>> good morning everyone and welcome to the meeting of september 18, 2014, of the board of supervisors neighborhood services & safety committee my name is supervisor david campos i'm the chair of the committee i'm joined by schmeer the vice chair and we'll be joined shortly by supervisor norman yee who is a member of the committee clerk oh, also joined by schmeer the clerk is derrick evans and covering the meeting jennifer lowe mr. clerk any announcements

please be advised the ringing of and use of cell phones, all the speaker cards should be submitted to the clerk today is a historic day in san francisco we have a hearing today to discuss how san francisco, california continue to play the role of being a leader and how we treat aids i hiv fact is the hiv aids movement started in san francisco as we phase the possibilities with this new drug it makes sense that san francisco about take the first step in getting to a point where almost eradicating aids in san francisco it was approved by the fda a couple of years ago and yet even though in san francisco we have made a

great deal of process in 2013 there were 3 hundred and 32 hiv infections. >> i'm sorry we need to call the first item. >> item one is a hearing on the aide aids precipitation question have 20133 hundred and 32 hiv infections we have s had 2 thousand individuals that contracted aids in san francisco prepare and the puss u as you use of preparing can eliminate hiv infections by 29 percent daily use of preparing works and when taking it daily it reduced

the risk of hiv infection by 90 percent right now many insurance companies will will navigate preparing but it's difficult to get the approval for the coverage some people choose a keeper affordable act plan with a high deductible that makes it impossible i'm proud of the city's history many things the department of public health is work with the nonprofits agency like the san francisco aids foundation but san francisco must do more not only must we do more because it saves lives but from a financial standpoint it makes sense for every hiv infection we prevent we save 3 hundred and 55 thousand dollars in treatment it makes sense for us to make a

small investment not only to save lives but save hundreds of million dollars that the city will otherwise have to spend in treatment because i want to make preparing accountable i want to make it contrary we'll be introducing a budget supplemental on tuesday at the board of supervisors that will create a co-pay sups program in san francisco that will insure that individuals that point access to pretty sure can a have it without the co- payments they now have to pay i additionally my proposal establishes a set of in fact, our notations the county to help people in fact the process for shuns and medi-cal and the manufacturers patients program thank you to

supervisor wiener for co-sponsoring this and my colleagues have xhments comments to make i want to thank supervisor wiener for talking about how this is an important personal issue for him fact is we have the possible in san francisco to be the first time city in the world to make preparing successful we know that what happens in it san francisco often leads to other jurisdictions doing it it's about time it is not only morally the right thing to do but financially it makes sense i labored to the presentations but before we go to the presentations i want to i'm going to turn it over to i know that supervisor wiener wants to make a few remarks. >> thank you very much mr. chairman and thank you for the work you and your staff have been doing on this incredibly

important issue preparing is one of those things that for anulnar acceptablely large segment of the community go under the radar a lot of people don't know about it all the time and a lot of people that may have a sense of what it is but they don't fully understand how beneficial it is and the bracket of the community that it can benefit and we have a responsibility as elected officials working with the community to make sure that we are changing that situation and i think it is really boils down to 3 things increase awareness around prep

how beneficial it is and how the medication causes side effects for very, very few people it is shocking how few people are on it because of a lack of public awareness anything we can do to make sure that prep exists what it is and the dramatic reduction in the risk of infection that it will provide if you take it daily anything we can do to expand the awareness is going to have positive that impacts in terms of our community health and so on and so forth so by having this hearing and punishing this issue forward and i know that my, you know, the reason i made the decision to disclose my use of preparing to forward the conversation and tell people this is an important

prchgs issue this is not enough there are still numerous stigma around prep and some of the 12ig ma a stigma we see things that that address sexual health it's amazing people are fighting against expanded birth control access because it is somehow going to result in god for bid women becoming promiscuous cousin there are that people fighting access to the h i pb access for young women because that will cause them to be sexually active meantime something t is rock solid proven to get people the control over

their health and lives that argument is not sound it's an author if we deny people access and shame people from using measures he know will deep them healthy if we use enough shame and block access they'll somehow do we we want them to do putting aside the fact no one should be doing, you know, what other people tell them to do it is 94 none of their business how people conduct their lives putting that aside it is completely baseless in negligence of science and our experience if i block people access to public measures threatening people will going do what they're going to do but people will be less healthy and

it means we're going to be less effective prevention in our community and so prep like birth control and the hiv vaccine is a proven measure that will reduce infections and that will benefit our county so that he we have to move away from stereotyping and take a scientific per will periodic in promoting this we have to expand access agree with supervisor campos that prep is untangleable for people that have topnotch insurance it's acceptable for people on medi-cal unfortunately, it is there are a lot of people who have notions or who have insurance with high deductibles and co-pays that's not acceptable for that them and the

city has to change that roll so i look forward to the conversation and thank you for the work in the community for the works in the chamber and people that have devoted years eave years of their lives for the prevention measure. >> thank you, supervisor wiener and a quick fact in the last 5 years there were 2 thousand and 66 san franciscans that were newly diagnosed with hiv even though prep has been approved fewer 5 thousand people have prescribed in 2012 and 2013 and fewer were made in san francisco supervisor mar thank you supervisor campos i want to thank you for championship this issue and breaking the stereotypes and the still it's a attached to it and

