HIV HEALTH SERVICES PLANNING COUNCIL
Milton Marks Conference Center
455 Golden Gate Avenue (Polk & Larkin)
Lower Level, San Diego Rooms
Monday, April 24th, 2006
4:30 - 7:30 PM
DRAFT MINUTES

I. Call to Order
Co-Chair Randy Allgaier called the meeting to order at 4:38 p.m.

II. Roll Call
Council Support called roll and a quorum was established. [See Attachment A, Column 1]

III. Review and Approval of Agenda
The agenda was approved without objection.

IV. Review of March 27, 2006 Minutes - VOTE
The minutes were approved without objection.

V. General Announcements

VI. Public Comment

Ms. Elizabeth Colomello, from the San Francisco Redevelopment Agency said there was an upcoming hearing concerning HOPWA that may be of interest to the Council.

VI. Council Membership Applicant and Term Renewal Recommendations

Mr. Molnar delivered the recommendations of the Membership Committee.

The Membership Committee recommends two applicants for Council Membership.

• Catherine Newell

Upon recommendation of the Membership Committee, the Council voted unanimously by a show of hands (21/0) to approve Ms. Newell for membership.

• Stephen Herman

Upon recommendation of the Membership Committee, the Council voted unanimously by a show of hands (22/0) to approve Mr. Herman for membership.

Mr. Allgaier noted that they would become voting members of the Council upon receiving a letter of appointment from the Mayor.

ACTION: COUNCIL SUPPORT TO ADD MS. NEWELL AND MR. HERMAN TO ROLL, OUTLOOK, DATABASE, AND OTHER DOCUMENTS AS NEEDED. Send appropriate correspondence for Mayoral appointment letter.

The Membership Committee recommends one Council Member for term renewal.

• William Blum

Upon recommendation of the Membership Committee, the Council voted unanimously by a show of hands (22/0) to approve Mr. Blum’s for renewal of his membership.

ACTION: Council Support to make necessary changes on database and other documents to reflect Council Member renewals. Send appropriate correspondence for Mayoral renewal letters.

VII. Brief Training and Presentation of HIV/AIDS Statistics & Epidemiology
Maree Kay Parisi, Program Director, SFDPH, HIV Health Services, made a presentation, “Status of the HIV/AIDS Epidemic in San Francisco.” She also answered questions from Council Members and the public concerning her presentation. Particular areas of interest were expressed in the statistics involving, the aging, women, and people of color (African American women and Latinos were mentioned specifically). Some wanted more data on the breakdown of the population over 50. Many of the elderly don’t know that much about AIDS.

Public Comment on this item.
Ms. Sue Gallego from the San Francisco AIDS Foundation noted the Latino population figures.

Mr. Brian Basinger, AIDS Housing Alliance, asked a question concerning the HIV/Homeless rates. He wondered whether the HIV problems contributed to the homelessness or did homelessness contribute to the HIV. Ms. Parisi said they had not collected information concerning this.

IX. Discussion of Eligibility Criteria, Severe Need, and Special Populations Definition
CM Laura Thomas suggested the Council discuss whether eligibility for services should be allowed within the entire Eligible Metropolitan Area or continue to require clients to live in the county of the provider. A drawback of the proposal might be to increase demands on some who are not already appropriately funded. CM Dorothy Kleffner said that she had surveyed some other EMA’s who had responded that discrimination on a county by county basis might not be appropriate with federal funds...She thought present policy discriminated against those in rural areas. Others opposed the concept and added that county allocations were the norm in the Washington, D.C., EMA. Finally, the program might be costly to administer.

Other Council Members asked for more information about the impact of the proposed change. The Council needed to approach this thoughtfully. A pilot project could provide that information. Transportation costs had ramifications for the proposal. Ultimately, this proposal might depend on a centralized system of care that we neither had nor realistically could expect to have. The Council might also look at the way DPH funds the purchase of care services in other counties. Regardless of the present policy many folks are in fact getting services out of county.

Some suggested that the Planning Committee would have responsibility in developing the proposal. Others suggested that the Community Outreach and Advocacy Committee might have a role as well.

Public Comment on this item.
Mr. Basinger said that removing county barriers might impact his present argument for housing funds that folks needed to continue living in San Francisco in order to continue their medical care here.

Ms. Gallego drew the Council’s attention to how such a program might impact standards of cultural competence.

Ms. Naomi Prochornik, Continuum, said that the proposal would require case managers to be competent in the services provided not just in one county but all three.

