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DATE: |
December 9, 2025 |
07 |
SUBJECT
Title
AUTHORIZE ACCEPTANCE OF FUNDING TO ADDRESS SEXUALLY TRANSMITTED INFECTIONS, SUPPORT HARM REDUCTION SERVICES, AND APPLY FOR FUTURE FUNDING OPPORTUNITIES (DISTRICT: ALL)
Body
OVERVIEW
The County of San Diego (County) receives funding from the California Department of Public Health (CDPH) to develop, expand, train, and sustain the disease intervention specialist workforce (locally known as communicable disease investigators or CDIs), who respond to new cases of syphilis, HIV, and Mpox. Prior authorization for this funding was received from the San Diego County Board of Supervisors (Board) on November 2, 2021 (11) to accept a four-year grant agreement from July 1, 2021, through June 30, 2025, totaling $2,093,808.
Sexually transmitted infections (STIs) remain a significant public health concern locally and across California and the United States. STIs can increase the risk of HIV acquisition and transmission and can cause multiple health complications, including infertility, blindness, hearing loss, and death. Surveillance data demonstrate that the incidence of reportable bacterial STIs has been increasing in San Diego County since 2003.
Additionally, substance use disorder is one of the drivers of increases in syphilis, HIV, and Mpox. Behavioral health concerns, such as substance use disorders, are some of the root causes of high risk behavior determined during STI case investigations. The County was notified on September 24, 2025 of a new grant award from The Center at Sierra Health Foundation for the California Overdose Prevention and Harm Reduction Initiative. This funding is an opportunity to address STI concerns within communities impacted by substance use.
Today’s action requests the Board approve and authorize acceptance of approximately $2,355,534 in funding for the period of July 1, 2025 through June 30, 2030, to support core STI disease intervention workforce development activities in San Diego County; $300,000 for the period of October 1, 2025 through May 31, 2027, to support harm reduction services; and to authorize the execution of all required grant documents, upon receipt, including any annual extension, amendments or revisions that do not materially impact or alter the services or funding level and apply for additional funds for STI testing and prevention resources.
Today's action supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by training and supporting staff to link residents who are vulnerable to HIV and STIs to testing and prevention resources, as well as ensuring that residents living with diagnosed HIV and STIs are linked to care and treatment services.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grant, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants.
2. Authorize the acceptance of $2,355,534 in Disease Intervention Specialist Workforce Development Grant funding from the California Department of Public Health, AIDS Drug Assistance Rebate Fund, for the period July 1, 2025 through June 30, 2030, and authorize the Chief Administrative Officer, or designee, to execute all required documents, upon receipt, including any annual extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
3. Authorize the acceptance of $300,000 in California Overdose Prevention and Harm Reduction Initiative funding from The Center at Sierra Health Foundation, for the period of October 1, 2025 through June 30, 2027, and authorize the Chief Administrative Officer, or designee, to execute all required documents, upon receipt, including any annual extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
4. Authorize the Chief Administrative Officer, or designee, to apply for additional funding opportunity announcements, if available, for sexually transmitted infections testing and prevention resources.
EQUITY IMPACT STATEMENT
In San Diego County, gay, bisexual, and other men who have sex with men comprise 62% of recent HIV diagnoses and 70% of persons living with HIV. Moreover, like much of the United States, HIV has disproportionately impacted some of San Diego County’s most vulnerable residents, which include Black and Hispanic communities, gay, bisexual, and other men who have sex with men.
Additionally, substance use can increase the risk of contracting sexually transmitted infections through impaired judgment, risky sexual behaviors and social factors. When compared to population and community data related to the Social Determinants of Health, the groups who experience racial inequity tend to experience measurable disparities in health and well-being outcomes, including higher proportions of substance use, according to the Racial Equity: Framework and Outcomes Brief, reported by the County of San Diego, Health and Human Services Agency, Public Health Services department in October 2025.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed action supports the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services and resources, and Sustainability Goal #4 to protect the health and well-being of San Diegans. This will be accomplished by increasing the capacity and skill of our disease intervention staff with an aim to prevent, identify, and treat sexually transmitted infections (STIs). Testing, identification, and treatment of STIs will improve the overall health of communities, reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs. Additionally, this will be accomplished by providing overdose and disease prevention education, outreach and engagement, and linkage to care, such as substance use treatment and other healthcare and supportive services.
FISCAL IMPACT
Recommendation #2: Authorize the acceptance of Disease Intervention Specialist Workforce Development funds
Funds for this request are included in the Fiscal Year (FY) 2025-27 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs and revenue of $261,726 in FY 2025-26, and $523,452 in FY 2026-27, for an estimated total costs and revenue of $2,355,534 through FY 2029-30. The funding source for this grant is the California Department of Public Health. There will be no change in net General Fund costs and no additional staff years.
