Everything else there was multiple steps in making coffee and we did have a lighter roost because of the qualities of the keep once you roost it it home gisz the coffee. One thing about the coffee they were special blends and i spent seven years on one blend so thats my pleasure. Each bean they were all chosen and blended with each with different cultural and beans is like people and those people give me a reputation i cant buy. People love you my clients love me they take me to the moves movies. Fell in love with coffee and went to the coffee shops the Community Aspect i really enjoyed. I think its important to have a place for people to show up and talk to their neighbors and recorrect. Your surrounded with all those behalf communicated i communities i love my city San Francisco has a good name my has every cultural in this planet living in San Francisco its a small city 7 by 7 but its huge. I really like the idea of staying in the neighborhood and living in the mission ive lived here the whole time and the community really stick to it people talk about seattle and portland now they talk about seattle and San Francisco. Or portland and San Francisco but San Francisco is definitely on the cuttingedge of the coffee scene in the entire nation. Theres so many romance in coffee is surrounds the sourcing of that and thinking about where it came from and how and coffee is wonderful. I know for a fact i was born to make coffee. I have a notice from the dad let the life i live speak for me and lets have a cup of coffee and talk about it. December 1, 2015 good afternoon, the commission will please come to order and the secretary will call the roll. Commissioner [inaudible] commissioner karshmer. Approval the minutes of the Health Commission meet ging. Motion is in ord orphthe apruchbl the minutes. See moved; and is there a second . Second. Are there corrections to the minutes. Hearing none well proceed to the vote. All those in favor say aye. Opposed . The minutes are passedue naninously. There is no Public Comments for the next item [inaudible] good afternoon commissioners. Today is worlds aids day and there are lots of events going around in the city, but just want to acknowledge because it is worlds aids day and [inaudible] who has stay would the department for i believe over 20 years and shell tell usill have her come up and say a couple words. She doesnt know this yet, Tracey Packer is the Program Director fl for the San Francisco aids foundation is a incredible leader in the aids field. [inaudible] where there was no treatment so as we moved in our medical advances she is leading in bringing that prevention and treatment together so want to bring her up for one minute and give her a hand. Please correct me on the number of years you are with the department. 23 is a half. Thank you very much everyone. It is true you become the pract director . Senior director of [inaudible] it is a very exciting opportunity because i think we will get to 0, the San Francisco aids foundation will support that and the programs i will over see are 1035 market. Those [inaudible] i think it is a exciting time. Thank you for your commitment and your entirewe look forward to the work. She is not leaving us and know she phone call away from me. [inaudible] thank you very much for your services. I also brought [applause] there have been articles in the paper about needle and Syringe Access Services and the department as big leader insuring people have access to clean needlesx clean needles to save lives. The consequences is there is little to that issue and we have a great person in the department who is working at this with other partners in the department where we do have partnerships diz poles of syringes so would like to ask [inaudible] to come up and give a overview and take any questions since this is a emerging issue in the papers. Hi everyone. So just to give elean lockren and work in the community helths health. I work with our funded syringe access and disposal program. So, in response to the issue around discarded syringes, we are utilizing several mechanisms along with our programs doing heightened education to the clients that utilize the programs. I also work very closely with other city dw apartments, Police Department, the supervisors and department of public works to get a handle on the discarded syringe issue. Things we are working on in our branch is towe are in the process of hiring and working on developing a Rapid Response onse team and what thaet team will do is be in the community squurking up cleaning up the discarded syringes in real time and engage with drug users and emphasize the importance of safe disposal and be able to provide resources and referrals. We recognize the problem and that is why there is multiple strategies and we are really looking forward to actually this coming here because we have not only the Rapid Response team, but also other ideas in place to address the issues such as Community Clean up events, additional partnerships. I handed out a handout that all you have. On one side is a map that shows our outdoor disposal boxes we throughout the city. Most of them are placed in the tenderloin and it is based on need. The way we assess need is from 311 data reports and also Community Complaints and calls [inaudible] then we go through a thorough Community Process to get those placed. On the other side where it shows the visual, that shows all the Different Community partners we have working together on this issue of discarded syringes, so it is a collective impact approach of addressing this issue together. Are there any questions . If there are questions for ilean commissioneri guess one question is, you selected a number of places for these, but are thereis there a way of understanding that or are you already know from collection that this is widely known and used by the community of users, or do they offer other suggestions . I think the papers indicated that there were other areas outside of the immediate downtown, right . Yeah, the way we get the assessment or boxes is i get regular reports from 311 so i look at the number effcalls and go to Community Meetings and Police DepartmentCommunity Meetings and that is how we got the placement of those boxes. A lot of times i get a call that we need a disposal box but after a assessment and using the data it turns out it isnt a hot spot per se but it seems like there is a situation that came up and we can address that by sending crews out to do sweeps of the area. That might beif you think back on battery turnings, some of the pharmacies take some of these. Have we thought of pharmacies being a deposit point for these or are they willing do so . Wallgreens accepting syringes. If someone returns a disposal ben of up to 1. 