Transcripts For SFGTV 20150122

Yes. Can i have a motion . Okay. We can take that without objection. Please silent cell phones and devices and files should be submitted to the clerk and items will be on the january 27 board of supervisors agenda innocence otherwise stated. Thank you madam clerk. Can you please call item 1. Item 1 is for the recreation and Parks Program to accept and expend grant for 6,352,275 for the state of california for the department of housing and Community Development for housing related parks projects for the grant standard agreement for a period of november 17, 2014 through june 30, 2016. Thank you. I am tony moran and with the recreation and Park Department and the item before you is the legislation to accept and expend a resolution for the 2013 housing related Parks Program grant from the California Department of housing and Community Development in the amount of 6,352,275. This program is a formula grant based on the housing permitted in the city during a period of time and in this case it was 2010 and 2013 calendar year. Additional bonus dollars are granted if the park projects that are developed through the funds are in disadvantaged communities and park deficient communities. At the time of application the city staff that worked on the project determined that they would only select projects that were going to secure those bonus dollars so all the park projects funded by this program are in disadvantaged communities and park deficient communities. The application was prepared by the Planning Department, Mayors Office of housing and the rec and Park Department. Staff submitted the application for the housing parks grant. And in february the board of supervisors adopted a resolution that authorized the department to apply on behalf of the city and apply for the grant. We were notified that the grant was awarded, 6. 3 Million Dollars to construct various park and facilities and we have rdd parks and we have mayors Senior Community projects and two are planning projects, Planning Department projects including acquisition of dagid park and a temporary installation the living zone located on market street. Both the Mayors Office of housing and Planning Department also supported two of the park prrksz, 17th and folsom and hill top projected. They will administer the grant on behalf of the city and we will enter into an mou with the Mayors Office of housing and the Planning Department so i am recommending i am requesting recommend to the board of supervisors to accept and expend this grant. Okay. We have project sponsors available from planning and Mayors Office of housing to answer any questions that you may have. Thanks ms. Moran. First of all congratulations on the grant. Its a big deal for the city. Colleagues do we have any questions at this time . At this time. We dont have a budget Analyst Report on this item so we will open up the Public Comment . Anyone to comment on item 1 . Seeing none. Public comment is now closed. Can i have a motion to move this forward and we have a motion and we will take that without objection. Thank you everyone. Madam clerk can you call item two. Item two is a hearing for ending hiv infections in San Francisco with brief advocates and with the goal of eliminating hiv in San Francisco. Thank you madam clerk. This was a hearing request requested by supervisor wiener and campos and i am joined with them today and well turn it over to them to hold the hearing. Thank you chairman for allowing us to hold the hearing today and i want to thank supervisor campos for cosponsoring this important hearing where we will be talking about and receiving an update on the very aggressive and successful efforts to move us towards eliminating new hiv infections in San Francisco via the getting to zero strategy. Its a very, very exciting effort under way they think is going to bear significant fruit frs our city and potentially for the nation and were. The world if were willing to support it to make it successful. Ing colleagues as you know San Francisco has been at the epidemic of the hiv epidemic and we were hit hard during this time and the castro my district, was profoundly and determinedly changed as a result of this epidemic but as San Francisco is subject to do this city fought back hard even when the state and federal governments were no where to be found and devoted incredible resources to save our community, the community pulled together, and this city really innovated and adopted methods of care and prevention that are now models for the nation and for the world, and we have been incredibly successful in terms of giving people access to care when others in the country dont have access to care. We have been very successful in reducing infection rates and adopting very aggressive and innovative prevention measures but with that said we continue to face challenges. In addition to the 15,000 People Living with hiv in San Francisco some of whom are doing very well, others continue to struggle, nearly 400 people a year are zero converting and becoming hiv positive in San Francisco. 