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In my conversation with Lance Toma, CEO of San Francisco Community Health Center, we talk about his 25-year journey in community health, the organization’s evolution from an HIV-focused API community organization to a full-service FQHC, and the fight to ensure that the most marginalized communities receive the highest quality care — even amid today’s uncertain funding landscape.
Sarah Peaslee: Lance, you and the San Francisco Community Health Center have been pillars of the LGBT community in San Francisco for decades. Tell me a bit more about your journey. What brought you to SF CHC, and what keeps you there all these years later?
Lance Toma: I joined our organization a little over 25 years ago when we were known as Asian and Pacific Islander Wellness Center. I moved to San Francisco from Chicago to work here and to do as much as I could to serve the API queer community, which I identify with. Over the years, becoming Executive Director and CEO almost 18 years ago, I’ve really helped expand our reach, our breadth of services, and our commitment to San Francisco and the Tenderloin neighborhoods.
So, never abandoning our API commitment, but expanding that to include trans communities throughout San Francisco and beyond. And, of course, continuing to support immigrant communities, but also addressing the homeless epidemic, the substance use crisis, and the impacts of mental illness that the Tenderloin is experiencing. All of that is what San Francisco Community Health Center is now committed to, 100 percent.
Sarah: How has the work of San Francisco Community Health Center evolved and grown in your 25-year tenure?
Lance: Starting as an Asian and Pacific Islander HIV organization that came up in the late eighties when HIV was ravaging our communities here in San Francisco, we focused on providing a cultural and linguistic response for communities of color. We developed an expertise around how to reach folks with cultural and linguistic competence. That meant hiring from the community, providing services in many different languages, and having our organization look like the communities we were serving.
That helped us build capacity for what it means to really do the work in communities that are hardest hit and often marginalized or forgotten. Communities of color and trans communities have been the last to get the most up-to-date information and resources. Our organization has been at the forefront to ensure that doesn’t happen. The folks who are maybe most marginalized in our communities — and that still includes communities of color, trans communities, queer communities — but also homeless communities and folks dealing with substance use issues on our streets, actually deserve the most competent, highest quality services and access to the most relevant, up-to-date information and resources.
So that’s how we’ve evolved over time. We’ve really doubled down on the competencies we’ve developed to ensure that we’re taking care of the broadest community here in the Tenderloin.
Sarah: When San Francisco Community Health Center became an FQHC, it was the first new federally qualified health center in San Francisco in over 30 years. Did that designation have an impact on your ability to serve the community?
Lance: That designation allowed us more resources to support our ability to serve anyone who comes through our doors who is low-income or Medi-Cal eligible. That’s a mandate for us. HRSA supports us in making sure we have the resources, and that we’re able to get paid through Medi-Cal and Medicare. We can be part of the managed Medi-Cal system through the San Francisco Health Plan and Anthem Blue Cross here in San Francisco. We’re members of those networks so we can accept payment and serve all the folks who need the kind of care we provide. So it was a game changer for us.
Sarah: You’ve talked about a variety of the services you provide — everything from your street medicine teams to your trans youth services. I believe you're also operating a homeless shelter. How do you as an organization evaluate community needs and decide where to focus your resources and effort, neither of which are infinite?
Lance: That’s a great question, because there’s so much need and of course there are limited resources. The bottom line is, we don’t want to duplicate anything. We want to make sure we’re contributing to a safety net system here in San Francisco that’s not just about us. It’s about a broad array of incredible other organizations, the city, and our public health department. As we think about what it means to grow or expand, it’s always in collaboration with others.
When we advocated for more resources for trans shelter, we had to ask ourselves: do we even enter into this new area that we weren’t familiar with? But we do know how to ensure that a trans-focused service is run by and for the trans community. We have a track record there. That’s where we leaned in, and that’s where the city looked to us. That’s how the Taimon Booten Navigation Center, South of Market, the only trans and gender non-conforming emergency shelter, came to be. It’s now upwards of 70 beds, filled to capacity, with a waiting list.
So, it’s always about assessing the need and asking, are we the right one to do it? Do we have the resources? Can we work with others? Are there city resources? It’s always thinking through all of those questions. If we are the best one and we have the capacity, we will do whatever it takes to ensure that a key gap in our community’s needs gets met.
Sarah: Shifting gears, you’re also the Chair of the Board of NMAC, which represents over 3,000 community organizations across the United States. Tell me a little more about NMAC and the work you all do toward ending the HIV epidemic.
Lance: I’m proud to serve on the board of NMAC, and I have for a number of years. NMAC is near and dear to my heart. It started as the National Minority AIDS Council. We run the United States Conference on HIV and AIDS and the Biomedical HIV Prevention Summit. We’re about ensuring that people of color get what they deserve with respect to HIV. If we’re going to see an end to the HIV epidemic, it has to be about engaging communities of color, gay men of color, trans people of color, and leaving no one behind. It’s about making sure there’s a steadfast commitment.
Being Board Chair of this organization that I love so dearly, the stakes are high. There’s so much riding not just on NMAC, but on many other national HIV organizations. We have to do everything we can to stay on the path toward ending the HIV epidemic, which we know is possible. But there are so many obstacles we have to keep overcoming to ensure we don’t lose the momentum we’ve built.
Sarah: As someone who’s led a community health center for over two decades, what do you see as the biggest challenges facing community health today?
Lance: Right now we’re engaged in a pretty troubling environment. There’s a fight ahead of us, and we’re all trying to figure out what that means. Every health center is trying to figure that out, because our funding is at stake, Medicaid is hanging in the balance.
Part of the work here at San Francisco Community Health Center has always been about advocacy. We wouldn’t be where we are if it wasn’t for our advocacy — and advocating with our clients and communities — because we want to ensure that the folks who don’t have resources, have resources. And it takes advocacy to ensure that happens.
Sarah: Wrapping up on a somewhat lighter note. If you had a magic wand and could make one change to end HIV, what would it be?
Lance: If we could eliminate the stigma that is attached to HIV, that has always dragged us down. The stigma that causes shame and discrimination. We will get there. Without that stigma, we could make the advances we need. I'm not even sure what the issue is. But it’s grounded in stigma. That’s why communities of color haven’t had access to the resources and advances.
If I could erase that stigma, I feel like trans folks would be in their power to create the communities they deserve. People of color would do the same. I just feel like we would be an amazing society. We’ve lost too many people to HIV, and that has been horrific. If we can stop that from happening, if we can end this epidemic, our communities are going to thrive. And I just feel like that’s what we deserve.
The health impacts Community Health Centers have, with relatively little, are phenomenal. Community Health Centers are embedded in their neighborhoods and governed by their communities. We know what it takes to achieve good health outcomes. We have to make sure we don’t tear apart this incredible structure of Community Health Centers across the country.
Lance Toma
CEO, San Francisco Community Health Center
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