Nonprofits, we can truly make a difference and save peoples lives. Im particularly proud of the department of Public Health. They continue to show their commitment to innovative and groundbreaking health solutions. I also want to thank ucsf and getting the goal coalition and all of those with us who continue to show their commitment to addressing this issue as well. Even though weve reached this incredible milestone here in our city, we know that there are still disparities that exist, specifically by race and ethnicity, by age, by gender, and, sadly, by housing status. These disparities highlight the work we have to do to continue to get to zero and really trying to remove the barriers, the stigma, the discrimination, so that we can truly end new infections, which is our ultimate goal. In fact, in 2018, africanamerican men had the highest diagnosis rate. Africanamerican women also had the highest diagnosis rate. Fighting this should be our focus and we are taking steps to do so. This week the department of Public Health will launch a competitive bid process where we will allocate 8 million in additional funding to Community Organizations primarily serving the africanamerican, latino, transgender and substanceuser communities in order to strengthen the work that we are already doing. [ applause ]. Mayor breed we have programs right here at ward 86 that others will talk about to really continue to help those that, sadly, we know are homeless. Just last week, we announced our new initiative to help those suffering from Mental Health and addiction who are homeless on the streets. This initiative, our heal our city initiative, will help us to serve, treat, and house those living with h. I. V. And help prevent new h. I. V. Infections. Again, i want to thank everyone here today who is doing work, including dr. Graham cofax who has been an advocate and working in this field for so many years, your incredible leader of the department of Public Health. I want to thank the positive Resource Center for their work. The San Francisco aids foundation which had an incredible event and continues to raise money to invest in this effort. The transgender law center. Aids legal referral panel. The lgbt center. All of the leaders of the getting to zero coalition. Your work is truly appreciated and the value of what you do makes a real impact, as we can see by the numbers that were presenting here today. It is something that we should be proud of. And yes, the work and the investments will continue to be made. This is a milestone for our city. I want to thank each and every one of you for your work and advocacy to get us to this point. With that i want to take this opportunity to introduce a champion in this effort. This and so many other issues that we need to address in San Francisco around Mental Health reform and others, supervisor Rafael Mandalman has been an incredible force in addressing this issue as well. The supervisor for ward 8, supervisor mandalman. Thank you, mayor breed. Thank you for your tremendous leadership on this and so many other issues. As i walked in today, i had a couple of thoughts. One is every time i walk into ward 86 i get a little bit ver clempt because of the amazing work that has been done here for decades and then the amazing work that continues to be done to chart a new path to actually get us to zero. I am such a fan of dr. Gandi and of all the folks who gave me a tour early this year or last year, i dont remember when it was. This is an extraordinary place. Walking in here and seeing this collection of the citys Public Health talent, i am just we are very, very lucky. [ applause ]. Yeah, they deserve some plaza for the work they do each and every day to keep this city healthy and make it healthier. This report has fantastic news. Dropping under 200 reminds me a little bit of 20 years ago, 21 years ago at this point. I am old enough, as some of you are as well, to remember when the bay area reporter had its first no abyss issue. Now we are trying to get to the next step of no deaths and no new infections. To the folks who conceived that several years ago and have been pushing for that goal, i want to extend profound thanks and congratulation on the success that weve made. Some of the data i mean, my aide got me some of the amazing statistics. Overall in the city, 94 of the People Living with h. I. V. Are aware of their infection. That is an extraordinary number. That is not true in the rest of the country. You know, there were no children under the age of 13 were diagnosed with h. I. V. Since 2005. Babies are not being born with h. I. V. In this city. That is an extraordinary accomplishment. We are getting people tested. We are getting folks into treatment. That is how we got closer and closer and closer to zero. That leaves the bad news in the report that were going to hear more about, which is the persistent challenges and, in fact, the increasing rates of infection among africanamerican, latin max, folks on the street, folks struggling with Substance Use disorder, and Mental Health issues. I want to thank dr. Cofax and mayor breed for the creative thinking they have brought to that issue. We know we will not get to zero until we get a handle on really getting care to the folks on the streets who are living with so many challenges, who you see every day in ward 86. I think what the mayor has recognized thank you, madam mayor for recognizing it it is going to require crossdepartmental collaboration, nonprofit government, private actors all working together to really solve these challenges. Everybody can do their part. Here at ward 86 youve come up with a popup, Innovative Program to give folks the care they need. They