2025 Impact Report

Message from the CEO

If there is one defining moment that encapsulates who SFCHC is at its core, it is the evening of February 13, 2025—when SFCHC’s board voted to be a plaintiff in the lawsuit being filed by Lambda Legal, challenging the constitutionality of the President’s Executive Orders related to diversity, equity, and inclusion (DEI) and gender ideology. Just weeks before that, we received notices demanding compliance with these executive orders, and later one of our CDC HIV prevention awards was terminated outright based on the gender ideology executive order. After weighing the many pros and cons, it became self-evident that suing the Trump administration was the only path forward. 

We have known since last November that organizations like ours were a clear target for the new administration. Because of our explicit and unswerving commitment to the Trans community, to gender-affirming care, and to all the services that we have built over the decades. Because we have focused on people of color and LGBTQ communities, and “DEI” is inextricably attached to these communities. Because our long history as an API HIV advocacy organization has always included work on behalf of undocumented communities. What has made us a prime target for the administration is exactly why we are a beacon of hope for our communities.

And then, on June 9, we won our preliminary injunction from the U.S. District Court for the Northern District of California.

As I reflect on this moment, I am beyond proud. This is who we are. It is always who we have been. When evil threatens the lives of our communities, we look it directly in the eye and fight. But equally, we know that our communities continue to lead and show us what resilience and joy look like. Beyond this, this is the truth—resistance and resilience—that defines our work, who we will continue to be, and how we will continue to fight.

Lance Toma, CEO

“When illegal and vicious attacks come our way, we have no other choice but to fight back. The health and lives of our patients and communities were at stake with these executive orders and this injunction will allow us to continue providing the critical, life-saving services to LGBTQ people, people living with or at risk of HIV, youth, women, and many other populations. The Court’s decision makes it clear that we are paving the way forward to ensure the rights and lives of our queer community members are protected and affirmed. We stand with conviction and pride.”

- Lance Toma on the preliminary injunction granted for our lawsuit led by Lambda Legal

Measuring Our Impact

SOCIAL DETERMINANTS OF HEALTH

Health and wellness are shaped by the social and environmental conditions of our daily lives, which directly influence health and wellness.

We work to address these daily realities, recognizing that many communities face overlapping forms of oppression that compound negative health outcomes. By tackling the root factors that drive health and well-being, we move closer to advancing health, wellness, & equality.

Shelter

Safe and stable housing is essential to health and provides the foundation for physical safety, mental well-being, and continuity of care.

As a part of our commitment to eliminating barriers to high–quality health services, we offer street-based programs, drop-in space, as well as emergency shelter. Addressing the homelessness crisis in the Tenderloin and beyond is critical to reducing inequities and ensuring our communities can heal and thrive.

Beds are provided through Taimon Booton Navigation Center (TBNC), Hotel Rooms, and RESTORE Rooms.

Meals

We cannot address more acute health care needs for our clients if they have not eaten anything that day. 

Access to nutritious foods is a fundamental part of health care. It can help prevent disease, support recovery, and promote overall health and quality of life. Providing meals directly addresses the food insecurity our community experiences and ensures that everyone has the opportunity to get the health care they need.

Community Groups

We know that when people—particularly those who are historically marginalized—feel connected to a supportive and affirming community, they experience dramatically better health outcomes.

This is why we emphasize belonging through community-based programming at all of our sites. Our community support and community groups are life saving and critical to improving mental health and well-being.

Major Challenges & Opportunities

“The path forward requires courage, creativity, and UNWAVERING commitment to our patients’ wellbeing, even when federal policy abandons them.”

- Dr. Tatyana Moaton

Federal Policy Attacks

In the past seven months of 2025, the utter turmoil emanating from Washington, DC, is wreaking havoc across the country. Our communities have been in the bullseye for existential erasure. This is beyond reprehensible. The federal Executive Orders targeting diversity, equity, inclusion, and gender-affirming directly threaten our ability to serve LGBTQ+ people, immigrants, people of color, and those living with or at risk of HIV. SFCHC has chosen to stand on the frontlines of this fight, taking legal action not just for our patients, but for communities nationwide.

