toward General Equality”) 30
Rights and Duties (“Inherent Nature of Community”/Solidarity”)
14
Compassion (“Assisting the Weak and Suffering”) 45
Chance (“Lottery—Let the Universe Decide”) 0
Equality (“Equal Allocation”) 8
Merit (“Past or Current Contribution”) 7
Market (“Ability or Willingness to Pay”) 0
Power/Coercion 0
Fidelity 12
Prevention 3
XV. Adjourned
The meeting adjourned at 7:30 P.M.
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