Jean Shepard, who has been the Health and Human Services Agency acting director since November, was officially appointed agency director in May. As director, Shepard is accountable to the county’s chief administrative officer and the County Board of Supervisors. Shepard and Terry Cunningham, chief of the Office of AIDS Coordination, spoke with the Gay & Lesbian Times recently about the county’s involvement with San Diego’s GLBT community.

HHSA, created in late 1996 when the San Diego County Board of Supervisors approved a merger of the five largest health service providers in the county, affects almost every nonprofit and HIV/AIDS service provider in the county, including The Center, Bienestar and APICAP.

HHSA manages the county’s allotment of statewide Ryan White funding, which was cut twice recently – $500,000 from the state funds, which was supplanted by Ryan White Care Act money, and then an additional $530,000. Shepard said speculation that more cuts will occur in July and January is unfounded.

“We don’t expect any more cuts,” she said. “We’ve got our planning board and our prevention board, and anything that we do in terms of reductions, we always go back to them, they identify the priority services, so we use our boards very well in helping us manage those cuts.”

Along with the chief operations officer, Shepard oversees an annual budget of more than $1.4 billion and an executive team that directs the hundreds of programs and 6,200 employees that comprise the 12 divisions of HHSA, including Mental Health, Public Health Services, Alcohol and Drug Services and all regional offices of Aging and Independence Services and Child Welfare Services.

Customers are served in county facilities, at home, in hospitals, community clinics and agencies, as well community-based organizations under contract with HHSA. Staff at Aging and Independence Services, for example, assess the needs of seniors who are homebound and arrange for services, assist low-income pregnant mothers, provide health education outreach to workers, make service referrals and identify welfare risks such as protective custody issues.

The Center receives funding from HHSA for HIV/AIDS care and treatment services and for HIV prevention services with HIV-positive individuals and families. Bienestar receives county funding for their programs involving Latino men who have sex with men (MSM). APICAP does not receive county funding directly, but subcontracts with The Center for their Positive Action and Operation Samahan programs.

Though HHSA is strong on HIV/AIDS support, there are few, if any, county-funded services addressing other needs of the GLBT community, including those of GLBT seniors, youth and homeless.

“We do not get any funding for LGBT services even though we do provide a variety of social services for our Latino LGBT community,” said Carolina Ramos, regional director of Bienestar. “We have support groups, advocacy services, translation, court accompaniment, and that’s to name a few.”

When asked if this was due to reluctance on behalf of the county to address those needs, Shepard, who has worked for the county for almost 28 years, 20 of which have been in the health and human services division, said it has more to do with funding priorities.

“I don’t consider it accurate,” she said of any perceived reluctance. “As I said, I’ve been around here a long time. I was around when the Office of AIDS was first established many years ago, when we realized that HIV/AIDS services were a priority. I don’t think we’re reluctant to address it; I think we deal with the funding that we get from the state and the feds – I’m not quite certain about a reluctance.”

When asked what the county is doing in terms of social services, support and addressing the primary healthcare needs of the GLBT population, Cunningham said the county supports pre-existing organizations that provide support.

“We depend a great deal on funding from other sources, and we support those organizations that do have programs for lesbian, gay, bisexual, transgender and questioning individuals,” he said. “You know, a significant part of the funding that The Center receives is from the county. Although it is targeted for people with HIV and AIDS, it still helps in the infrastructure of the organization and Family Health Centers has the transgender clinic and men’s clinic, as well as the Ciaccio Clinic, and so we help with the infrastructures in all of those.”

“That’s a complicated question,” said The Center’s executive director, Delores Jacobs, about the need for county funding to address GLBT issues beyond HIV/AIDS, “but the short answer is: I believe the recent needs assessments of youth, seniors and now women clearly tell us that there is great need for services other than HIV services in our community. Those needs are for youth programs, senior programs, housing/shelter programs, family support and mental health programs that are delivered in a sensitive and appropriate fashion to our community members. While I’m not a big fan of ‘big government’ and I do understand limited resources, I also think that LGBT citizens are taxpayers who deserve their tax supported health and human services funding to be directed to provide some support for their community’s needs.”

Jess San Roque, executive director of APICAP, agreed. “As Dr. Jacobs has stated, other program needs in our community are for: youth, senior, housing/shelter and mental health programs,” he said. “I also agree with Dr. Jacobs that these programs must be delivered in a sensitive, but most importantly, culturally specific/appropriate [way].”

Shepard said the details of how Aging and Independence Services will handle outreach and education to seniors and about the expanded domestic partner benefits they will be eligible for when AB 205 is implemented January 1, 2005 will be worked out once the state has revised all of their forms and issued instructions to the county.

“I just know that there are going to be benefits that will be available, and of course the county will follow along with the state and federal guidelines on any benefits that are to be given to domestic partners,” Cunningham said, adding, “The county does not look at sexual orientation when they’re providing services, so services are provided to everyone in the county equally, including lesbian, gay, bisexual, transgender individuals.”

Cunningham said all providers who have contracts with the HHSA have contract language that specifies eight hours of cultural competency training per year, which includes a section on GLBT sensitivity.