State and Local Budget Pressures

Our state funding for LGBTQ+ communities was also at risk of elimination due to budgetary issues, and we advocated in Sacramento to protect our life-saving programs. Despite a nearly $1 billion deficit in San Francisco, we did what we do every year and protected every dollar of HIV funding for the entirety of the San Francisco HIV safety net. These victories underscore our dual role as both a health care provider and an advocacy organization—defending critical funding while continuing to deliver essential care to thousands of people every year.

Community Needs and SFCHC’s Role

Our programs and services are at the tip of the spear when it comes to addressing the critical and imminent needs of our communities. From HIV prevention to housing navigation, from mental health services to gender-affirming care, our programs save lives every single day. We are at the intersection of the complex interplay of substance use disorders; homelessness; mental illness; and the conditions that impact health, as well as the harmful policies that are actively attacking our communities with dire consequences.

Opportunities Ahead

The common theme that persists is that we can never stop fighting, because there is too much at stake. Our mission is not only about resistance, but about building health equity, dignity, and safety for every person we serve. Our goal is to be uniquely positioned to meet this particular and extremely complicated moment. This has always been one of our hallmarks. We know from experience that our persistence matters—our advocacy, community partnerships, and resilience have time and again preserved access to care when it was under threat.

The ability to meet this moment is a testament to the impressive constellation of programming that SFCHC has built over the decades. It is not only about the services themselves, but more profoundly about who is providing the services, how we incorporate lived experiences into the design of our program models, and how we engage and activate our communities in the implementation of our models. Looking ahead, we know the battles will remain fierce, but together with our patients, partners, and communities, we will not only withstand them, but build the future our people deserve.

A note from Dr. Tatyana Moaton, Director of Strategic Innovation & Partnerships

Our community does not go down easy. We’ve turned mourning into mobilization before and will do it again. From the HIV/AIDS crisis to the ongoing attacks on our bodily autonomy, we are still here. Still resisting. Still building. Still demanding more. This is not a moment for despair. It’s a call to action. 

The path forward requires courage, creativity, and UNWAVERING commitment to our patients’ wellbeing, even when federal policy abandons them. SFCHC’s mission becomes more critical, not less, in this hostile environment. “To transform lives by advancing health, wellness, & equality.” 

To our donors: your support now matters more than ever. It is the difference between reactive policy and proactive resistance. Your giving fuels the grassroots, the organizers, the policy strategists, and the programs and services that make survival possible. If you’ve ever wondered whether your donation made a difference, let me be direct: it does. It always has. And now it must.

A Partnership Rooted in Dignity, Hope, & Compassion

Honoring Code Tenderloin

“I spent 18 years laying on those streets myself, so I know what it takes. At Code Tenderloin and the Health Center, we put keys in people’s hands—give them their dignity back. Not giving it back, because they never lost it—they just didn’t know where it was.”

- Del Seymour

At this year’s Show of Hope Gala, San Francisco Community Health Center proudly recognized Code Tenderloin with the Community Impact Award for their tireless service, fearless advocacy, and deep love for the Tenderloin. The award celebrated the visionary leadership of founder Del Seymour and Executive Director Donna Hilliard. In his remarks honoring Code Tenderloin, Miguel Ibarra, Managing Director, said, “In preparing for this, we came across a beautiful and profound quote from Del, where he said, ‘Once a person finds their dignity, you better get out of their way.’ At SFCHC, the care and service we provide to our clients aims to do just that.”

For more than 30 years, Del Seymour has been a champion for the Tenderloin, so much so that he has been nicknamed, “The Mayor of the Tenderloin.” Del founded both Tenderloin Walking Tours and Code Tenderloin to uplift his neighborhood and shift how San Francisco sees and engages with its communities. Del has touched countless lives throughout his life, and his work and service can be seen and felt all around us. Del shared, “Someone would come sit next to me and start talking about their house and their new job. And I wonder, ‘Why is this person babbling out about their apartment and their job?’ And after a while, they say. ‘Del, you don’t know me. You gave me the apartment five years ago.’”