dont have to make the appointments. They come in and youll wrap around them and give them everything you can in each of those encounters you can. Monica gandi moved out of this ward, so im not happy about that. Im happy youre still in San Francisco. All of you who have gotten us to this milestone and going to get us to zero, thank you so much. [ applause ]. Mayor breed thank you, supervisor mandalman. Now to talk a little bit about the report is the director of the department of Public Health, dr. Grant cofax. Thank you all, today. Its great to be back in ward 86. I worked here for over a decade and im looking forward to returning to the clinic to be a clinician as well. I experienced, as with many of you, the grief and the sadness and advances that weve made with h. I. V. I started as a medical student and weve seen the progression that weve made and the progress thats been accomplished. Whether youre a community provider, a clinician, a researcher, a member of the press, i think the legacy teaches us that it takes a collective vision, a collective effort. Prioritysetting, and understanding what are the priorities in the system to help us do better. Thats the San Francisco h. I. V. Model. Thats our homegrown model that got us here today with h. I. V. It will get us to zero. Getting to zero has the departments full support going forward. I think as importantly is the San Francisco model for what we do with h. I. V. Will also be the model for how we address what may seem like intractable Health Problems today. Think about where we were 20, 25 years ago. Think of where we started. Who would have thought were getting below 200 . We still have much more work to do. We must be bold. We must be innovative, both and h. I. V. And with Mental Health and with Substance Use and with addressing the intersection between health and homeless. Speaking of both vision and innovation and getting us to where we need to be, one of the key people in this city whos doing groundbreaking research, dr. Hyman scott of the Public Health department. Dr. Scott. [ applause ]. Thank you, grant. Thank you for inviting me to say a few words about some of the work that were doing, and the focus on really addressing disparities in our epidemic in San Francisco. Im a clinician here at ward 86. I came to San Francisco because this was the model of how you take care of people as they come. I think our focus on disparity has to focus on ensuring that we reach people where they are and that there are no hardtoreach populations. There are just hardtodeliver services and we need to rethink the way that we approach some of those services. I think popup is a great example of that. Some of the other street medicine and other opportunities to expand prep and treatment outside of the four walls clinics. Although my focus has been on prep and weve seen overall increases in prep use and continuation in San Francisco, we have seen lower rates uptake among black m. S. N. , for example, 10 in other race and ethnicities. In 2017, that was the case. In 2018, it does look like that gap is closing. Weve also looked at some of our data across our primary care clinics. It does appear when people start prep, they dont always stay on prep. The average duration on prep is eight months, despite continuing risk for h. I. V. Acquisition. We take care of individuals after they have been on prep and stop prep. Some of the barriers people have are related to access, costs, insurance changes, perceptions of risk, and discrimination. I think we really want to support people as they initiate prep in their communities, with their providers, to ensure that people who want to access prep can stay on prep. We also have a focus in ensuring that the systems in which people receive care particularly for prep and treatment are affirming places and that we address the structural issues, including Structural Racism that a lot of our san franciscans are experiencing in the health systems. So were really excited about the opportunities of these new efforts to really address these social determinants of health which are driving many of these disparities and preventing us from closing those gaps. I think if any city and jurisdiction in the country can do it, we can do it here in San Francisco. Thank you. [ applause ]. So thank you, dr. Scott. I just want to emphasize the focus on health equity. We must make sure we drive down the inequities that were seeing in San Francisco. Its been a privilege to serve under mayor breed and this is a priority of the Department Going forward. I also know we cant do this alone. The Health Department is a key piece of this work, but it also takes partnership. One of the great things of San Francisco is the partnership weve had historically with ucsf. Its my great honor to introduce a leader, an internationally known leader in h. I. V. Research. She really brought the model that was being used internationally and successfully. I was able to be part of those early conversations about whats going on locally and how do we turn the tide locally . What do we need to do . I think that key commitment of ucsf and the key commitment of professor Diane Havlier in her team, making sure were looking locally, she has been an amazing advocate. A key supporter of getting to zero. Shes going to talk a bit about her vision today. Thank you. Diane havlier. Its an honor to be here today. Im going to be talking on behalf of getting to zero. What is that . That is bringing people together from different sectors and communities with a common goal of ending the aids epidemic. It is built on the spirit of San Francisco because it requires collaboration, volunteerism, and action. So the report that came