San Francisco pioneers HIV/AIDS program

‘THIS IS MY FAMILY’– Ricky Fletcher, who has full-blown AIDS (lower right) counts Harbor Light staff members as family. (clockwise from top) Juan Castro, Dan Collins, Mickey Anderson, Fletcher, and Janet Williams.


In the early days, when the public was only just beginning to understand the impact of the AIDS crisis, The Salvation Army was at the forefront of dealing with specialized programming in the recovery community.

Harbor Light Center was one of the first two alcoholic treatment facilities for people living with HIV/AIDs in San Francisco.

Today, Captain Phil Smith, director of the program, says that on any given day, as many as a dozen of the program’s current clients are HIV-infected.

In the mid to late 1980s, what had previously often been des-cribed as an alcohol and mental “dual diagnosis” progressively became a “triple diagnosis.” It soon became apparent that a number of clients suffering from addiction and depression in San Francisco also had AIDS. Harbor Light observed universal health precautions, added specialized supportive services, developed a strong education program and started looking for new monies to respond to the growing problem.

When federal Ryan White Care Act money became available through the City in August 1990, (then) Captain Larry Shiroma, the director of the program at the time, applied immediately. Funds were awarded in 1991.

“It was a very emotional time,” says Byron Hudson, a former employee who is now an administrator with Mission Assertive Community Treatment Pro-gram. “There were people succeeding in treatment who were suddenly jolted into the reality of a life-threatening disease about which there was little information. Others, already diagnosed as HIV positive and afraid for their lives, felt helpless about attempting any kind of substance abuse recovery. It was a time of increased awareness of disability needs, increased need for specialized staffing.

“Whatever the city saw as a need, whatever they asked for in treating substance abuse ­ assistance for HIV clients, deaf clients, wheelchair clients — the Salvation Army came to the call,” Hudson remembers. “We tried our very best.”

Carrie Graham, MSW, MPG, who work-ed there as Harbor Light’s health services coordinator from 1992 to 1994, is currently a case manager in adult psychiatry at Kaiser, South San Francisco. She remembers describing the Army’s program to a number of community groups, including the Gay/Lesbian/Bisexual/Transgender Task Force, Disability Task Force and Baker Place.

“I think they may have felt there was a perception in the community that the Army might have difficulty working with the HIV-infected gay community. But after a few referrals they found out it just wasn’t so. By our actions and presence, we were raising awareness. Thanks to the openness of Captains Larry and Vickie Shiroma, we made great strides.

Graham left Harbor Light after two years to continue her schooling. In 1999 she returned to write grants and helped facilitate a program with Kaiser, which does not have residential services, but contracts out with recovery programs and hospitals for certain clients in their outpatient program. It’s a per diem arrangement. Harbor Light staff does the work. Kaiser pays.

Joe Gonzalez, L.C.S.W. CDRP, program director of Kaiser Permanente Medical Group, Inc. is supportive of the program, noting that Harbor Light plays an important role in the continuum of service. Of the patients he refers to Harbor Light, a number of whom are HIV-infected; there are strong success stories. “They’ve used their treatment at Harbor Light to build a solid foundation for ongoing recovery and have subsequently returned to Kaiser to make good use of the outpatient program.”

The original 10-bed integrated recovery program in 1991 provided detox, primary and recovery program activities, specialized counseling and support groups, plus linkage to community health care facilities. In 1994, thanks to a second round of Ryan White Care Act funding, services were expanded still further through an additional 12 bed, 21-day co-ed facility for individuals with HIV/AIDS. Services include specialized counseling and community linkages including transportation for emergencies and primary care appointments.

In 1998, $1.164 million in annual funding was lost when the City of San Francisco determined that the Army’s employee benefits as described by Domestic Partners legislation were inadequate. Private donations have kept the program open, but at a reduced level.

Smith reports, “Though our bed space has diminished, the quality of care has not. We continue to make great strides in improving the quality of care and are recognized in the community as one of the leading providers of substance abuse treatment.”

The work continues. And, unfortunately, so does AIDS. As a resurgence of the disease continues in both the gay and straight community, Harbor Light continues to see clients who are affected ­ people with dual and triple diagnoses, people who have been suffering with health problems for a long time.

Recently, a client died of AIDS-related complications at San Francisco General. He had lived at Harbor Light for some time and his death left the house clearly devastated. Although pain is a daily occurrence at Harbor Light, this was a particularly heavy loss.” Smith gave the eulogy. To illustrate life’s fragility, he pointed to a wobbly chair literally on its last legs. It was fragile…but not broken.

“We may be beat up and tore up, but we’re not shut up,” he said to a room packed with recovering alcoholics. “We all came here with some damage, but the important thing is…we came! I’ve never been in such a place where people held each other up so well. Edward was one of those people who came alongside those who were worn and damaged and he supported them, helped them find strength they wouldn’t have had on their own. Life throws stuff at us sometimes that we don’t know quite how to handle in our own strength. That’s when we need to look beyond ourselves for comfort…

“There are good people in this room tonight. People who care about you and want to support you in your recovery, people like Edward who will come alongside you and hold you up and quite possibly give you that glimmer of hope you need to stay here one more day…”

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