The celebration also highlighted the bold and compassionate leadership of Executive Director Donna Hilliard. The teams of San Francisco Community Health Center and Code Tenderloin found each other while doing critical outreach and work side-by-side in the Tenderloin. The collaboration that grew between our organizations has always been grounded in clarity and action, and carried forward with trust, sweat, and heart. For Donna, the recognition resonated personally: “Many years ago, my sister was a sex worker struggling with heroin addiction and AIDS. San Francisco Community Health Center embraced her then. She later became a case manager, and she advocated for me to get off the streets and do this work. I would not be here today if it weren’t for SFCHC. This is an honor coming from an organization who has set the pathway for others to thrive.”

Over the years, our joint efforts have included vaccinating the Tenderloin, tackling the fentanyl crisis head-on, and creating community spaces and shelter where thousands of neighbors find care and connection. Together, San Francisco Community Health Center and Code Tenderloin have:

• Connected over 5,000 people to vital resources

• Linked over 3,000 people to medical care

• Enrolled over 300 people in medication-assisted treatment for substance use

The partnership between San Francisco Community Health Center and Code Tenderloin is more than collaboration. It is a testament to resilience, community, and shared hope. Kate Franza, Managing Director, noted what she admires most about Donna’s leadership: “One lesson she taught me without ever needing to say it outright was the power of never saying no. Instead, she always asked, ‘yes/how?’ That small shift in language became our compass.”

Hope for San Francisco

Taimon Booton Navigation Center

“TBNC shows us what is possible when people are treated with dignity and respect, and that there is a possible end to the unhoused crisis in our beautiful city. It gives hope that one day the streets of San Francisco will be for travel and leisure but never a place that someone needs for shelter.”

- Saurabh Bajaj

While San Francisco still struggles to house those without homes, what we don’t see is the absence of 75 trans people from the streets at night. 75 of our fellow San Franciscans have a safe and warm place to sleep. This safe and warm place is SFCHC’s Taimon Booton Navigation Center (TBNC). 

TBNC is the only shelter for unhoused trans people in San Francisco, and one of the few that exist in the country. At first glance, it seems like most shelters—it’s a grouping of low-slung buildings, the living space is dormitory style, there are shared bathrooms, and one must pass through a metal detector to enter the Center.

But something feels very different about TBNC...

Megan Phalon, the wonderful director of TBNC, mentioned that, unlike the vast majority of shelters in SF and beyond, TBNC is not based on a prison model. Staff members are dressed in similar fashion to the clients, and everyone is warm and friendly. While there is security, it is unobtrusive. There are no large print posters of prohibitions. Rather, residents agree to a list of organizational policies and community agreements.

Staff have worked intentionally and diligently to make the atmosphere feel relaxed and comfortable, not tense and unwelcoming. There were thoughtful touches everywhere: from the community space and kitchen that are open 24 hours a day; to the culturally responsive mental health and case management services offered onsite; to the taxi rides given to clients so they can access Trans: Thrive, SFCHC’s trans community center; and the other top-quality care services offered by SFCHC at its different sites, including gender-affirming medical care.

Most remarkably, residents who move into their own homes often miss the community at TBNC. In another break from traditional shelters, TBNC allows former residents to return for activities offered onsite, such as karaoke nights. The sense of community is co-created by staff and the residents; the trans community has a long history of taking care of each other. TBNC encourages and helps build an even stronger community among clients.

Many unhoused folks do not go to conventional shelters due to safety concerns (all the more true for trans folks). Restrictions also make it nearly impossible to have both a place to sleep and a personal life. TBNC staff have worked with the community to create a  space that is so much safer than other shelters and community agreements that encourage people to stay, rather than leave. There is no curfew; someone can stay with a friend, partner, or family member overnight and not lose their bed. And if someone does not abide by one of the community agreements, staff don’t automatically ask them to leave. Instead, they give second chances, working even more closely with that client to reduce the harms they may be bringing to others or to themselves. SFCHC does its best to ensure that residents leave only when more permanent housing becomes available.

TBNC shows us what is possible when people are treated with dignity and respect, and that there is a possible end to the unhoused crisis in our beautiful city. It gives hope that one day the streets of San Francisco will be for travel and leisure but never a place that someone needs for shelter.

Samantha’s Story

Taimon Booton Navigation Center

Samantha is one of TBNC’s current residents. She is a charmer. Her sense of humor, authenticity, and empathy would make anyone feel at ease in her presence. 

