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San Francisco Department of Public Health AIDS Office records
SFH 4  
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Collection Details
 
Table of contents What's This?
  • Access
  • Publication Rights
  • Preferred Citation
  • Provenance
  • Related Materials
  • Administrative History
  • Scope and Contents
  • Arrangement

  • Title: San Francisco Department of Public Health AIDS Office Records
    Date (inclusive): 1982-1994
    Identifier/Call Number: SFH 4
    creator: San Francisco (Calif.). AIDS Office
    Physical Description: 66 Cubic Feet 66 cartons
    Contributing Institution: San Francisco History Center, San Francisco Public Library
    Abstract: Records documenting the formation and activity of the AIDS Office, including files of Directors of Public Health, Mervyn Silverman and David Werdegar, prior to the Office's creation in 1985, followed by successive directors of the Office itself; records from four of the five branches of the AIDS Office, including Fiscal Services, Health Services, Prevention, and Surveillance; and records documenting the contracts process, including grant requests, Request for Proposals (RFPs) from and contracts with community-based organizations, working folders, contract processing and development files, reports, and other materials. Includes substantial material on programs and organizations funded by the Ryan White CARE Act, which provides federal money for AIDS services.
    Physical Location: The collection is stored offsite.
    Language of Material: English
    Language of Material: Collection materials are in English.

    Access

    The collection is available for use during San Francisco History Center hours, with photographs available during Photo Desk hours. Collections that are stored offsite should be requested 48 hours in advance.

    Publication Rights

    All requests for permission to publish or quote from manuscripts must be submitted in writing to the City Archivist. Permission for publication is given on behalf of the San Francisco Public Library as the owner of the physical items.

    Preferred Citation

    [Identification of item], AIDS Office of the San Francisco Department of Public Health Records (SFH 4), San Francisco History Center, San Francisco Public Library.

    Provenance

    Transfer; Special Collections, University of California, San Francisco; May 14,1997.

    Related Materials

    Related archival materials in this repository include: People vs. Owen Bathhouse Closure Litigation Records, 1984-1987 (SFH 31), which includes records from the Bureau of Communicable Disease Control, San Francisco Department of Public Health.

    Administrative History

    The AIDS Office of the San Francisco Department of Public Health (SFDPH) is responsible for all non-acute AIDS activities administered by the city, including surveillance, research, administration and oversight of much of the city, state, and federal funding of AIDS-related services; coordination of non-acute care services for people with AIDS (PWAs) and HIV+ people; coordination of AIDS education and prevention programs; and planning and policy development related to AIDS for the city. Information the AIDS Office collects is also passed on to appropriate state and federal offices (CDC, NIH, etc.) to help them understand what is occurring with AIDS and AIDS-related services in San Francisco. It was formed in 1985 from the merging of the AIDS Activities Office (formed in 1984) and the AIDS Surveillance Unit of the Bureau of Epidemiology and Disease Control.
    The initial response to the AIDS epidemic by the San Francisco Department of Public Health (SFDPH) was centered in the Bureau of Epidemiology and Disease Control, which, until 1985, was the site of most AIDS-related surveillance operations within San Francisco. In addition, in 1984 the AIDS Activities Office was formed to identify needs, address health education, and arrange for funding of AIDS-related services in San Francisco, with Jeff Amory, Michael Bala and Gary Titus as the initial staff.
    AIDS-related policy development and planning has also been done within the office of the Director of Public Health. Mervyn Silverman was Director during the first half of the 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, former head of the 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) of the Bureau of Epidemiology and Disease Control were combined to form the AIDS Office. Dr George Rutherford was appointed Director, with Jeff Amory 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 AIDS Office moved from SFDPH headquarters at 101 Grove to 1111 Market. It outgrew that space and moved to its 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 of the AIDS Office.
    During the last half of the 1980s, the AIDS Office grew rapidly, and an increasing number of contracts were awarded to an ever-larger number of organizations. Initially, many contracts were simply bestowed by the AIDS Office to agencies already performing work in the area being funded. This was an informal process; no bidding system had been established, and much of the decision-making was done by the AIDS Office's Administrative Director, Jeff Amory. By the late 1980s, requests for proposals (RFPs) began to be sent out, and a more conventional bidding process ensued. Information from the Surveillance Branch of the AIDS Office was used to develop RFPs that targeted specific needs. One of the needs recognized by the AIDS Office at this time arose as a result of information gained from a number of surveys conducted by the Surveillance Branch. These surveys demonstrated that the needs of men of color were not being adequately addressed. The AIDS Office's response was to develop RFPs that specified community-based models. This was the factor that initially encouraged people of color to form their own agencies with services based on the cultural norms of their particular communities. A major problem with this approach slowly became evident; gay men were generally outside the community norms required by the AIDS Office. This was partially dealt with by careful attention to language, and it was based on the 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 of behavior.
    In 1990, the United States Congress passed the Ryan White CARE Act, which provides a great deal of money for direct services to the cities most affected by AIDS. This was a significant moment in the history of AIDS services in the United States, both for the sharp increase in federal funding and because of the apparatus it set up to distribute those funds. In San Francisco, a consortium of individuals active in providing or using AIDS services was formed as the Ryan White CARE Council (hereafter simply the CARE Council). The Director of the AIDS Office, or the Director's agent, acts as coordinator of the CARE Council. After it was formed, funding decisions were no longer made solely by the AIDS Office; the CARE Council as a whole conducted much of the planning and set goals for the dispersal of CARE funds. However, the actual bidding and awarding of contracts funded by CARE monies remains in the hands of the AIDS Office. Another change evident since 1990 has been the increasing tendency of the AIDS Office to develop RFPs for collaborative programs. This occurred because the AIDS Office, and the CARE Council, became convinced that joint contracts create stronger and more effective programs, as different levels of administrative skills, knowledge of the client population, and experience among agencies could enhance the quality and quantity of services.

