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Politics & Policy

Supervisors approve $6.5M increase to harm reduction contract, but raise questions on outcomes

A Board of Supervisors’ budget committee approved a funding boost to a Department of Public Health (DPH) contract for harm reduction services, but not without some hesitation in light of the city’s alarming rate of fatal overdoses. 

If passed through the full Board of Supervisors, the budget amendment would add $6.5 million to the health department’s existing $36 million contract with the San Francisco AIDS Foundation, a longtime provider of harm reduction and sexual wellness services in the city. The contract, which funds syringe access and disposal services, is in effect until July 2026. 

According to DPH, the additional $6.5 million will go toward increasing HIV and Hepatitis C testing, health education, and additional harm reduction support. But members of the budget committee voiced reservations about what they viewed as a lack of data around uses of past funds and the impact of their programming on an ongoing overdose crisis exacerbated by fentanyl. 

Supervisor Matt Haney cited $1.6 million in surplus funds that were awarded to DPH in March with the goal of reducing overdoses, and asked the department to explain what those funds were used for. 

“I think that with a contract of this size a further conversation is important,” Haney said at a Nov. 10 meeting, asking the Department of Public Health to return with a more detailed report on the funding.  “We approved a million-plus dollars for a very specific purpose earlier this year, and I’m yet to hear whether those specific positions and those specific civic services have been deployed and who has been served by them.”

Haney, an outspoken supporter of harm reduction, said he was "frustrated" by what he saw as a lack of outcomes from a previous $1.6 million allocation. | Camille Cohen

Nikole Trainor, a clinical research coordinator from the Department of Public Health, said on Wednesday that the department allocated $600,000 of the $1.6 million to the San Francisco AIDS Foundation to implement a mobile contingency management program, designed to provide low-barrier services and counseling to drug users. The other $1 million went to funding the DOPE Project, a national harm reduction coalition focused on overdose prevention. 

The mobile contingency program started in July, and by the end of October had interacted with 527 people, distributed 628 doses of nasal naloxone, and facilitated the reversal of 164 overdoses, according to a DPH report provided to the SF Standard. 

After losing Internet connection for much of the discussion, Haney motioned to move the amendment to the full board with a positive recommendation. 

The city is currently under contract with the AIDS Foundation for $109.5 million across 13 contracts, some of which date back to 2011.

The current $35 million contract for syringe access and disposal amounts to over $4 million per year, as part of over $14 million in annual contracts that the foundation maintains with the city. The contract was initially established in a 2016 agreement for two years and $4.9 million. The Board of Supervisors later renewed the contract twice, the second time in 2019 for a seven-year, $35 million deal. 

As is a practice in harm reduction, the AIDS Foundation promises client anonymity in order to reach people who have fractured relationships with the health care system. According to Eileen Loughran, the Department of Public Health program manager, this complicates the process of collecting data and showing verifiable success markers.

“It would be my desire to see more [data] tracked,” Safai responded at that meeting. “As members of the Board of Supervisors, we are constantly asked ‘what are you doing measurably to deal with the crisis of addiction’…If you ask people’s names, will they just walk away and not participate?” 

Loughran responded that asking for names could lead to a low utilization rate owing to “distrust in the community” among people seeking to access supplies for safer drug use. 

Haney said that while the board has “huge respect” for the AIDS Foundation, he hoped to see clearer outcomes of their work. According to the Medical Examiner, the city witnessed 511 fatal overdoses between January and September of this year, the majority of which involved fentanyl. 

“With the scale of the fentanyl crisis in my district, everywhere I look people are dying,” Haney said on Nov. 10. “I know that you’re on the frontlines of this, but I continue to feel that whatever it is we’re doing is nowhere near enough.”

David Sjostedt can be reached at