50,000 people a year continue to become positive each year in the u. S. And over 2 million per year worldwide, so despite all of our strides and all of our successes we have work to do and we do have a path to ending new hiv infections and so we know how we have to do that and were going to hear about that today. There is a consortium formed a year ago called the getting to zero consortium, a wonderful coalition of Government Agencies and department of Public Health and ucsf and Community Based organizations and i know my office and supervisor campos office have been involved and we will hear about the strategy today to end hiv infections. We know if we get people tested regularly so that people know their status that when people do become positive theyre immediately connected with treatment to quickly suppress their viral load making it less likely they will transmit the virus to anyone else. We know if we can keep people consistently in treatment so theyre healthy and have a suppressed viral load that will reduce new infections and we know if we continue to promote prevention every times, including traditional prevention efforts like condoms as well as prep which is an incredibly important newer method of dramatically reducing the rate of hiv infection. All of this allows to have a future where we have no hiv infections and if we do it right here in San Francisco it will spread to other the parts of the country and the world, and we know in order to make this successful we have to put the resources behind the effort. This doesnt happen for free and we know in saving this community and the Community Saving itself through the height of the hiv epidemic this city did that because City Government even when there wasnt the state and federal support, and we continue to get more federal cuts today even, this city put the resources behind these efforts, and we need to do that again today making sure that people have access, not just to testing, but also to treatment, and also to prep, and i know we have to continue to do a lot of work to make sure that were expanding access to preexposure prove axis and i asked to be assigned to the Budget Committee because i know were all working hard to come forward with a proposal for the next budget to make sure were funding some of these getting to zero efforts so its exciting and i look forward to working with everyone and move forward, and i want to offer supervisor campos the opportunity to speak before we get to our wonderful list of speakers today. Thank you supervisor wiener and i want to thank the chair and the committee, Budget Committee for hearing this item. I think its important to have this hearing as were beginning the process of completing a city budget. I think that the issue of hiv aids needs to be a critical part of the equation as we put together a budget which ultimately reflects our priorities as a city. I also want to thank the Provider Community that is here, and look forward to the discussion and presentation. One thing that i would say is that i think our goal should be that we eradicate hiv infection here in San Francisco that that to the extent San Francisco has been a sanctuary for so many different people and issues that we are a sanctuary city city for immigrants that we should aim to be a sanctuary where there is no hiv aids infections here in San Francisco. I think thats the objective. I also think that you have to put the context provide some context for what is happening here. We have come a long way, but we still have some ways to go, and there are still many disparities in certain communities, the africanamerican community, the latino community, the transgender community, and i think that the reason why San Francisco has been so successful in leading the way is because were not afraid to try new things and thats where i think this new focus on prep has come in, and i think that we have taken an important first step but its only a first step. I think a lot more needs to happen for us to really pat ourselves on the back and were doing everything that we need to do. The last thing that i would say, and i would encourage the folks in this room and people who are paying attention to hiv aids funding is that for hiv aids funding to be successful it cannot exist in a vacuum. You cannot talk about serving those living with hiv without talking about the other issues that impact their lives. Housing is an important issue and we have a housing crisis in San Francisco and lets be honest. City hall has done very little to build affordable housing. We still have a large number of erks visions. The ellis act evictions are down but overall theyre up in San Francisco and in the mission, the castro a lot of people, including members of the Lgbt Community are being pushed out. Access to health care on so many levels is unequal in San Francisco and then we have a large number of the Lgbt Community who are homeless, and more people are living on the street. Many of them are living with hiv and the fact theyre on the street does not help the situation, so i hope that as youre coming to this building to make sure that hiv funding is protected that you also take the time to advocate for other funds that is critical to the communities youre trying to protect so i look forward to the presentation. Thank you. Thank you supervisor campos and before we get to the speakers i want to thank adam taylor and my office for the work and representing the office for the getting to zero consortium so we have several different speakers today. First were going to hear from several participants in the getting to zero consortium and then the department of Public Health and then from happen, the hiv aids providers and when dph presents i am interested in knowing what the likely federal budget cuts are going to be in the next fiscal year, and its sad that we have to assume theyre going to be more cuts but given the insanity and melt down in washington, d. C. Which impacts many Different Things we know every year there are millions more although i think its less this year and ryan white and cdc funds and the mayor and board has been great in back filling the federal cuts and were doing beyond that in terms of moving forward with great prevention efforts. I want to start with the getting to zero consortium and followed