25, wallgreens will accept it and give a empty ben. All the syringe sites take back dirty syringes and give out either a disposal ben or a lox like this called a [inaudible] this is perfect for someone who [inaudible] because it can easily fit in their [inaudible] and holds 20 syringes. So, [inaudible] would you actually be listing wallgreens or is this not for public this particular flier is just for Community Meetings but in a different flier that we have for participants of the syringe sites we list out all the different places they can dispose of syringes and wallgreens is listed on that commissions any other questions you might have . No we have relationships with the Fire Department for restroom access and maybe we can include the Fire Department on this list. I think people may be more likely to go in the Fire Department. That is a great idea and something that is own the list of trying to expand our relationship so i mean that is great idea and think that we should move forward with trying to expand the relationship with the Fire Department and other first responders. Do clinics have these too or not . Clinics are disposal sites and that is listed on a flier for the clients, but we didnt put disposal boxes on that in particular. Do we know exactly why people dont use the Disposal Services and is there a reason maybe they need an incentive like we do with refundable cans or what not . That is a good question and one wree discussing internally a lot. In the next few weeks we will have focus groups with injection drug users and they are the questions well ask of what is not working and what can we do to help us come up with ideas that will be more effective. Anecdotally, i think it seems like people are getting moved around a lot so they leave their packs behind or drop stuff andbut you know, education about proper disposal is a key component of the service. I think what we are working on internally is that our Syringe Programs have more of a system that ties the board of education process of like every time you have the one on one of like, do you understand the importance of proper disposal and the mechanism for proper disposal, so we are working on enhancing that. Is there a downside of having hundreds of these disposal boxes . Eightyone one of the challenges with outdoor disposal boxes is we found it takes a good 6 months before people start using the boxes and there is always differentsomeone may not cross the street for whatever reason, so no different than using a garbage can, if you walk down the street to through it away it is easier to toss it. There may be a downside for having lots and lots of them, but if they are ubiquitous it is easier to not just drop them. I think a challenge is that in placing the disposal boxes we have to get a Community Process and community input. That can also be the biggest challenge because while someone may support disposal box, they dont want it across from their house or their neighborhood, but we areit is ongoing conversation about increasing boxes. It is just whether or not it goes throughit meets the criteria and goes through the different mechanisms to get placed. I was going to ask if infact there is a optional unit now, mobile unit or 2 and there sole function is to go throughout the city when different calls request for service pertaining to this areaas a example it says park and rec and syringe clean up, but let me tell you, the movement of people. You go out to the park this morning you will have more than 20 tents out there even around the play ground and conservatory and aaround the academy of science. [inaudible] move people when activities move and the same time when there are functions that park or in the communities [inaudible] there are different activities a lot of the next day or that evening i have a number of syringes and other things close to Buena Vista School and Rafael School and you get complaints from the teachers and they are afraid to work through and call 311. We have like one or two units and the major function is work the pick up and educate at this point. That is something the Rapid Response team because their sole function is clean up syringes and provide that education and that is what was miss ing before. The funded providers all do sweeps of syringes and in our office we respond to calls as well but it is not our sole function so i think having this team of 3 out there and being able to be proactive and respond will make a difference, because one the challenges now is if you see syringes on the street and call 311, it can take up to 2 or 3 hours to pick them up. Commissioners we hope we will be hiring as rapidly as we can the 3 individuals on a temporary basis and annualize that in the budget and maybe have to grow that team if we see they are very busy during the time period we have them on, so this is a Important Team that we just put together to respond to this issue. Well give you an update as we see that. It is dark side of a very Successful Program so i look at it as somewhat of a blessing we are having this problem. We know clean needle distribution saves live jz have to deal with the outcome of that by insureing the public hasthere is concern for their safety fraurm dirty needles so hope the Response Team is part the solution but scr lots of partners helping as well. Thank you very much. Look forward to the update but the department is moving forward to respond to this issue that is in the papers recently. Shall we move to the next item . Yes. Item 4 general Public Comment and i received no request so we move to item 5 which is report from finance and planning committee. Thank you, in place of commissioner chung and was privileged to chair it with commissioner pating and we went through monthly contracts report and are reviewed that and are prepared to ask you for recommendation just as a brief discussion, our San FranciscoCommunity Health authority is asked to continue to administer the Healthy Kids Program and well provide the private providers which is the second contract. The third contract includes not only administrate was services but developing the subcity Program Infrastructure for our program that we had voted on the bridge to coverage. That amount of money is not just merely for administration of healthy San Francisco, but the expanded healthy San Francisco and the covered options that we had passed under the bridge to coverage program. Lastly, is the contract for the regions of the university for [inaudible] care of the amount of 2. 1 million which is the same amount that we have set aside in the past and it does serve about 800 Different Services for us per year. So, for those services that we dont have as of general. We reviewed the year revenue and expenditure report and we are positive the First Quarter. It is only the First Quarter and mr. Wagner pointed out the big unknown will remain. The 1115 waver formulawe are scheduled to get a update on that in the early part of next year, but at this point in time they are continuing to use the same formial through the rest of this year through december. I put into risk for the second half of the year, the first half of the year, the First Quarter is what was estimated at this time. The third item that we took up was a review of the San Francisco annual report outline and well look at that and have added comments. Lastly, we are in discussions of updated the contract review process. We are very pleased that under the new process that we are able to actually be more diligent on the large contracts to represent 90 some odd protect of the contract dollars and yet we will be able to have a list of the other contracts and understand those services. So, our recommendation on the consent calendar is to pass the contracts report. That leads to item 6 which is the consent calendar. If there are no questions in that well move on to item 6. We are prepared for athe committee put