ACTION: PLANNING COMMITTEE WILL DEVELOP THE PROPOSAL FURTHER FOR POSSIBLE FUTURE COUNCIL ACTION.

X. Dinner Break
There was a break for dinner at 6:14, and the meeting resumed at 6:34.
Meeting Evaluation Forms were distributed to Council Members during the Dinner Break.

XI. Update on REGGIE
Ms. Michelle Long, SFDPH, HIV Health Services, said that there was a proposal to eliminate the option now given clients not to share information recorded in the REGGIE system. She said that 1/3 of the maintenance tasks for the system could were required because of the option. When REGGIE was first adopted, she had a staff of 16; now she had a staff of 8 of whom only 3 were full time. Sharing the information would mean that a client would only need to register once. She said that other EMA’s do not offer a shared option. 86% of clients now opt for sharing anyway. One could not tell how many of those who did not choose the shared option objected to sharing since there was paperwork missing from many of their files. One half of the remaining 14% did not have any consent form on file indicating the preference of the client. DPH was still gathering information on the nonconsenters. Where did they go for their services? What services do they use? How much of the failure to consent could be attributed to poorly trained front line personnel?
The discussion centered on whether the privacy issues outweighed the administrative advantages to the proposal. Perhaps some administrative burden could be lessened by making sharing the default option. Eliminating the option might increase the number of untruthful answers. There might be a distinction between those with AIDS and those with HIV diagnoses. Ms. Long also described the PIN system of sharing noting that the loss of the PIN number made future access to the stored data impossible.

XII. HIV Health Services Quarterly Report
Ms. Long provided a handout that summarized the report. There was some discussion about the meaning of the scores (ours in the 80’s) and the formulas using the score to determine awards. Other EMA’s appear reluctant to share their scores. Ms. Thomas indicated that she had developed formulas by which she could back out the information, but that they are not readily available. Scores may not be reliable indicators of funding with some members noting that a high score a few years back was accompanied by a large cut.

XIII. Presentation and Discussion of Proposal for Implementation of Ryan White CARE Act Title I Reduction of Funds for Fiscal Year 2006-2007
Ms. Long said that in the past reductions of funds has been uniformly spread among the various programs. This has administrative problems in that each program must be readjusted with each program generating a separate paper trail for administrators to complete and oversee. This year DPH was committed to backfilling the entire cut pending next year’s budget. Therefore, it made administrative sense to cut just one program (housing) rather than all and save the paperwork problems. Should the funds not be in next year’s budget, a program by program reallocation could follow. Mr. Pearce said that he supported the proposal but we would need to remember what we’ve done should the cuts be extended without corresponding general funds backfilling.

Motion to approve the reduction passed (See Item Attachment A, Colum 2).

XIV. Review and Discussion of Proposed HRSA (Health Resources Services Administration) Housing Policy - VOTE
Ms. Antonetty presented the recommendation from the Steering Committee. She reviewed the history of HRSA’s proposal to define a length of stay for transitional housing. 461 subsidies would be affected by the new proposal. While DPH was going to draft its own response and a resolution for the Health Commission, others such as SFAF were drafting their own responses unfettered by DPH’s need to maintain a working relationship with HRSA. The Steering Committee is recommending that the Housing Work Group draft a response for the Council. If time precludes Council action, then Steering could act on its behalf. The Council’s previous response asked that a pilot program on HRSA’s recommendations be established in San Francisco to assess the policy and that it be paid for by HRSA.

Motion from Steering to have the Housing Workgroup draft a proposed response and refer it to the Steering Committee passed unanimously (21/0).

XV. Discussion of Policies and Procedures
This matter was not taken up.

XVI. Update from Planning Committee Regarding Prioritization and Allocation Schedule
Ms. Thomas presented the update on behalf of the Planning Committee. She said the schedule was on track. At the next meeting there would be a discussion of other funding streams. There also would be a presentation from Marin County

XVII. Ryan White CARE Act Reauthorization Update
Ms. Thomas said that the Government Accounting Office has reported on a disparity in the funding of Ryan White dollars. She believed that the funding analysis was flawed by failing to take into account Title III funds. California was actually below average in the amount of funding received. She predicted that Title I would continue with flat funding with any increases in funding unlikely.

XVIII. New Business/Next Agenda
There was no discussion

XIX. Adjournment
The meeting adjourned at 7:42.

Meeting minutes are considered to be in DRAFT form until reviewed and approved by Council attendees.

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