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As part of $25 million in proposed funding cuts to the San Francisco health department for fiscal 2005-2006, officials are considering reducing spending for city HIV programs, the San Francisco Chronicle reports. The city is facing an expected overall budget deficit of $102 million for the fiscal year. Health department officials are preparing two sets of funding cuts--an initial $14.7 million cut and a second-tier cut of $10 million that will be implemented if necessary. Among the HIV services set to receive funding reductions in the first round of cuts are case management programs and those helping to pay for anti-HIV medications. The second round of cuts would reduce funding for programs providing in-home nursing care for people with chronic illnesses, including HIV; the closure of a neighborhood health center; and reduced hours of services at other health centers. "This is very difficult for us," city health director Mitch Katz told the Chronicle. "We understand the fragile nature of our integrated service delivery system and fully appreciate how reductions in service in one setting will put pressure elsewhere in our system of care." Health advocates in the city say some health department funding could be restored by the San Francisco board of supervisors, but the fiscal problems looming before the city make it likely that substantial funding cuts will be enacted.