forth the proposal for the passing of the 4 contracts so we are prepared for the vote if there is no extraction of the items. All in favor say aye. Opposed . The consent calendar is approved item 7 is getting to zero update. Doctor good afternoon, [inaudible] direct bridge hiv which is based in the helt department and the Steering Committee getting to zero which is a broad consochium of [inaudible] working to get to zero hiv infectionsjust looking for my slides. Here we go, zero new infections and zero stigma and discrimination. Today is World Aids Day and we made substantial progress and appreciate you inviting me back to speak. So, i thought that i would begin by saying where does getting to zero fit in the Strategic Plan and it is how [inaudible] item 6 on that graphic of the Strategic Plan, but we do also have impact on our others in particularly the issue of black African American health because African Americans are disproportioninate ly effected by hiv throughout the u. S. And San Francisco is no different but we are doing better. I will show briefly updated slides and i wanted to remind that this beautiful annual report that susan sheer who is sitting in the audience who heads the [inaudible] group she and her team put out year. If you would like hard copies we can get your hard copies and it is on the website and it has Interesting Data soben that wants to dig into this in more detail, if you like hard copies let us know. I believe i may have shown this at the summer meet ing which shows we are at the lowest number of new diagnosis in 2014, [inaudible] and deaths living with hiv [inaudible] the death rate is lower. This is new diagnosis by race, ethnis te. This is the total number of new diagnosis per year from 2006 to 2014. The blue line is white individuals, the nob nub line is black individuals and you can see there is a significant decline in both groups. If you were to adjust this for the size the population, however, again we still have a disproportioninate impact on African Americans and latinos. The good news is that in 2014 we only had 14 new diagnosis in women so we are making headway in most populations but still have room to move. I showed woe had 177 among People Living with hiv. What you see is the decline in blue on deaths among that population that are hiv associated that are caused by hiv and non hiv deaths in raed so we tremendous progress in the hiv associated death. I want to show the non hiv causes of death over time and point out the green line is drug overdoses and the purple line are suicides. Both of those are increasing and so we are doing a very Detailed Analysis now of what has happened with those individuals with drug overdoses and suicides and be happy to report back to you if you would like to hear about that the next time i present, but again, doctor sheer and her team have been doing a fantastic job of digging into the data. Is that [inaudible] or opiates . It is both. It is both. It is methadone, it isit isnt heroin, it is methadone, senththeticopeoids like oxy conten and different kinds of stimiants and it ask also unfortunately benzodiazepines. In the green line is San Francisco. I dont know howthey ratio up differently on your handouts. The middle line is california and the yellow line is the entire United States and what you can see if you start with the group infected, we only have 7 percent of those lichbing with hiv in San Francisco who is unaware of the infection. We are doing better receiving care and prescribed [inaudible] and viral surepress so wree at twice the rate that exists in the United States but still have room to move, so i wanted to then talk very briefly about getting to zero initiative. Preexposure, [inaudible] these are brief updateswe have now prep nav gators at 3 dph clinics and dh money allocated for nav gators at Community Clinics will be announced this month. We got a 1. 9 Million Dollar a year grant for 3 years from cdc under doctor urgone and doctor phillip who are heading this effort for prep scale up and out reach particularly with emphasis on people with color and transjnder individual. We are dog doing a lot in building capacity and building awareness and building a tracking system to measure impact and well see the first data from the tracking system after this worlds aids event. Rapid has been shown to make a Significant Impact on time from diagnosis to vieral suppression and a protocol is developed and implemented city wide. In terms of retention and quer the same cdc grant had nearly a Million Dollars a year for retention. I think you aware of the [inaudible] grants given of 500 thousand dollars specifically for retention nav gators that are in the field and we are looking into the data on oferndose suicide and deaths. We will never get to zero without dealing with thes issues of stigma and disrimination so we have a committee that is formed that has a plan in place. I willthese are the collaborations i know we are short on time so dont want to take time away from other peoples presentations but just to let you know there is a fast track city that is highlighted on the website. Many peoplemany cities are signing on, our mayor signed on to it, we are the furcher north American City to be signed on to this website so we have a lot to be proud of. Are there questions i can answer . Thank you. Commissioners, questions or comments . I do think since our other fellow commissioners are not here if we can get a copy of the hiv report you eluded to that is helpful if is hot demand this year. It is a beautiful thing each year so glad it is getting so much use. [inaudible] so proud of this initiative and what we accomplish. I still share with the visions that dont believe it and say you have to be kidding. We are turning the [inaudible] the possibilitiesbuilding a sense that the amount of what we accomplished and the number of heads that we still can turn with this is amazing and the response i get where people see what is possible is more than amazing. They get very excited for us and our nation and thank you for leading the way. It is the whole department that has done this from the beginning and under director garcias leadership. We are partnering now with alameda county. Could you on the slide of the hiv [inaudible] 93 percent where diagnosed and aware we had 69 percent under treatment, so what happened to the other segment . Is it lots to follow up or is there opportunity there to be helpful . Nationally that is the biggest drop off. For people that are newly diagnosed, it is like 83 percent i believe who are linked to care within 6 to 9 months and are working on making that better. That is points otrapid. The issue is getting people to stay in care. When they get into care all most everyone is in treatment among the people in care, but the challenge is keeping people in care and so this is representing all of the people in San Francisco living with hiv. I will say there is a underestimate because there are people that moved out of San Francisco. This is a great example of collective impact and the fact this is in the long haul, this isnt a short term that the department is part of this whole agenda for a long time and it is exciting to see it pay off. Y i want to recognize Susan Phillip and susan sheer and Tracey Packer, they are working diligently towards this effort. Very