The mood three years ago was fearful as a new austerity bore down on Sonoma County officials and service providers working with patients with HIV and AIDS.
Up to $1 million in federal funding for HIV/AIDS treatment, prevention and testing was being eliminated. Similar funding from the state was to be cut too. Monies for prevention and testing -- key elements in the strategy to control the disease's spread -- were to be slashed.
"It sounded like disaster; the whole thing's going to fall apart," said Rick Dean, executive director of Face to Face/Sonoma County AIDS Network.
It wasn't and it didn't. Providers partnered in new ways and the emergence of community health centers as hubs of of HIV/AIDS care streamlined delivery of services.
In a surprising story of adjustment, collaboration and initiative, the county's network of care for HIV/AIDS patients and the efforts to contain the disease have remained intact, and in some cases grown.
"Through a lot of really thoughtful planning and people really stepping up, I think we've got a great system of care," Dean said.
Care and prevention have changed in various ways.
Virtually all HIV/AIDS patients not in private care now get services at federally qualified community health centers around the county, from Guerneville to Santa Rosa.
After a county-run HIV/AIDS clinic in Santa Rosa shut in 2010, free HIV tests were available just two afternoons a week, at Drug Abuse Alternatives Center, or DAAC, in Santa Rosa.
Now six locations in Santa Rosa offer the tests daily. Mobile testing services are available around the county between 10 and 14 times a month and periodically at other social service agencies. And at Face to Face, which used to provide testing three hours a week, counselors trained by Drug Abuse Alternatives Center staff offer testing 32 hours a week.
Physicians with the Santa Rosa Family Residency Program now rotate through the needle exchange run by DAAC. The experience working with HIV-positive intravenous drug users broadens the physicians' ability to treat the disease elsewhere, expanding the prevention and treatment net.
"It's just one of the collaborative things that came out of reduced funding," said Lynn Campanario, director of outpatient services at the nonprofit Drug Abuse Alternatives Center and chairwoman of the county's Commission on AIDS.
"It's the economics of scale or efficiency," said Mark Netherda, the county's deputy health officer, who helped steer a planning process that starting in 2009 brought HIV/AIDS care providers together to manage the transition.
The shift from HIV/AIDS patients being largely treated separately by the county to being seen in community health centers has had multiple benefits, experts said.
For example, providing care in one place for HIV/AIDS health issues and more general issues, such as diabetes or nutrition, makes patient treatment more seamless and also saves money.
"We really do see the integration of HIV/AIDS speciality care and primary care as being ultimately very important for our patients and for our ability to continue to provide the services our patients need," said Mary Szecsey, executive director of West County Health Centers.
And, she said, "There's not duplication of systems, of records and doctors and staff."
Another positive change, Netherda said, is that patients with HIV or AIDS -- who had worried about losing in the Santa Rosa clinic a private place to be treated for a disease with a stigma attached to it -- have been successfully "blended" into the general patient population.