    Scope and Contents

    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-AIDS Office (1981-1985): While this period is sparsely represented here, there are some significant records present. Most pertinent documents can be found in the files of Dr Silverman (carton 1), and Dave Rutherford (carton 3). The bulk of Dr Silverman's records, records of the AIDS Activities Office, and AIDS-related records from the Bureau of Epidemiology and Disease Control, have apparently not survived.
    • Early AIDS Office (1985 through 1990): Many cartons from this period have been retained. Besides contracts, the largest number are in the files of Doctors Werdegar, Rutherford, and Hernandez. Files can also be found in records of the Health Services and Prevention Branches.
    • Recent AIDS Office (1991 through 1995): The initial dispersal of funds under the Ryan White CARE Act in early 1991 marks the boundary between the categories of Early AIDS Office and Recent AIDS Office. Many feet of files 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 AIDS Office), Requests for Proposals, Contracts (funds to organizations from the AIDS Office), and Fiscal Management. This collection holds records of all of these areas, though records of Grants were generally not accessioned. The majority of Fiscal 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 HIV (PWAs). These services cover six areas: Primary Medical Care, Home Care & Mental Health, Psychosocial Support, Housing, Substance Abuse Treatment, and Case Management. Records of this 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 of papers (1989-91) of the AIDS Health Services Advisory Committee are located in Carton 11. Files documenting the HIV Health Services Care Council and CARE Funding are located in Cartons 18-22. Many of the 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 gay/bi 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 HIV Testing Services are held in Carton 17-18.
    The Research Branch conducts a variety of studies on a cohort of 6,705 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 of the 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 of the AIDS Registry. These are confidential files and are not available for research. The only files included from the Surveillance Branch are various reports, surveys and projections held in Carton 22.
    For a more detailed discussion of the organization of the AIDS Office and responsibilities of the Branches, see the "History and Description" file at the front of Carton 1.
    The first 12 cartons of this collection are from the Administrative Offices of the AIDS Office. These are files of the Director of Public Health, the Director of the AIDS Office, and the Assistant Director of the AIDS Office. These files document activities and problems from each branch and from many AIDS organizations. Others deal with politicians, legislation, extra-governmental bodies, and a wide range of issues related to AIDS. Of particular note are the Troubleshooting Files (Cartons 7-8, 10) which document problems with particular contracting agencies and how these problems were handled. Additional important sources are minutes and other documents of various internal committees, advisory bodies to the AIDS Office, and external groups organized around specific needs (Cartons 110-12). Minutes of some of these groups, such as the Minority AIDS Advisory Committee, which was renamed the People of Color AIDS Advisory Committee in 1990, have been compiled from both within the AIDS Office and from the records of several community-based organizations with representatives on these committees. Files on a few groups hold meager records; these were retained to document the existence of these bodies. The last two cartons are late additions. Carton 65 holds long-range planning records. Carton 66 holds reports, KAABs, and other monographs published by the SFDPH or other agencies of the city of San Francisco.
    The financing of AIDS-related activities is a factor critical to understanding the growth, development, and history of the response to the epidemic. While funding comes from a variety of sources, by far the largest portion is from governmental funds. In San Francisco, most federal, state and city funds for AIDS services are provided through contracts awarded and/or monitored by the AIDS Office of the Department of Public Health. The development of funding priorities, specific proposals by various agencies, contract development, and contract monitoring and reporting activities provide the broadest perspective for understanding the development of AIDS-related services in San Francisco; this arena, referred to as the contract process, is described below.
    In a nutshell, the AIDS Office obtains grants of money from various governmental sources (CDC, Ryan White Care Funds, NIAID, Title II, etc), generally earmarked for specific purposes. The AIDS Office looks at these grants and at local needs, and decides on more specific criteria for funding. It then sends out a general announcement of funds available and solicits proposals from agencies (these solicitations are commonly known as RFPs, or Requests for Proposals). Individual agencies then apply for funding on a competitive basis. Those applications with the most well-written and best-documented proposals are approved. Awards are made on the basis of preset evaluation criteria set by the AIDS Office and clearly spelled out in the RFP. Those chosen will be awarded a Contract which stipulates exactly what is to be done, how funds are to be used, and what kind of reporting back to the AIDS Office is needed. Monitoring of these reports, as well as actual site visits and audits, ensure that the contracting agencies fulfill the terms of their contracts and that funds are spent on authorized, needed services. They also provide the AIDS Office, and now the CARE Council, with data about the utility and effectiveness of particular services and educational efforts. This data, in turn, provides information useful in targeting specific needs and planning for future funding cycles. Thus, the contract process is cyclical in nature, with planning for the future developed from lessons of the past. Although these documents may not be intuitively understood, a careful reading can produce a week-by-week, month-by-month chronicle of the details of AIDS services in San Francisco.
