Public health flags STI/HIV disparities and funding cliff; harm reduction program reports 40% client increase and launches new overdose response tools

Santa Clara County public health staff presented the annual epidemiology report on sexually transmitted infections and HIV and followed with an update on the county’s harm reduction program, which administrators said has expanded services and demand.

Epidemiology highlights: staff reported that chlamydia, gonorrhea and syphilis rates rose through 2019, fell during the COVID‑19 period primarily because testing declined, then rose again in 2021–2022. Early 2023 data show a drop in rates that mirrors statewide and national trends. New HIV diagnosis rates have remained broadly stable; however, Hispanic/Latinx residents showed persistently higher case rates and case rates among Black/African American residents were disproportionately high (some data suppressed for privacy because of small counts).

Public health used the Healthy Places Index to map resources and infection rates and said higher STI and HIV case rates correlate with census tracts that have lower access to social and economic resources. Dr. Sarah Rudman told the committee the department is prioritizing access for vulnerable and hard‑to‑reach groups and noted concern about several funding sources that are “sunsetting” or being reduced; she said the department has already scaled back some programs and is exploring reallocation of county general fund resources.

Harm reduction update: Dr. Akanksha Vaidya reported the harm reduction program served 40% more unduplicated clients in fiscal 2024 than the prior year. Staff said syringe distribution has declined since 2022 as the program expanded distribution of safer alternatives to injection; naloxone doses distributed rose 29% and fentanyl test strip distribution rose 57% from the prior year. Program staff reported 562 self‑reported overdose reversals in the last fiscal year.

The department described new initiatives funded in part by a CDC Overdose Data to Action (OD2A) grant and opioid settlement funds: a public website (odfreescc.org) with prevention resources and a data dashboard; post‑overdose support teams that perform outreach after nonfatal overdoses; harm‑reduction vending machines; and expanded partnerships with community clinics. Staff also described a low‑barrier medication‑assisted treatment (MAT) program that served roughly 120–150 clients per fiscal year and noted that MAT funding in the prior year was about $500,000 shared between a community medical provider and navigation services.

Budget and funding: committee members noted approximately $5,900,000 in current county general fund appropriations tied to STI programming; public health staff said much of that funding is already committed to clinic operations and to match state or federal grants, and that shifting general fund dollars risks jeopardizing other revenue. Staff said they are leveraging opioid settlement funds and exploring options but that the loss of federal and state grants poses a major risk to sustaining services.

Committee action: supervisors moved and seconded a request to bring STI program funding and potential reallocations to the county’s May budget process; the motion passed on recorded ayes from Vice Chairperson Abakoga and Chairperson Lee. The committee also voted to receive the harm reduction report. Staff will continue collaboration with behavioral health and community partners to maintain services as funding landscapes shift.

Public comment: multiple public speakers raised child abuse and screening concerns; one commenter, Ben Zee, urged immediate screenings for children he said had been abused and asked county staff to follow up. Committee members and staff identified confidentiality, mandated reporting pathways and coordination with child advocacy resources as separate processes from the STI/harm reduction items presented.