While Samantha had only the kindest words for the staff and facility at TBNC, her journey through the shelter system and the blatant transphobia she faced is shocking. In other shelters in San Francisco, she was forced to dress and use bathroom facilities not in line with her gender identity. She was even kicked out one time for using the women’s bathroom.

Samantha complained to the administrators of the shelter; San Francisco, after all, has many protections for LGBTQ people. Yet often, it came down to the staff and security who were in charge that evening at the shelter. If those staff barred her from using the women’s bathroom and showers, there was little recourse at the moment, and further complaints led to worse treatment from staff. Policies that protect trans folks and their dignity only work when every single staff person at a shelter follows them and believes in them.

The alternative—life on the street—Samantha said, is incredibly rough for trans folks. At one point, Samantha contemplated suicide. It is heartbreaking to think that our system was so badly failing her that she no longer wanted to live. Samantha’s willpower, and the staff of TBNC, saved her life.

She joked that everyone who works at TBNC is trans; she knows this isn’t true, but said that every staff person deeply understands what clients are going through and that many of them share the lived experience. ‘You’re treated right; you can dress the way you want, act the way you want, and the staff is awesome. I love them to death,’ she said. She had particularly had high praise for her case manager, Shira Noel.

As a client of San Francisco Community Health Center, Samantha accesses services at all the other sites, including her medical care for her upcoming bottom surgery. When she spoke about her upcoming gender reaffirming surgeries, she said she didn’t want to do top surgery because she has enough and that ‘having more than a mouthful just feels like a waste.’ Anyone would feel lucky to spend time with her.

Samantha wants to leave San Francisco one day. Since she completed her 12-step program, she finds the streets depressing and the open use of drugs too sad and now tempting. So often, quality of life conversations acknowledge the misery unhoused people endure and the emotional impact of that on those who are housed, but unhoused folks also are deeply affected emotionally by the suffering of those around them.

And yet, within the TBNC complex, Samantha feels safe, happy, and at home for now. As any person would feel, for her, this means the world.

HIV Prevention Leadership

Our Pioneering efforts with Long-acting injectables

Long-acting injectables (LAIs) represent the newest wave of interventions across a wide spectrum of conditions—from psychotic disorders to medication assisted treatment for opioid use disorder (OUD) to both prevention and treatment for HIV. They offer an advantage over daily oral medications through improved adherence and thus control of chronic conditions, reduced stigma, and decreased pill fatigue. LAIs have cross-cutting benefits through reducing hospitalizations, HIV infections, and drug relapse rates.

“Given the unique challenges that many SFCHC patients face on a regular basis, from their competing priorities of finding food and shelter to having their oral medications stolen or lost during encampment sweeps, LAIs have freed patients of this additional burden of taking a daily pill while also helping them achieve their health goals.”

- Dan O’Neill, Chief Medical Officer

As a result, many SFCHC patients have successfully remained free of psychosis with their periodic paliperidone (Invega®) injection from our psychiatric nurse practitioner. Or they may have avoided relapse into fentanyl use with their monthly LAI buprenorphine formulations (Brixadi® or Sublocade®), often stolen on the streets as pill or films. Many patients living with HIV have finally been able to achieve an undetectable viral load with the only LAI for HIV treatment regimen - cabotegravir and rilpivirine (Cabenuva®) - administered every 2 months. And for those at high risk of HIV transmission, two options are now available for LAI PrEP - cabotegravir (Apretude®) and lenacapavir (Yeztugo®). While Apretude® is administered intramuscularly every 2 months, Yeztugo® is given every 6 months as two shots under the skin. 

As one of the first clinics in the city over this past year to use Brixadi® to rapid-start patients on medication assisted treatment for their OUD, SFCHC is on the forefront of LAI use for chronic disease management. In July 2025, less than a month after FDA approval of Yeztugo®, we administered our first injection of this powerful new intervention. 

LAIs offer an exciting new approach for SFCHC patients. And we look forward to making them increasingly available to our patients in the future.  

2025 Fiscal Year-End Financials

Behind every number is a story. The following financial summary highlights the resources that powered our work this year—funds that translated into meals, shelter, medical care, and community support for tens of thousands of San Franciscans. Just as importantly, these resources sustain our staff, many of whom bring  invaluable lived experience to their roles. Our expertise, commitment, and passion for our communities are what make our programs deeply community-based and responsive to the people we serve.