    To help comprehend these documents, a list of definitions of common terms used in the contract process follows:
    Definitions of Contract Terminology Used at AIDS Office, SFDPH Thanks to Galen Leung, former Director
    Budget: AIDS Office contract budgets were not very detailed before 1991 but are key to finding out what was paid for by the City and what was supported by donations.
    Budget Justification: Detailed explanations for each line of the budget; useful for understanding exactly what was paid for.
    Contract: A legal and binding agreement detailing services provided for a set sum of money; a contract consists of a contract boilerplate of legal language; a narrative describing the need, the services to be provided, the methodology for providing the services, the target population, the quality assurance, and the timelines for delivering services; a budget; a sample invoice; and a set of insurance accords. Contracts are effective only when the Controller's Office certifies the accompanying encumbrance document: a Contract Order, but the contract must first go through the City system & gain approval from 6 different bodies before it can get the 7th approval.
    Contract Development Documents: Term used to refer to all pre-Contract documents.
    Contract File: File with only the signed and certified contract and encumbrance document (contract order).
    Correspondence: Letters & memos between a contractor and the AIDS Office person in charge of the contract.
    CRDC: Cost Report & Data Collection (form); not found in AIDS Office contracts but used by staff overseeing mental health and substance abuse services for their contracts.
    Grant : Funds received by AIDS Office which do not originate from San Francisco; these funds may be used to support civil servants, contractual service providers, and operating expenses. Often, organizations label any set of funds coming into the organization as grant funds to distinguish these funds from contracts, which are funds leaving the organization.
    Monitoring Report : Monitoring is an activity administered by the Program Branches (Prevention and Health Services); copies of Monitoring Reports are part of the Working Folders. A summary of efforts to review and assess a set of contractual services, the report summarizes responses to a protocol, findings from a team of community experts (non-AIDS Office persons), findings from an AIDS Office team that reviews fiscal and administrative policies and procedures, and corrective actions to be taken along with timelines. Most reports are the result of site visits by a monitoring team; however, a number of reports are based on a review of client records without an in-depth site visit. The report records the performance of a contractor.
    Processing Documents : Documents needed to process a contract through the seven bodies for approval; these documents are usually found in the working folder and include summaries for the Civil Service Commission, Human Rights Commission, and Health Commission and accounting documents.
    Quarterly Reports: Demographic and risk-factor data of clients from each contractor; form changed each year.
    RFP (Request for Proposal): a competitive method to select a provider for a service; the process involves advertisements and mailings, a description of services to be performed, forms to fill out, a bidders' conference, minutes to the conference, proposals from each organization, a technical review team that is usually composed of community experts (non-AIDS Office persons), criteria by which to score each proposal, score sheets, a report on each proposal's strengths and weaknesses, the team's report/recommendation, and the final decision by the head of the office. Each RFP is numbered and corresponds to a service or a set of services; the number sequence uses 5 digits (015-94; the last two figures for the year of the RFP and the first 3 figures for the ordinal place (so 015-94 means the 15th RFP in calendar year 1994). RFPs must be approved by the staff of the Human Rights Commission.
    Sole Source: A non-competitive method to select a provider for a service; also a justification for the selection of a provider when an RFP is not used; sole sources must be approved by the Health Commission and the staff of the Human Rights Commission.
    UDC (Unduplicated Clients): the number of individuals served by a contractor or a program.
    UOS (Units of Service): e.g., hours of case management services.
    Working Folders/Working Papers: Files with uncertified copies of the contract narrative and budget, demographic information forms, correspondence, monitoring reports, insurance documents, and a cover memo to the Health Commission. As currently used by the Fiscal Services Branch, Working Folders are usually the most complete record of the contract process. They are generally preferred to the contracts themselves, unless there have been changes made in the actual contract, which may be reflected only in the certified copy.

    Arrangement

    The collection is organized in two record groups: Record Group 1: Administrative Records and Record Group 2: Contracts and Related Documents. Record Group 1 is arranged in three subgroups: Subgroup 1: Director's Office; Subgroup 2: Branch Files; and Subgroup 3: CARE Files.

    Subjects and Indexing Terms

    AIDS (Disease) -- California -- San Francisco -- History.
    San Francisco (Calif.). AIDS Office -- Archives
    San Francisco (Calif.). AIDS Office