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AIDS Office SFDPH.Tif :;J . AIDS Office ofthe San Francisco Department ofPublic Health - Records (MSS 95-01) 1982 - 1994 66 cubic feet The AIDS Office (AO)ofthe San Francisco Department ofPublic Health (SFDPH) is responsible for all non­ acute AIDS activities administered by the city. This includes surveillance, research, administration and oversight ofmuch ofthe city, state and federal funding ofAIDS related services, the coordination ofnon-acute care services for PWAs and HIV+ people, the coordination ofAIDS education and prevention programs, and planning and policy development related to AIDS for the city. Infonnation the AO collects is also passed on to appropriate state and federal offices (CDC, Nlli, etc) to help them understand what is occurring with AIDS and AIDS-related services in San Francisco. The responsibilities and activities ofeach branch ofthe AO and the duties ofindividual staffare described in the "Resource Directory" located in the folder marked "History and Description ofthe AIDS Office" located at the beginning ofCarton 1. Historical Sketch The initial response to the AIDS epidemic by the San Francisco Department ofPublic Health (SFDPH) was centered in the Bureau ofEpidemiology andDisease Control, which, until 1985, was the site ofmost AIDS­ related surveillance operations within San Francisco. In addition, in 1984 the AIDSActivities Office was fonned to identify needs, address health education, and arrange for funding ofAIDS-related services in San Francisco, with JeffAmory, Michael Bala and Gary Titus as the initial staff AIDS-related policy development and planning has also been done within the office ofthe Director ofPublic Health. Mervyn Silvennan was Director during the first halfofthe 1980s, handling numerous explosive issues such as the bathhouse dispute of 1984. David Werdegar replaced him in 1985, followed by Dr Raymond Baxter in 1990. Dr Sandra Hernandez, fonner head ofthe AIDS Office, was selected to succeed Baxter in 1994. In 1985 the AIDS Activities Office and what was by then called the AIDS Surveillance Unit (ASU) ofthe Bureau ofEpidemiology and Disease Control were combined to fonn the AIDS Office. Dr George Rutherford was appointed Director, with JeffAmory as Administrative Director. Bala and Titus from the AIDS Activities Office and Tim Piland and Nancy Hessel from the ASU were all moved into the AIDS Office. In 1986 the AO moved from SFDPH headquarters at 101 Grove to 1111 Market. It outgrew that space and moved to it's present location at 25 Van Ness in 1989. Rutherford was replaced by Dr Sandra Hernandez in 1990. Hernandez accepted a new position in late 1992, and Mitchell Katz was appointed head ofthe AIDS Office. During the last halfofthe 1980s, the AIDS Office grew rapidly, and an increasing number ofcontracts were awarded to an ever larger number oforganizations. Initially, many contracts were simply bestowed by the AO to agencies already performing work in the area being funded. This was an infonnal process; no bidding system had been established, and much ofthe decision-making was done by the AO's Administrative Director, JeffAmory. By the late 1980s, requests for proposals (RFPs) began to be sent out, and a more conventional bidding process ensued. Infonnation from the Surveillance Branch ofthe AO was used to develop RFPs that targeted specific needs. One ofthe needs recognized by the AO at this time arose as a result ofinformation gained from a number ofsurveys conducted by the Surveillance Branch. These surveys demonstrated that the needs ofmen ofcolor were not being adequately addressed. The AO's response was to develop RFPs that specified community-based models. This was the factor that initially encouraged people ofcolor to fonn their own agencies with services based on the cultural norms oftheir particular communities. A major problem with this approach slowly became evident; gay men were generally outside the community norms required by the AO. This was partially dealt with by careful attention to language, and it was based on this strategy that terms like "gay men" or other identity­ based descriptors were supplanted with alternative terms, such as "men who have sex with men", which described targets on the basis ofbehavior. In 1990, the United States Congress passed the Ryan White CARE Act, which provides a great deal ofmoney for direct services to the cities most effected by AIDS. This was a significant moment in the history ofAIDS services in the United States, both for the sharp increase in federal funding and because ofthe apparatus it set up to distribute those funds. In San Francisco, a consortium ofindividuals active in providing or using AIDS services was formed as the Ryan White CARE Council (hereafter simply the CARE Council). The Director ofthe AO, or