out just a few minutes ago is our report card. It is how are we doing in getting to zero with our goal to end the aids epidemic in our city. One of the logical questions is, what is the getting to zero contortiums response to the report . Many of the members of the Steering Committee here, we want to share with you our reaction to the report. We are pleased, but not satisfied. We are pleased because we broke the 200 barrier. Just to say that in San Francisco over the last five years, new h. I. V. Diagnoses have gone down over 50 . I dont know if you know this but in the United States it has become completely flat. We are pleased because people are starting treatment earlier. Many of them on the same day with a program that was pioneered in our ward 86. A couple of years ago this was simply unheard of. We are pleased because people from all around our country, all around the worldcom come to San Francisco and to this ward to find out what were doing and how we get results. What starts in San Francisco doesnt stay in San Francisco. We are not satisfied. Im just going to go back to the 200. Were not satisfied because we nearly had nearly 200 diagnoses of h. I. V. In our city, and its a preventable disease. Were not satisfied because of his disparities. Youve heard africanamerican h. I. V. Infected male, his mortality is more than half that of his counterpart. We have many disparities. Getting to zero, were making the strategy. What are we going to do about it . So lets start with we have a double down on these gaps that were seeing. What we need to do that is we just need to listen. Thats one of the things in getting to zero, we convene people together, put the problems out there, have multisector discussions how are we going to work on this. We need to listen. We need to deploy new innovative approaches with tools that we have like prep. And longacting injectable therapy that could make it easier for some of our populations. And finally, the biggest challenge we are going to partner with the Mayors Office and all areas of San Francisco with the structural barriers to care. We know what those are, inadequate, gaps in housing, Mental Health services, and for Substance Abuse. Thats what were going to do. Ive been working in h. I. V. I came here in 1984 committed to the aids epidemic for decades. It is a conniving and very successful virus. I know that we can reach our goals. I just want to put forward for us who have been working in h. I. V. For decades, these are the questions of our time. Should we invest to end the aids epidemic . Can we end the aids epidemic . Will we end the aids epidemic . On behalf of getting to zero, our answers are yes, yes, and yes. We think we can do that because were San Francisco. Just look around here because were in it together. So thats what i wanted to share with you on behalf of getting to zero. So now id like to turn the podium over to colleague dr. Monica gandi who is the director of ward 86 and one of the huge structural barriers that were addressing is the Homeless Population and monica is going to talk about popup. [ applause ]. Its really an honor to be here. Just to tell you a little bit about the history where youre standing right now. We opened ward 86 in january of 1983. So this is the oldest h. I. V. Clinic in the country. Then across the street simultaneously opened an inpatient ward 5 b and 5 a. And many innovations in h. I. V. Care have come from this clinic. So a lot of the investigational therapies in the 1980s and 1990s were tested here starting way earlier than the rest of the country and the world. A rapid program, as diane mentioned, and a prep program. We know that many elements that are key to success for People Living with h. I. V. Are challenging if you dont have a place to live. That would be making and keeping appointments, particular set of appointment times, where do you store your medications and keep them safe, that theyre not stolen, safe sex, healthy eating. All of these barriers are amplified 100fold if you dont have a home. In addition to all these treatments we have here, we started the popup program and that was in january of this year. Im going to tell you about the popup program, but mention one statistic from this report that was released a couple of minutes ago thats so relevant to the popup program. Among people who are homeless living with h. I. V. In this city, the goal of therapy is 34 and among those who have homes is 74 . That is tremendous in terms of virulogic suppression. We aim to reduce that discrepancy in virulogic suppression rate. People who are living with h. I. V. And homeless are 27 times more likely to die than those who have homes. What does popup do . The people who were coming here were not just coming for the appointments, but for urgent care and to get food or to be warm for a minute or to come in for a minute. The idea was to have a popup clinic form around this clinic. Its like a popup restaurant where it is care that is designed especially for them. The popup clinic is composed of two or three designated m. D. Providers, a doctor, social worker, nurse, and nurse manager. It is a Certain Group of people who pop up around the patient, provide primary care, vaccinations, provider vouchers, food, warm clothing, hygiene kits. All of that is done in the context of no appointments. It doesnt make sense to have a tuesday, 3 00 p. M. Appointment, when youre living in an encampment. They can come any time of the day. If theyre a member of the popup clinic, our group forms around them and does this tenderloving care. It has been successful so far, and i hope to tell you about that in a later forum. There is no way that reaching this last 10 and these