good. Thank you again. Commissioners, item 8 is std update. There is no Public Comment . Not for that item. Okay, next item. Good afternoon and thank you commissioners. I am Susan Phillip director of disease prevention and control and std controller in San Francisco and want to thank you for inviting me back to speak with you again about std and glad to do it on World Aids Day along with my colleagues doctor buck binder and all the others we work with closely. This is the same framework. There is specialized expertise with std that resides [inaudible] we have the biomedical std clinical work as well as work with clinical providers and disease intervention i control which i lead and then we have Important Community engagement and assessment eeffort that are happening with the [inaudible] branch led by Tracey Packer. If we lookthose are the specialized areas but where std prevention lies . It goes beyond that throughout the department and community och providers and everyone at risk in San Francisco. If we look at the cross utcutting efforts std work is important in black African American health, mu turnl and adolescent health and health for people at risk living with hiv. When we think fwt std we need to understand what drives transmission of std and any infexs disease because if we understand the factors then we taylor or nrtd ventions to group together to address any of these. If we take the example of infexs syphilis, the likelihood of transmission has todo with several areas. One is how likely is someone exposed to a infexs partner. Those can depend on what the local std epidemology is, how privilege are the infections and what is the sexual behavior people are uner taking and screening and treatment that this includes notifying partner and getting preventive treatment out to people. We also want to impact how long a partner might be infexs and screening and treatment is the primary way we are addressing that. How many people have partner jz sex with partners without condoms. Factors that influths that are how accessible are condoms and it goes back to sexual behavior and do People Choose to use condoms if they are available. What we are trying to impact is the population curfb. What are the std rates and how to bring them down and i showed them to you in the past so i want to take a step backthat is what we care about, but as a department and a branch within a population health, we also need to be aware of and work on quality and improvement on the factors that we do control. This is looking from 2010 to 2015 at the speed with which we initiate internally contacting a person who we are notified through a laboratory provider has a case of infexs syphilis. The standard is contacting within 3 days. That is the red line and you see we increased from over 50 percent to 94 percent which is good but we can do better. We are focusing on contacting within one day because sooner contact is better. It is fresh in the mind and may be able to remember part ners and show there is improved ub89 ability [inaudible] we are focus on contacting with 1 day and up to 78 percent and will try it do better than that and try to get that to 85 percent. This is a internl performance measure to work on to contribute to the larger goal oof decreasing stds. I will turn focus to look at a couple populations that are of highest priority because they have disproportioninate risk of std and the first group is men who have sex with men. This is a similar relate today the slide you saw earlier. Superimposed hiv and std curves now. The gold bars are hiv diagnoses and they are declining. Superimposed are the std rates for gonorrhea, chlamydia and syphilis. What is true is std and hiv are very much linked in a couple ways. One is it is critical to understand the std work is essential to getting to zero work and thank doctor buck binder for the acknowledgment of work for the peoplet thado std function. One way we know from our epidemiology and colleagues around the country having infections, particularly rectal like gonorrhea and syphilis and chlamydia [inaudible] a person that is hiv uninfected those are the people we want to perform hiv testing on and if they are positive get them linked into car and if negative we should offer prep. The other effort is Partner Services so for infexs syphilis we attempt to interview all cases and interview the partners. Those people are offered hiv testing and this is a wiwe do case finding and integrate Sexual Health services [inaudible] the biomedical advances that allow us to get to zero, also will allow people at times to have sex without condoms and have seen that is reported in surveys over time there is decrease condom use so at the same time the biomedical advances allow decrease in hiv there is decrease in condom use. That is true opprep but primarily true of prevention that are hiv positive. [inaudible] as a result we need to think differently and think about new approaches to decreasing stds because the old advise of using condoms for hiv and std are nolt always applicable. The decreased condom use is reported, but we do need to increase our efforts to promote condoms, understand when condoms are acceptable and make sure they are available and reinvigorate the conversation around condoms. This is important to understand this isnt something that is happening in San Francisco in isolation, it is happening national and throughout california. We are on the leading edge of this in large part because of our success with biomedical miv re prevention. The rest the country is looking for us to lead this. We are working closely with cdc and partners throughout cities and state and the Nation Coalition of std directors and are looking to for our input. We are invited to tog about our spaerns at National Panels and we are one of few cities invited to present at a syphilis consultation at cdc next month. Because we dont have prep for std and vaccines but we very much hope thaes become available in the future we have to fall back on behavioral intervention and Sexual Health behavior. Using condoms and working us to notify partners. Those are the key things that will lower rates and will take new expertise and be anal to understand how to motivate people to do those things and how we can make those activities easier. Make them the default. We will engage with a [inaudible] and they will build on the work we have done with focus groups and town hauls. Summaries were in the background materials. We understand that this engagement work andmunity activation work and feedback will be the key for std among gay men. So, some the new actrivties and the groupings here have to go back to the slide to show what the key interventions would be based on what causes infection to transmit in the community. We want to have this behavior come on board and anticipate that will happen in january is whatory target date is. We are thinking about new condom education and std education campaigns in the First Quarter of 2016. In terms of decreasing time a person is infexs we continue to do base line efforts and supporting San Francisco aids foundation at magnet and other sites and increase Community Base screening by the [inaudible] brarn that happens where people congregateer bars and gyms. How do woe get people to think about increased condmom use . Some hof that work is