Recommendation #3: Authorize the acceptance California Overdose Prevention and Harm Reduction Initiative funding
Funds for this request are included in the Fiscal Year (FY) 2025-27 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $151,059 and revenue of $147,450 in FY 2025-26, and estimated costs of $156,283 and revenue of $152,550 in FY 2026-27. The funding source for this grant is The Center at Sierra Health Foundation. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $3,609 for FY 2025-26, and $3,733 for FY 2026-27, for a total of $7,342 through FY 2026-27. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the costs. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The HIV Planning Group recommended approval of the recommendations at its November 19, 2025 meeting.
BACKGROUND
The County of San Diego (County) receives funding from the California Department of Public Health (CDPH) to develop, expand, train, and sustain the disease intervention specialist workforce (locally known as communicable disease investigators or CDIs), who respond to new cases of syphilis, HIV, and Mpox. Prior authorization for this funding was received from the San Diego County Board of Supervisors (Board) on November 2, 2021 (11) to accept a four-year grant agreement from July 1, 2021, through June 30, 2025, totaling $2,093,808, which was invested in expanding the public health workforce. On July 29, 2025, the County was notified of the Disease Intervention Specialist (DIS) Workforce Development Grant funding from CDPH for the period July 1, 2025 through June 30, 2030.
The purpose of the DIS Workforce Development Grant is to develop, expand, train, and sustain the DIS workforce. This is the second time CDPH has distributed DIS Workforce Development Grant funds across 61 Local Health Jurisdictions in California. The focus and goals of the grant are to:
• Expand and enhance frontline public health staff;
• Conduct DIS workforce training and skills building;
• Build organizational capacity for outbreak response; and
• Evaluate and improve recruitment, training, and outbreak response efforts.
The County Health and Human Services Agency (HHSA), Public Health Services (PHS) department monitors the impact of sexually transmitted infections (STIs) in San Diego County. In 2023, in San Diego County, there were 1,089 reported cases of infectious syphilis (down from 1,131 cases in 2022), 6,651 reported cases of gonorrhea (down from 7,694 cases in 2022), and 17,720 reported cases of chlamydia (down from 18,144 cases in 2022).
This funding will support the County in continuing to intervene in the transmission of STIs by providing timely investigation, linkage to care, and partner notification. It will also provide ongoing training and development for communicable disease investigators who are assigned to STI, HIV and Mpox cases. Moreover, it will support the ability of the County HHSA PHS to respond to outbreaks of known and currently unknown STIs, such as the emergence of Mpox in 2022-2023.
The County will receive $261,726 for the period of July 1, 2025, through June 30, 2026, and then $523,452 annually for the period of July 1, 2026, through June 30, 2030 from the DIS Workforce Development Grant funding from the CDPH, AIDS Drug Assistance Rebate Fund. Year 1 is half the funding for a full 12-months of service due to an overlap between the first and second funding agreements.
Additionally, the County was notified on September 24, 2025 of a new grant award from The Center at Sierra Health Foundation for the California Overdose Prevention and Harm Reduction Initiative. This funding is an opportunity to address STI concerns within communities impacted by substance use.
People who inject drugs are at high risk not only for medical and mental health issues, but also transmissible diseases such as syphilis, HIV and hepatitis C, and are more likely to die prematurely than people who do not inject drugs. Injection behaviors, such as sharing or re-using injection equipment heightens these risks.
On April 29, 2024, the County officially initiated the Harm Reduction Services Program which provides integrated disease screening activities including HIV and hepatitis C testing, wound care, provision of harm reduction supplies, referrals to wrap-around services, and health education. In the last 12 months, the program served 1,954 individuals and dispensed 7,455 doses of naloxone and 5,415 fentanyl test strips. Program participants reported 747 overdose reversals due to the availability of the naloxone. Additionally, there were also 86 HIV tests and 77 hepatitis C tests conducted. Rapid syphilis testing will be added in 2026. The purpose of the California Overdose Prevention and Harm Reduction Initiative funding is to support the introduction of a contracted Peer Support Specialist to provide overdose and disease prevention education, outreach and engagement, and linkage to care, such as substance use disorder treatment and other healthcare and supportive services; bolster administrative support to carry out plans to expand harm reduction services in the county; improve syringe disposal availability through the purchase of a safe syringe disposal kiosk, and enhance supportive services focusing on transportation and nutrition.
The County will receive $300,000 from The Center at Sierra Health Foundation for the period of October 1, 2025 through May 31, 2027.
Today’s action requests the Board authorize the acceptance of CDPH AIDS Drug Assistance Program Rebate funds in the amount of $2,355,534 to support disease intervention workforce development activities in San Diego County; the acceptance of $300,000 from The Center at Sierra Health Foundation for expansion of harm reduction services; waive Board Policy B-29 as the funding does not offset all costs and the public benefit of providing these services far outweighs the costs by providing necessary health and social services to populations unlikely to access services in traditional settings; and authorize the Chief Administrative Officer, or designee, to execute all required grant documents; and authorize applications for additional funding opportunity announcements to support STI services.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the Equity (Health) and Community (Quality of Life) initiatives in the County of San Diego 2025-30 Strategic Plan, as well as our commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This is accomplished through education about Sexually Transmitted Infections (STIs), interruption of the spread of STIs, and reduction in the impact of STIs on San Diego County residents, leading to improved physical health and a healthy, safe, and thriving region.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
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