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 cartons
(66 Cubic Feet)
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.
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
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