done with Community Engagement and town halls. We will try to coordinate with all the efforts happening around getting to jeero including the cdc grant doctor buck binder mentioned. [inaudible] leverage of new dollars to think about Sexual Health broadly and includes std [inaudible] and do retention and hiv clinical care. Here is a quick post thorf town hall we had in july to give their input of what we can do better. The second group at highest risk are young women particularly young black African American women. We are thinking ways to decrease likelihood of exposure. Some of this is overlapping and will try to leverage but the messaging has to be slightly different because the communities are not overlaps and want to make sure twee are relevant and culturally comprehensive. So, in partnership with San FranciscoHealth Network [inaudible] is a really critical piece of this and the [inaudible] in just a moment well hear more about that. To decrease the time is a person is infexs we want to think about a pilot and one way is home based screening that way they dont have to come to a clinic and increasing condom use. [inaudible] focus groups and particularly town halls and try to do parallel wurb with behavioral hemth consultancy in order to really understand what the needs are and what the key messages might be and where we can assist and provide information. Ill turn it over to my colleagues doctor bennett who is a board satisfied pediatrician and interim medical director for [inaudible] foundser and exectev director of the [inaudible] okay. I think we have 7 minutes, so im going to let myself be very brief and let you expand me with question because that i think will maybe get us out of here in a timely fashion. There i go and i learned how to use it. Our goal is all the 15 to 25 year old women in the city will be screened appropriately so not just testing women who are symptomatic but women who came with a cold and havent got screened will get screened. The things that underlie that are somewhat different dependent on the clinic. We have youth spinge clenics that operate different thanly the childrens clinic mpt the questions are the same, the answers may be quite different. What are the current screening rates . Getting data from the emr to work with data from city clinic and making sure we are aware who is infected and due to screening. They were not as simple as you may imagine and work on it and hope within the next few weeks we will have good baseline data. Susan ask i have for years have some collaborations from site to site but how can we do a better job around these issues to have every clinic have good robust reslaigzships with population and who they are screening and are there resources to ugment impact of screening and letting them know they are infected [inaudible] will people be able to use condom and willing to use them and what are the behaveer and resources in the communities that change the diseases [inaudible] that isure cbos and schools and there are other actors in this outside of this. So, our first steps are coordinating with planning planning and preconception helths. [inaudible] is director of Family Planning. The title 10 program , office of Family Planning with state have a intense interest in chlamydia screening but those services are not necessarily coordinateed well with the clinic so suvon, myself and susan hopefully will be the Network Prevention and population and those programs together to talk about a coordinateed approach. We get the baseline data in the next few weeks to month. We are looking where we are doing well. The youth Testing Centers have a higher testing rate. There are fewer competing issues in the health of the population. We are not trying to do this as well as Diabetes Care but they developed more robust [inaudible] we document what those are and trying to create some solutions to the barriers or ways those practices can be operationalized in other places. Part of that is doing pilots on how to improve testing and make it easier. Is that giving a testing packet for something at home or picking up at wallgreens or rapid [inaudible] do their sample and drop it off as a Wellness Center. We will test all those. Third street is the ink baiter and that is in place before i got vauchbed and will take time but we hope as we move through had process we will approach clinics to look at their individual issues and offer them a menu ways we know we can tweak the system to make them better at completing this task and let them know the standard we expect them to get to. That is the [inaudible] brauject. Those pilot projects and there are several we will try to get done, we are not sure which will work, maybe they wont send in the mail and get them in the drop off and be incorrectly collected. We will have to work through and see what will work and then we will know what we can offer. Any questions . Are you done that is susan continuing. We need to same biomedical prevention like we have for hiv. People have said we are not worried about std and worry about hiv andinate others. We do worry because there are cases of ocular syphilis and in seattle some have permanent visual loss. [inaudible] the great work that is happening for treatment but treatment is expensive and dont people to get these infections if they dont need to. We need it think about advances and are on the forfront of that so we need vaccines and rapid tests for stds. We need prep for stds and we dont have that now. We need condoms people want to use. There are no advances in condom science in the entire condoms have existed and need to be at the forfront och all that chblt we vagreat resource here in the department here and that is sit a clinic. People want to come to us to test new treatments and new diagnostics and work with those areas to try to advance for the people of San Francisco so we are grateful for the staff and the patients that come to try to get treatments and diagnostics. City clinic is at the forfront and are trying to do std prevention and have great partners like doctor bennett and the rest the network and leadership of director garcia, i think we will make strides in this area, but there are challenges as well. Thank you and either of us are available to take questions. Questions . What is the timeline for the [inaudible] please come to the like mike roophone. The larger project the timeline will differ from the other focus areas. For ours we hope to get through the pilot phase and document the best protects thaz youth clinic in the next 4 to 6 months at the most and over that time talk to the larger clinics but what their barriers are so we can start looking at implementing some type of intervention towards the later part of next year. Some of the ideas will also test out with the men who have sex with men earlier part of the presentation . That type of overlap. What we really want to do is get the Behavioral Health consultant expertise to help us understand whatyes, that concept of pilots and trying new things is important but we want to know what we should try and where to put the emphasis. We are trying to [inaudible] making sure we have screening and emphasize condoms and what would help turn the dpurfb with stds is help the community inform us. We have a lot of hope because this is a community that turns hiv around in San