by the aids foundation, dph and ucsf. Good morning supervisors. I am jeff sheea and living with hiv and i was the hiv advocate to gavin newsom and serve on the governing board on the California Institute of regenerative medicine. Thank you supervisor wieners and supervisor campos for sponsoring this meeting and thank you supervisor farrell for the opportunity to present today and thank you Barbara Garcia and the department of Public Health and i am part of the consortium and were here to talk about the historic opportunity for San Francisco, ground zero in 1981 at the beginning of the aids epideppic to be the first mutiny of injury new infections, zero deaths from hiv and zero stig ma. This is a realistic goal for several reasons. First there is the amazing and compassionate response from the San Francisco community to hiv aids starting with initiatives by mayor Dianne Feinstein and speaker willie brown and every mayor and the board of supervisors. San francisco has the finest system of care and prevention in the world. Thank you. Second, two major studies have presented results recently. One showed that Healthy People without hiv but at risk for becoming infected can achieve greater than 95 protection from getting infeblghted if they take a single antihiv pill everyday, prep. The others show that patients with hiv who are successful treated to the point that virus levels in the blood are undetectable would have near normal life spans and reduce the ability to transmit to the uninfected partners by 96 . We are presenting initiatives that target three key populations. Prep for those at risk for infection, rapid, therapy for those newly infected with hiv and a Retention Initiative which we hope over the years to include more and more on housing because all of us agree with supervisor campos that the elephant in the room for anything that is happening in San Francisco right now is the desperate need for housing, especially for middle, low income people and people affected by disabilities like hiv. Our retention effort will focus these patients at risk of becoming loss to care or loss in care. Its important this is feasible and a financially sound initiative because the expansion of access to Health Insurance due to the Affordable Care act so we have a great debt of thanks to president obama. Let me introduce my Consortium Members presenting today. Dr. Diane hadley chief of the division of San Francisco aids in San Francisco General Hospital. Dr. Susan buck binder at bridge and at San Francisco department of Public Health and kneel jewel ano and the first presenter and the chief executive officer of the San Francisco aids foundation. Good morning. Thank you mr. Chairman, supervisors. I will present some information today just to give you an up date on the data and you will hear specifically about the proposal in a bit as well. This pin wheel is important. Its as important as it is colorful because it represents all of the various partners within the community who are involved, members of the consortium, partnering organizations in the public and private sector as well as the Steering Committee members. To point out that no one entity no one organization, foe one group is. Get to zero by itself. This chart shows the success in reducing new infections and reducing the number of deaths in San Francisco to hiv aids. And increase of persons living with hiv in San Francisco and im not going to go through these specifically. You have the presentation, but its a good trend but as indicated earlier with 359 new diagnosis in 2013 we have a way to go in reduces infections in San Francisco so what are some of the trends . The overall number decreased just in about every cohort, men and women, africanamericans and caucasians, men who have sex with men, decrease in people who infect drugs but we see an increase in the 2529 years old and while we know disparities remain and there is the highest new infections in africanamericans and latinos. Really great message and a true Success Story with regard to hiv in San Francisco is the tremendous advancement in pediatric cases and you look at the Great Success there are no hiv infections in newborn babies since 2006. The hiv care cascade has been talked about and looked about in the United States and closely in San Francisco as well. What you see in the red bars are the percentage of peoples in the United States on the far left that are aware of the hiv status. The middle, blue and red indicating those linked to care and on the far right the significant impression of the fact that 63 of our folks in San Francisco are virally suppressed while nationally the number is only 25 . This poses a great opportunity for us because we need to increase that number from 63 to 100 . When people are viralally suppressed as you heard they are not infectious and the virus cant be spread so thats an important part why we can be successful being the first city to end hiv in San Francisco so good news that overall death rates and positives have decrease since 2006 but the disparities still remain. More than three quarters of the death occur in people over 50 years of age. And were seeing now that survival among the Homeless Population can be as good as people in that are housed with hiv positive and probably is because of the housing related initiatives which points out to the comment that supervisor campos made just a little bit earlier. Its very important for us to remember that there is a relationship between what were doing in housing and hiv. There is a relationship to what were doing with Mental Health and hiv. These things that youre going to hear in a bit in regard to getting to stwrr are not in a vacuum all by