Supervisors approve $301,600 reserve for PrEP navigators, place funds pending implementation plan

The Board of Supervisors' Budget & Finance committee voted to accept a reduced mid‑year supplemental appropriation of $301,600 to expand access to pre‑exposure prophylaxis (PrEP) for HIV prevention, placing the money in the committee reserve pending a detailed implementation plan from the Department of Public Health (DPH).

Supervisor David Campos, the item's lead sponsor, told the committee the measure would fund “navigators” to help people access PrEP through private insurance, Medi‑Cal, Healthy San Francisco and manufacturer assistance programs. Campos said the supplement is intended to increase education for patients and providers and to reduce stigma around PrEP use.

"PrEP has the potential to save hundreds, thousands of lives," Campos said. He described the appropriation as a first step and urged the city to continue investing in prevention.

Supervisor Scott Wiener, a co‑sponsor, framed PrEP as one element of a broader “Getting to 0” strategy to eliminate new HIV infections and disclosed his own use of PrEP as part of destigmatizing the intervention. "It is still impacting an enormous number of people in our community," Wiener said.

DPH representatives told the committee the department already runs PrEP demonstration programs and has staff who can transition into benefits‑counseling and navigation roles. Colleen Shawwa of DPH said the department recommends PrEP for people at highest risk — including gay and bisexual men, other men who have sex with men, and trans women — and highlighted prior studies and ongoing monitoring efforts that support broader access.

Community providers and advocates testified in support. Bill Hirsch of the AIDS Legal Referral Panel and representatives from Bay Area clinics, the San Francisco AIDS Foundation, HealthRight 360, API Wellness Center, the Harvey Milk Club and others described barriers to access — including out‑of‑pocket costs and language or cultural obstacles — and urged a focus on culturally competent, multilingual navigators. Several speakers gave personal accounts of difficulty accessing PrEP or of benefits gained from the drug.

The committee considered an earlier staffing estimate of 12 navigator positions and a larger dollar amount. The budget analyst reported that the original $602,400 figure (for 12 positions) was superseded by sponsor changes and recommended the appropriation be placed on reserve while the department completes an RFP and implementation plan. The committee approved the amendment and advanced the item without recorded roll call; the motion was taken "without objection." The appropriation will remain in the Budget & Finance Committee reserve until supervisors receive the department’s detailed plan and budget allocations.

What happens next: The appropriation will be held in reserve and released after the Budget & Finance Committee reviews DPH’s implementation plan and RFP results. The full Board of Supervisors will consider required ordinances and final appropriations if and when the committee authorizes release.