Francisco and think 23 they put their mind to it and commit to it we will be able to achieve the goals for stds as well. Commissioner sanchez, i think it is a excellent report and follow up. I justone area that is always a ongoing challenge and that deals with 15, 16,[inaudible] founded child abuse and had integrated services in schools there were a lot of misconceptions about where the cohort would be and at that time we had military basis around and one of the initial studies done the largest cohort was children of ranking military officers. These were some of the cohorts that were brought to the center and a couple folks at that point and who started the program and it was shifted so forth and so on, but when you deal with this type of information and protocols and whatever, especially with our unique populations and many refue gees coming. It doesnt matter if you are irish, italian, latin, we have to be aware and respectful and at the same time provide some or think about how could we if we do get something on the radar how do we make sure there is a positive intervention protectingstill make a positive impact for the community because it is tough and it is really hard because of the uniqueness of our communities and as you said so well, the different cultures within the communities. A lot of the communities are no longer white and whatever, they are diverse as they have always been but the community shift jz gives the schools and Health Clinics that are very very necessary another unique eye to look at how kids are being treated and what we can do to provide interventions if requested i think that is why we are trying to be flexible and keep our cbo partners, the schools and other people in the loop and as part of our response because that immigrant child where we have confidentialalty issues and what the family thinks they are doing, those are kids maybe we should contact at the school in the Wellness Center and dhat is the only way we have contact with them. The traditional age use have other issues where they have access. It will be have to be tailored to the population in each clinic but that means people have to be nimble and know their options and now i dont know if we have a good enough menu of options to be flex b89 ability. I have so many questions but i think what ill ask is we heard this at the Community PopulationHealth Committee but may ask we come back sooner to get a more details assessment. I have always known std issues are important from a Public Health perspective but relative scale of overdose obone end and getting to zero on the other, the community thought is my hiv is being treated, so stds, what does it matter, i can get a pill and take my pen sellen and be back in the game or community so where think it is falling off and messaging is important. I want to ask if you can speak to the importance of this a little clearer and secondly what is your thought about our ability to flatten the curve. I guess i want to ask specifically with regards to msm is rising and probably related to hepc, but what about with African American women, is it rising at the same rate . We are on a down slope, it is not helping to decrease the disparity greatly because everyone else is on a down slope. Young African American have quite a peak. There was quite a peak that is coming down but that gap persists regardless. Yes, there is some improvement, it is not rapid enough. [inaudible] African American women there is a big disparity there. Terseiary syphilis and gonorrhea and in infants [inaudible] are we seeing a lot of sequelae or do those come down . We are not seeing a lot of sequela in San Francisco. Syphilis is not primarily in women, it is ovwellmingly in men. We have not had a congenttle syphilis case since 2009 to 2014, so the sequela are not as apparent. I think doctor bennett was saying the disparities are so striking and even though they are coming down it is unacceptable disparity and the fact it is associated with public infamitary disease and [inaudible] women ithis age range so we want to make sure we follow those and pay the most attention with the groups with the highest disparity and here that is African American young women as in the other parts the country. I also think sequela [inaudible] that person by the time they are 20 are flirting with a life of infertility at a time in their life where that doesnt seem important but will seem more important at 30 and that is true of the added [inaudible] of hiv and other sex wale diseases [inaudible] women getting hurpys and hiv those are not as dramatic and interesting and dont trickle to the community to add lat level of fear. [inaudible] so many at risk behaviors it seems this is worth while. Reducing stds and reducing Everything Associated with that in terms of affiliated consequences and associated disease, that is why we brought [inaudible] because we integrate the project with pregnancy prevention parts the department with pregnancy access to help of young women center around a few issues that go together. Thank you very much for helping me understand that. What i would like to do because this is a very important topic we have been following for several years and at this point it looks like we have taken a number of new steps to try tobound this curve back down or continue the downward slope of chlamydia in the African American community. Is that as commissioner pattings we have a follow up to see how well we are doing or where we at the Committee Level and perhaps in 6 months we can hear futher. I think the documentation of focus groups call for a integration and with your consultant that would be something i would hope we can hear that is moving forward because the message remains the same and seems clear on the side of the men with men that they are not recognizing the importance of the stds in their lives. Those that have gone through even beforei wasnt there before penicillin but pretty close, recognize the importance of trying not to consider that these are just colds that can be taken care care of. There needs to be all that type of education and the fact you are getting a conceltant will be helpful. On the practical side they did have comments about the availability of the city clinic after hours and i hope that would be addressed and be looked rep. At Committee Level to be more responsive to the community or if those are flukes. I think you are right, a lot of people rely upon it and looks like woo can be more responsive to answer the immediate needs rather than [inaudible] some problems with the phone exchange. If i can focusinterested on the educational strategies and messaging and the other is access issues, access of condoms and clinics, access tothe relevantwhatever the key elements in the screening to detection streement. We think this is a good start that we have heard that we are taking a new initiative, bringing a consultant and work with our hiv partners where is where the sexual message will get out and using our consultant expertise to really make that as effective as possible so thank you from the committee side we follow that and will have it back at the commission in about 6 months then anddoctor garcia would you like to make comments . I want to thank the staff. We challenged them to come from a new direction and think they have done that. Particularly i