While black residents make up less than 4 percent of San Francisco's population, they account for 15 percent of AIDS cases. Still, the city's Department of Public Health has proposed a nearly 90 percent cut in funding to the Black Coalition on AIDS in its fiscal year 2002-2003 budget. The coalition, which had a budget of $1.3 million this year, expects to receive $140,000 in city funds next year. 

"The need is still out there," said Andre Robertson, the coalition's director of prevention. "The same rates of infection are still out there. Yet, I can't have the staff I need to do outreach," he said. The organization, which is one of the nation's oldest agencies working to stop HIV/AIDS in the black community, is scrambling to find grants to cover its budget shortfall. It is not replacing staff members who leave, and its transgender project is currently under-funded. "That population probably has the most acute need," said Robertson. 

Even when the coalition is fully staffed, its mission is difficult, Robertson said. In Bayview-Hunters Point, the city's predominantly black neighborhood, health issues often are less of a priority than environmental and economic issues. "In the Bayview, HIV is not a top priority when you are living next to a Superfund site and you have violence all around you. People have so many other issues on their plate that HIV doesn't get the attention that it should," said Robertson. 

"The message that has typically gone out to the larger white gay community is simply put on a condom and you will protect yourself," Robertson said. "In our approach it is much more than about relationships or put on a condom. It is a whole package because we are dealing with institutionalized racism." 
He noted, "If you have never had a positive experience around the healthcare system, then you aren't going to get tested for HIV."