And providing support for them is costing San Francisco millions.
ABC7 News reporter Lyanne Melendez walked through the downtown area to see who and what is keeping San Francisco from falling into a slump and reviving its lackluster image.
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That's where she met Louie Hammonds of Urban Alchemy. Think of him as a street negotiator between those with severe challenges and the rest of us.
"It hurts my heart, it hurts my heart, yes it bothers me," he told us.
But rather than ask them to leave this is what he brings to these streets every day.
"There has to be a continued conversation and that conversation would have to be kind, courteous, polite to where they feel respected but at the end of the day they say, 'you know you're right,'" he said.
We then saw him engage with them and then showed kindness by buying them snacks.
They were grateful. A few seconds later, out of respect for Hammonds, they left the area.
"Love is a verb. It's about action, that's it," he reminded us.
MORE: Why some of SF's formerly unhoused set up tents, frequent the streets again
Why some of SF's formerly unhoused frequent the streets again
Urban Alchemy has 530 full-time employees and many more part-time workers.
The nonprofit told us their contract with the city is for 43 million.
They are not to be confused with the Welcome Ambassadors, greeting tourists.
SF Travel has 60 of these ambassadors and spends $4 million a year on the program.
The folks at the Tenderloin Community Benefit District have one of the most challenging jobs in the city, keeping the neighborhood clean and safe.
There are 86 staff members, 32 of them are on the clean-up team.
"They do all the sweeping, they take care of the 86 trash receptacles that are on the corners throughout the Tenderloin. We do needle removal, we do graffiti abatement as well as all the power washing," said Enrique Ovando of the Tenderloin District Community District.
MORE: SF Night Navigation Team reaches out to drug users in at-risk neighborhoods
The community district receives money from several city agencies and from a special tax from residents and businesses.
All Pit Stop facilities and some public bathrooms are staffed by paid attendants who make sure the bathrooms are maintained and used for their intended purpose.
Initially, there were only three sites, all in the Tenderloin. Public Works will spend $11.9 million this year to staff 31 sites in 13 neighborhoods.
Here's another costly program. Because people were using BART elevators for drug use, in 2018, operators were brought in to make sure people weren't overdosing or using them as bathrooms.
Today that program has expanded, and BART and the San Francisco County Transportation Authority share the costs.
The budget to keep those workers in place is $3.6 million this year, going up to $3.7 million for fiscal year 24/25.
Here's why:
"The project team determined that six additional attendant staff were needed (36 total), and costs for required benefits and oversight of staff were higher than anticipated."
The police department currently spends $6.1 million on 104 community ambassadors who are retired officers. This program has been expanded since 2022 to help improve public safety in San Francisco.
Supervisor Joel Engardio who represents the Sunset District made it a priority to bring them to his neighborhood.
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"The merchants like it, the residents like to know that someone is there. It's not full-time police officers but it's something during the day. Anything is better than nothing," said Engardio.
These are only a few of the programs and nonprofits keeping the city in check.
"A lot of those services are being duplicated," said Sam Cobbs, CEO of Tipping Point which awards grants to anti-poverty nonprofits.
He says the homeless and drug problem will never go away, "As long as we continue to throw money at the problem as long as we continue to just say money is the answer to the problem. We also need to audit them. Are we getting our return on our investments, are we getting what it is we're paying for from an outcomes perspective?"
See more stories and videos about Building a Better Bay Area here.