like the initiative where we are using Public Health side to influence the direction of our Clinical Services and i know it takes time because of the issues we talked about that the clinics are focused on the whole person care and that is a lot of Different Services at least in the Youth Clinics we can give this a focus. Alameda county started a Initiative Like this as well so we should look to them as the work they have done as well but want to acknowledge both of their works and think we will see progress in quirking to the community. I appreciate our intimately the 2 divisions are working on this. I know this is something we are working towards and to see it is great. [inaudible] that is where we are trying to get to. One logoyou can connect one bridge to the other bridge. Be careful. [inaudible] we just had conversations about that thank you. Really appreciate your presentation and you can see that we are very interested to make sure that we can move the needle on this i very much appreciate the commissions interest. This is important area that doesnt always capture attention so appreciate the opportunity the think through this with you. Any other Public Comment . No Public Comment to this item. Due the the issue of timing, commissioner sanchez has to be at the foundationsthank you to the donors today this afternoon that we would recommend deferring the remainder the agenda to the next meeting with jour consent and is there any other Public Comment that we need to take at this time . I did not rev requests we prepared for vote for adjournment all in favor say aye. All in favor say aye. Opposed . The announcer b dreams and good grades arent enough to get into college. There are actual steps you need to take. Finding someone who can help is the first and most important. For the next steps, go to knowhow2go. Org. So were going to take alfred welcome to your unit so were going to take you. Hi, im carl with the fishermans were thrilled to have you here i get to open a lot of buildings or buildings and none of them brings me more pleasure than today a one and 90 units of air forces Affordable Housing in the heart of San Francisco mere jobs and near transit in the middle of the worst housing crisis to see this project come to reality having done this inspires and brings mayor edwin lee me pride a huge Publicprivate Partnership this deals dates back to chris daily in 2003 and in his office talking about what level of affordability well need what is now infinity that deal 12 years ago is finally give me rise to this project and the two at infinity close to 4 hundred uptsz among those 3 sites so im grateful to the supervisor to the supervisors predecessor grateful to the mayor and the mayors predecessor for the public and private partnering to make that happen and grateful to the Mayors Office of housing whos down the logistics and more importantly thank you to don and n mtc that controlled that site and worked with us this is their product their housing were thrilled to be partners with t n d c the labor life company that saw and put money into this project that helps to provide housing. Jobs in San Francisco and perry this is a huge publicprivate partnering but you explicit come here to hear from me we got a call could we pull the agenda for this forward i week i didnt see what a wonderful morning to be able to open one 90 units of Affordable Housing on the dawn of the mayors reelection by more importantly the passing of prop a and the commitment to the housing bond in San Francisco so congratulations to everyone clapping. with great pleasure introduce mayor ed lee that helped to make that happen congratulations. Thank you. Thank you, carl. Well campaigns is over were going right to work and i am also grateful to carl and to your relationship with tndc to our work request supervisor kim and making this happen he was here already months ago looking at the some of the unit and visualizing what some of the new residents will see are a long, long time im glad theyre here that is the exact the stories were chasing when we said lets get a promotion up before the voter and get a 310 million which will be matched with other money from the budget thanks to the board of supervisors and us agreeing with a higher goal he, he we are already with this how do we do that . Bond were already locating nonprofit partners for more housing we are using the word carl something you and your investors know about investment and about leveraging and this was a parking lot that we invested in now were leveraging it into residences one hundred 90 brand new unit all 100 percent affordable it an incredible story i told don earlier hes the only one that can tell the history how many hands and how many relationships had to be built and trust factor to be created in order for today to happen it is complicated ill let don tell the story but those agencies that live to tell those stories im glad hes with us and not only do we have this particular site to celebrate but it is on the dawn of celebrating more well have a lot more keys given out to love people that need housing in the city the workforce is part of the success whether or not teachers the one teacher got in on an incredible lottery that she had to wind travels in order to get in but hopefully for teachers and Health Care Workers people that work in restaurant and hotels make a good living but find it did to the will live in the city in is what the housing bond does as part of this this is what the private segment a dog more and more with us in government is trying to match up what they can do with us so you can literally see that people in the business whether the marketrate or low Income Housing can find that connection with government and be supportive to make sure that more units are affordable the obligation here targeted with one and 602 unit somehow and someway that story and that relationship was to solid with City Government we reached up to one hundred 90 units thats what we want to do supervisor kim; right . We want to set a goal and see how we can steady this is what the incredible story is about well do that in many sites certainly with the package of prop k you are joint efforts to locate oil public land weve gun control sites and some of the developers with literally calling and saying what wee, we do together now the message is clear you can do more we can all be more successful if we Work Together thats the message our prop a, prop k, our incredible relationships with the private developers and certainly with communitybased nonprofits im landmark to handing out keys and people will be happy to receive and having this incredible courtyard that is a positive experience right in the middle of San Francisco are these center and we have a number of sites within two or three block radius that are going to be underdevelopment in the next few years that signals on i didnt believe amount of of Affordable Housing people will say it great that is guarantee close to transit and close to our Civic Center Park and going to be center of a lot of good activities that people want to be close to as we want to live here and closeness to our arts organizations that continue to lead the effort along mid market and so theres a lot of good news and grad to see the office of Economic Workforce Development is here and the department of