the Director's agent, acts as coordinator ofthe CARE Council. After it was formed, funding decisions were no longer made solely by the AO; the CARE Council as a whole conducted much ofthe planning and set goals for the dispersal ofCARE funds. However, the actual bidding and awarding ofcontracts funded by CARE monies remains in the hands ofthe AIDS Office. Another change evident since 1990 has been the increasing tendency ofthe AO to develop RFPs for collaborative programs. This occurred because the AO, and the CARE Council, became convinced that joint contracts create stronger and more effective programs, as different levels of administrative skills, knowledge ofthe client population, and experience among agencies could enhance the quality and quantity ofservices. Description Although the following boundaries are somewhat arbitrary, it seems useful to group AIDS-related records from the SFDPH into three groups, characterized by age, in order to discuss what is documented in this collection. Pre-AD (1981-1985) While this period is sparsely represented here, there are some significant records present. Most pertinent documents can be found in the files ofDr Silverman (carton 1), and Dave Rutherford (carton 3). The bulk ofDr Silverman's records, records ofthe AIDS Activities Office, and AIDS-related records from the Bureau ofEpidemiology and Disease Control, have apparently not survived. Early AD (1985 through 1990) Many cartons offrom this period have been retained. Besides contracts, the largest number are in the files ofDrs Werdegar, Rutherford, and Hernandez. Files can also be found in records ofthe Health Services and Prevention Branches. Recent AD (1991 through 1995) The initial dispersal offunds under the Ryan White CARE Act in early 1991 marks the boundary between the categories of Early AO and Recent AO. Many feet offiles from this period are held. The AIDS Office has five Branches. The Fiscal Services Branch (formerly called the Operations Branch) coordinates and manages funds from Federal, State and Local governments. It is subdivided into four functional sections: Grants (funds from government to the AO), Requests for Proposals, Contracts (funds to organizations from the AO), and Fiscal Management. This collection holds records ofall ofthese areas, though records of Grants were generally not accessioned. The majority ofFiscal Services records are in Contracts and Related Documents (Cartons 23-64), although Budgets are in Carton 14, and some administrative files are in Carton 22. The Health Services Branch coordinates non-acute care services for People with AIDS or mv (PWAs). These services cover six areas: Primary Medical Care, Home Care & Mental Health, Psychosocial Support, Housing, 2 Substance Abuse Treatment, and Case Management,! Records ofthis branch, mostly from the late 1980s, are found in Cartons 13 and 14. Other records that relate to Health Services are scattered throughout Administrative Files (Cartons 1-10). A small set ofpapers (1989-91) ofthe AIDS Health Services Advisory Committee are located in Carton 11. Files documenting the mv Health Services Care Council and CARE Funding are located in Cartons 18-22. Many ofthe Contracts and Related Documents (Cartons 23-64) involve Health Services also. The Prevention Branch coordinates AIDS education and information services. It also conducts behavioral surveys and program evaluation. Major audiences targeted for AIDS prevention services include gaylbi men, injection drug users and their sexual partners, women, and adolescents. Prevention related records are located in Cartons 14-17 as well as in Contracts and Related Documents (Cartons 23-64). Records relating to mv Testing Services are held in Carton 18. The Research Branch conducts a variety ofstudies on a cohort of6,705 gay or bi men who were originally recruited at the city's VD clinic between 1978 and 1980 for a study on hepatitis B. No records from the Research Branch are held in this collection. The Surveillance Branch documents the nature and scope ofthe epidemic by tracking, and making projections about, morbidity and mortality related to AIDS in San Francisco. This branch also keeps its own non-current records, including the complete files ofthe AIDS Registry. These are confidential files and are not available for research. The only files included from the Research Branch are various reports, surveys and projections held in Carton 22. For a more detailed discussion ofthe organization ofthe AIDS Office and responsibilities ofthe Branches, see the "History and Description" file at the front ofCarton 1. The first 12 cartons ofthis collection are from the Administrative Offices ofthe AO. These are files of the Director ofPublic Health, the Director ofthe AIDS Office, and the Assistant Director ofthe AIDS
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