themselves and we note the great positive trends and commitments of you and others in the community have made. Supervisors and the mayor have been very committed to the health and well being of San Francisco by back filling position can cuts that came through state levels and we would make note that the goal here and talking about this initiative of getting to zero this initiative is on top of and over and above all of the things that were currently doing. This is not a Replacement Program to replace funding for the existing supports and programs that is taken place so we appreciate the back filling that has taken place, and the support for the existing programs in the Community Today and were here to talk about a new commitment, a commitment to get us to zero that is a multiyear effort and we believe and the experts involved in the work that takes place in San Francisco enables San Francisco to be the first city to end hiv transmission and with they will turn it over to diane or susan. Thanks so much neil and thank you to the supervisor frs giving us the opportunity to speak here so im going to be talking about there are thee three initiatives, prep, rapid and retention and those are in addition to what were currently doing. We are planning to hold ourselves accountable at supports and town Hall Meetings on World Aids Day and we just had one on december 1 of this past year of 2014 so im going to talk first about preexposure prove lax us and reminding people that the formulation of two medicines can prevent hiv infections. There have been multiple trials now showning its preventing hiv negative people from being positive through drug or transmission. The effectiveness is over 90 if taken daily and its a well tolerated medicine with low side effect profile. The cdc and the World Health Organization have both endorsed this program for hiv uninfected people that are at risk for people to exposure and men who have sex with men and women and drug users and thats during what we call seasons of risk so its not receive long therapy which unfortunately hiv treatment is. Its really during periods of time when people might be exposed and i want to state that this program is a game changer when you look at where we have been. We have been in the same place for hiv prevention for the lasted 30 years promoting condoms and risk reduction. We havent had new tools to prevent infections until the proof that this Program Works and thats why Time Magazine named it in the top 10 medical breakthroughs in 2010 so i think you may have all seen the really wonderful Advertising Campaign that San Francisco aids foundation and others have undertaken to advertise and get the word out to individuals who may benefit from prep, and i just want to remind you that San Francisco really has been at the hub of the preexposure prove lax us world from the on set and the department of Public Health participated in the first prep studies in the United States, both a safety trial conducted by cdc and the groundbreaking study and bob grant at ucsf im sorry gladstone and the San Francisco aids foundation initiated and coordinated and was a Principle Investigator and that studied show that prep was effective and with men who have sex with men and San Francisco was one of the two u. S. Sites. There is a campaign that the foundation has launched the first project outside of a Clinical Trial took place at San Francisco city clinic here in San Francisco and cdc has granted a contract to San Francisco General Hospital to provide guidance to provider who is want to administer prep. If you look at the next slide you will also see that kaiser is one of the largest providers of prep nationwide and probably worldwide. Theyre now they have been offering prep and you can see if you know about this the theory of innovation diffusion you can see there is a Tipping Point and the number of people who have been initiating prep has really taken off so its now 30 to 40 people a month at least who are initiating prep, and in all of those that large number of people who have started this program there have been no new hiv infekdzs, again demonstrating the power of this help in preventing new inventions. If i can jump in. Its important the kaiser study. Unfortunately the headlines out of that study in that cohort there was a reduction in condom use so some of the people trying to deligitimize prep latch on to that and the press unfortunately focused on that. The bigger news even if there was a reduction in condom use that not a person zero converted and that is extraordinary and that should have been the head line and i appreciate you including that in the presentation. Absolutely. I think people dont recognize that condoms dont work all of the time. They break, slip and sometimes not used properly and people dont always use them properly, so their effectiveness is probably 80 in preventing hiv transmission. And so the next slide is really about paying for prep because it could be expensive. The great news is the cdc made the recommendation that its provided. Medical covers this in california and medicaid nationally. Most employee sponsored programs pay for it and we have patient assistance programs outlined here but its a complex situation and people seeking prep need a lot of assistance because each plan within a Given Program pays for a different amount and may cover one component but not visits or lab tests, and so we really need what we found is most successful in getting people prep is having the navigators that help them arrange the appropriate insurance and find providers willing to provide it, so we have a three pronged approach for what is needed for prep. We need assistance from providers