building inspection, because were all ready tarnishing not only the sites were going to do housing on but ideas as to how to accelerate them and an Accelerator Fund maybe talk with our kwiblt partners to accelerate all the goals we want because i know that our labor folks dont have enough to do want more work; right . Michael they want more work and do it the right way and get the housing up that is for the would it be fair to say as well thank you to you everybody all the partnerships weve had here and lets keep doing this more than slnlt lets go to work and get more done and video more smiles on families thank you. clapping. supervisor kim. First of all, i want to give a big congratulations to the mayor for winning his election 4 more years. clapping. weve not had much such a mayor and such an hour how were you to work with him and 24 particular were seeing 80 percent of San Franciscos development the statistic im proud of district 6 is building 44 percent in all of San Franciscos Affordable Housing clapping. and i would not be possible not for first of all, the strong support of our mayor and working with us to push the envelope both looking for the Nonprofit Institution and our private developers who know how important to hows everyone in the city but also i want to recognize we have a Strong Institution of communitybased organizations in the district that fight more Affordable Housing for decades and tenderloin corporation with search warrant r is one of them i want to acknowledge their work additional don fox leadership clapping. and building more Affordable Housing and we have several anymore sites im excited about mixed use p mission and howard and 4 and the forethought so when the revenue and the opportunities came forward we built Affordable Housing in the city where the land is incredibly scarce but what is exciting for me, i want to share a story in august i interviewed commissioners 3 applicants what was astonishing most of 3 applicant were recipients of the Affordable Housing program with an lived in my District Court and the second was the housing magnitude by lifesaving strfrtd and the third housing for 14 mists a tenderloin residents it is how for this work is it feels last week were not building enough when you meet the youth and families in the neighborhood weve built Affordable Housing those are the most cranial moments im excited to welcome our recipe to the in and look forward to serving you finally he just want to give a shout out and thank the city for their support of building more Affordable Housing it has been 20 years since we last passed the Affordable Housing bond no 1996 for one hundred Million Dollars and last night for one hundred and 50 million that will have a tremendous impact not only to the district i represent across the city and we have a lot to do a lot to do when i came into the office we were building at 80 percent of low Income Housing needs that is good but have to keep up the numbers we were this only building others less than 12 percent we have to continue to build low income Affordable Housing we have to we must build more middleIncome Housing in San Francisco in order to keep diverse San Francisco whether it is giant on this site or you know with future projects i look forward to making sure we are doing the balance we need to see thank you very much and congratulations to everyone involved clapping. thank you, supervisor kim im don fox ceo of the tenderloin development c n b c im tired those kind of projects have hundreds if not thousands i want to recognize our partners mayor ed lee supervisor kim and the Mayors Office of housing tishmans and hundreds of others we just are part of progress and those dont happen without a collection of people the story of this site begins in 1998 and so if nothing else this is a story of perseverance bank of america owned a parking lot the bart or parking lot the purpose was because they were going to eventually need to expand the data center right next door they were going to need more computers well, it turn out because of the rapid growth of Technology Computers dont need more space but less space they declared it surplus land and argued to to proposal to sell the property in a bargain sale below the market value value in order for us to build housing it is 17 years later thats a very arduous and difficult process through recreations and boosts the detergent of Affordable Housing resources that are available from the state and federal government many challenges to overcome to produce housing like this i think that is important for me to say and for us to understand this is not mark farrell Affordable Housing not mark farrell dwelling units those are homes and home is the platform for opportunity for people if people have Affordable Homes they dont have to make the choice been paying rent and medical skewer and teacher of the hear of their children we do much more than off for you walls and a ceiling thank you very much for being here and ems to the next person thats correct clapping. we have two units that are open for anything that wants to go in and see the units what else am i supposed to say eric. But we thank everyone for coming that this is a great public partnering thank you to everyone for working together to make this you. In landing a contract with the sfoifk is pretty champ but now with the opened Contracting Center visitors can get opportunity at the new state of the arc facility and attend workshops and receive oneonone Technical Assistance and learner what you need to become a primary contractor or what information to be a subcontractor and a created bed Public Commission it will help people to assist people to compete for and performance open city contract a lot of Small Businesses do have the resources to loblth the opportunity so one of the things we wanted to do was provide ways to access contract access to the plans spiefkz and a data place basis ease contracting opportunity and funding or capital training. This is and other documents that needs to be submitted. To compete is a technical skill that it takes to win a scheduling for a popular to you can win a professional services job or how to put together a quote its all those technical pieces. Looking at the contracting Assistance Center is our touch point with we get the people to come and see the planning specks and later than about projects earlier is he get training so youre ready to go arrest hello engineering it has all the tools that a contractor small or large can come here. I cant say enough about the center its a blessing. We do business all over the country and world and a place like the Contractor Center to identify the business in San Francisco the reality is you need training and thats what the center is here to train and make you Better Qualified to go work with the city and county and to be successful at the end. That will give people the Competitive Edge e edge at receiving contracts with the city. We have krafshth services here that help you find out where you need to get the skills forbidding. I mean local businesses participation in City Projects is a winning factor it helms help the business their local businesses theyre paying savings and a property tax and payroll tax and normally adhere san franciscans so their bowing goods and services in San Francisco it really helps the