thank bryan from the aids alliance 0 and the harvey milk democratic club and the movement that tried to insure as we talk about vision zero for the traffic death we talk about it for getting to vision zero for the hiv soccer field deaths and i did stigma attached i wanted to mention the cost effectiveness for programs not only in preventing people's safety but it you cost effective as well from what i understand from the department of public health it is a savings of 55 thousand dollars for gift tax infectious is a troublesome cost benefit is to the city as well i want to say this effort by even though community coalition and supervisor campos is a safety net my hope we look at

preventive efforts in the further not only for hiv but outlet efforts in the city thank you to supervisor campos. >> thank you supervisor mar supervisor yee. >> thank you supervisor campos i want to thank you peppering for bringing this to a hearing it is an issue that i'm not as familiar with this is what those hearings are for for people like myself to get educated and make an informed decision as you mentioned you'll be bringing legislation to us later on to see if we can help fund this and about this hearing i'll have a lot of questions i'm looking forward to hearing the comments and getting up to speed generally speaking i'm glaud you brought this in front of us advertise it would be a cost

saving but can save lives that is why i thank you. >> thank you supervisor yee as also thank my colleagues for being responsive to the needs of the community and we look forward to the conversation first, i'd like to call upon bryan in the aids housing alliances who has been leading on issues involving hiv and aids thank you, brian with the aids housing alliance thank you for having this hearing it is a great journey i was one of the ones that that initial questions about the roll up in our community and it's relative priority and having thought about it i'm a big believer in it now we have the ability to

prevent hiv transmissions and we have the moral responsibility to do it we must and one of the areas that i'm particularly excited but is the department of public health shown that the prevalence in the hiv of african-american gay men in the tenderloin is the primary driver of hiv infects we can take that example to other community that are impacted by hiv and use prepping to disrupt the new hiv infections and really profound ways and you know i there is not a lack of money by imagination how we take the resources and put them to the best use i really support the call for the supplemental on this i don't

want to pull from existing hiv services and i'm concerned about the kind of any kind of political conversations that could slow down reilly's of those fund and preventing lives we want to expedite those services into the community i make sure that the funds get released in an expeditious manner we don't want that to happen and for me personally at the aids housing alliance we saw that 20 percent of homeless people with hiv and aids the first episode of homelessness was in one year of testing positive so by 1u7b8 lowering the hiv infections we substantially lower homelessness and that saves us money thank

you for having this hearing and i hope we get those funds out there soon. >> thank you very much another incredible institution at the forefront is the san francisco aids foundation and i'd like to call upon dr. robert grant. >> thank you it's really a happy day today only partly because it's raining (laughter) the quality of mercy is not it falls from heaven and on this rainy day a time in san francisco doesn't mean a risk for acquiring hiv we can love and enjoy our human connections free from this deedadly disease

had a privilege to lead that this drug is preventive it was good for bisexual men and save for homosexual men and women and injections they mediate to fda approval in 2012 too years and cd c recommendation for the prep use issued this year the cd credit says people can benefit from prep by the way, as of september 2013 on 2 thousand 13 people railroad receiving prep? an opportunity to end this disease. >> as i ponder our new

opportunity i want to reflect on my thirty years in the research and care to the public health student i was a medical state penitentiary in the 180's i was devastated by aids death and my having so this little to offer yet every year we seemed closer to end this better diagnostics and a load that the therapy blocks the diseases and now prep. >> san francisco has lead the world in implementation of what works including the hiv contesting e testing and the use of diagnostic testing and therapy early in the course of

infection and structural changes like same-sex marriage everyone's relationships are valuable we've lead with grassroots initiate like clean needles and other things and disclosure yet we need to do more san francisco has made progress in limiting hiv transmission but if in the last 4 years no decrease in the hiv diagnoses we continue to have at least one new hiv diagnose everyday no 0 san francisco so we need to do more and preparing is an underutilized opportunity san francisco based on volunteers say and the department of public health played pertaining rolls and preparing remains underutilized

in our city let's remind ourselves of the key finding one is prepping works as if it's taken in the open label people had drug levels indicating near daily prep we also know from those research studies it that people can doorway to prep especially in san francisco the san francisco department of public health have shown more than 90 percent of people in the city who have prep will receive levels of prevention people can use prep effectively we've heard from jonathan from kaiser in their prep clinic they've not seen new

be directions so san franciscans are practical and adherence to prep the hiv incubation can became rare it's safe we found no things that are side effects and 90 people starting prep have no side effects others have limited side effects we agree with the cd cs distribution that the rental functions can be healthy some of the research says prep is not causing people to have restricter sex all behavior some t said it will lead to more partners and people

will stop using condoms prep has provided an opportunity for people to have a decision discussion about prep and people will become mindful and talkative about their hiv risks and other risks to lives as people take prep in calm moments they plan for their long term lives many have come to us asking for preparing not interested in a long term relationship become interested in relationships as they see create a atmosphere the safety so we have a lot of good news and this approved it's approved by the fda and yet fewer one

thousand people in san francisco using prep why? because it is so limit but the most important reason is stigma we good frequently pamper the pill in people's sexual lives it's a way to protect one sever and foster human connection in the city the health care provider have not learned how to issue prep too much of our talks why cpr prep our doctors and nursing nurses are practical people they need to knows how so to new educational program how to talk about sex and sex you'll practices is one