susan from our department of public health and begin by thanking our department of public health for the incredible work on this issue and they have been an important partner we've been working on this and so with that, dr. phillip's. >> thank you very much good morning and i want to take the opportunity to speak with you today i am a deputy health over i'm susan and also the director of the disease for the population health distribution of the department of public health i'm also on infectious disease physician and a care provider in san francisco so i'm very happy to be able to talk with you and let you and

everyone throughout the city know that the san francisco department of public health fully supports prep as an effective hiv prevention strategy in san francisco and to also further let you know unpraerld the san francisco dph as prevention in epididymis metrological and have long-standing experience no prep and all of us together are providing leadership and stewart's national leadership as the direct mentioned they've provide proposing to their san franciscans at risk for hiv in our city and as we heard from dr. grant san francisco has had long expertise and experience with preparing and many strengths to build upon the study was lead by

dr. grant the groundbreaking multi national study showed prep was effective in reducing freelance females and it is incredibly important globally but very much so in san francisco because of the population the global raven can be applied to benefit the health of san francisco furthermore, the san francisco department of public health was the first united states center and enrolled more people so san francisco community members and researchers have had a long commitment to show it prep was a prevention furthermore, that leadership continued the question remained how to we translate this prep

that has been shown into the real world so people can access it and such sf dph was sclektd to conduct the first demonstration process of how to deliver prep at the san francisco clinic as well as at other sister clinics in miami and washington, d.c. san francisco city clinic explored 3 hundred of the participants this will help us fourth how to provide it some of the things namely there's a high enhanced demand for preparing has proven by being able to enroll 3 thousand people when people know prep was available

people that participated in the demonstration were able to tank prep in a way that offered protection and degrees that were save so 92 percent of people in san francisco had positive results and people are not able to take prep in order to have effective protection so if we look at where san francisco is there's a lot of areas for hope and potential to have prep build upon that hope when we look at the hiv care and protection also known as the cascade and itself measurement of success nationally against hiv we see that san francisco is leading the country in multiple areas if we look at the left

hand of the undiagnosed hiv infection for the united states red is san francisco and undiagnosed hiv infection meaning an individual is infected but not aware 20 percent of individuals where hiv don't realize their infected by 6.3ers p in san francisco this is testing for the commitment of san francisco as a city to make sure that people are aware of their hiv status the next step if someone is diagnosed linking them to medical care so the prosecuting of those linked in 3 months exceeds that thought united states as a whole and finally the vir al incubation is important for the health of the

individual and incredibly more for research for hiv the environmental al infection desperation has a dual purpose for people living with hiv and offering levels of protection and san francisco far out stripes the estimate as a whole 28 percent of those infected with hiv are environmentally dressed based on people diagnosed in 2012 all of those are indicators the dedication of the people of san francisco and providers as well so why have we had the success partially because san francisco has had a very aggressive approach towards looking at the

scientific data and discussing what are the public health and policy decisions to best benefit the people living with hiv and those at risk so in 2010 san francisco became the first city in the you think u united states to romanced treatment for hiv patient we were the first in the u.s. and a joint from ucsf and ward 86 and the jeopardy hospital additional at any point after diagnoses and the decision to start treatment, of course, was a decision made by individuals in discussion with his or her provider so san francisco is ahead of the guidelines that is ahead of the curve we've heard and we have a strong history around the hiv

aids policy finally it's important to think about layers of hiv prevention and different strategies that might work forking for other people we've known since the right it day that condoms are effective against hiv they're not also practical for people at risk we have multiple as we learn more and see what's effective in the hiv prevention we added different strategies to people are able to use the ones most appropriate so in addition to condoms theirs virgin for people using drugs and hiv information and substance abused and screening and approach we now add this layer of preparing as additional prevention with

all of this in sum we're seeing in san francisco there are signs of success in our fight against hiv the red line represents new diagnoses in this city is from 2006 to 2013 and the pink deaths and the green are living hiv cases we're happy are increasing as people are getting on to treatment when living with hiv this graphic it the work of our really spent hiv group is the best in the country we have access to the best data but the work the actual effort is shared across the city not only dph but private providers and community-based organization and academic researchers and many,

many others this is the collective impact so, now we're at the point we're talking about a new challenge a goal where better in san francisco to think about it getting to zero in san francisco as we've heard that this is zero hiv infections zero hiv associated deaths and stigma this is a collective impact approach in an unprecedented bringing together of interested groups and stewart from you mean and the department of public health and the provider and activists and key providers and many, many others and we must acknowledge we're grateful to have support from the staff from supervisor campos and supervisor wiener in this effort as well it's been very much appreciate for their support and preparing is a key strategy in getting to

zero its been identified by this group as a key strategy and some of the components of that has been identified as comprehensive prep training and support for clinical providers to increase question and answer capacity for people to access prep and resources and assistance for a potential user of preparing in clear language clearly educational and in multiple routes that make it easy for people to understand what prep is and what it can do to them and developing the key metrics is stealing important we again have to take the lead and the department of public health is ready to be involved we need to know the true demand for preparing and the real accurate estimates and accurate

information as much as we can how many people are taking prep and further what are the barriers and obstacles are there harms from people really a stigma or even physical and side effects from taking prep so all this information will needed need to be gathered to provide prep in a safe and effective way it's important that the overall efforts the department in policy related to health reform in san francisco farthest access to prep and in san francisco get the support of the city and the department of public health we've been able to house a health access program healthy san francisco we're ahead in providing comprehensive health care and further the ac a allows

for 90 san franciscans to enroll and many insures cover prep kaiser and united health care and others so it is wonderful in san francisco now the department recommendations preparing for those at highest risk bye bisexual men and men that have sex with men and females will have sex with those men 85 percent of infection occurs within those groups it must be u must be sdrusz discussed with their providers and need to have clinically acknowledging believability providers our goal is to list the waters for everyone so providers 0 thought the city are able to have those conversations and providers i be

able to be relied on so for our own patients within the sf clinic we've provided access for patients providers will have ongoing access to training and communication to support them in the roll out of preparing including ward 86 treatment and prevention and from the department of public health as well the uninsured those who remain uninsured despite ac a we cover the preparing for san franciscans in a medical supported homes and those in non-medical homes may work with their medical care provider to access prep through the mustered medication in the program and access for all san franciscans at risk is another major roll

we'll develop training for all providers including in our network but more broadly throughout the city the providers are targeted group we'll continue to provide access so the san francisco clinics know that the people needing serves for the infections and sex all health are major candidates we do this with a illogical for insurance and primary care and supporting the resources as well is a goal many efforts are being put into many partners we're going to continue the research as leaders as we've shown and educating metrics for preparing in san francisco this obeying will be a key responsibility of the department we have a fact sheet on our website i want to thank you very

much thank you for your interest in 2, 3, 4 important matter and our time. >> thank you, dr. phillip's and to the department of public health for all you've done and clearly san francisco is leading the way i want to briefly ask you about something dr. grant said an estimation about one thousand folks in san francisco are currently educating prep in terms of getting to this vision zero i imagine that number has to increase dromofor that objective. >> yes. sitting down oversight tote go and trying to come to consensus on the overall 2340ub would be is very important one of the things we know is that most people are getting their hiv care in providers clinics and their preventive clinics that don't include dph

so we will have to make sure the key responsibility of my branch is to support the physicians and nurses in the roll out of preparing you're saying we're not going to do it through dph alone we've got to enable the providers that have shown the ability to have this high-up take of hiv treatment to take the next step we feel that providers are well able to take that step. >> thank you, dr. phillips i know i want to go into public comment i want to ask the deputy director i want to thank her and her staff for all the work they've been doing and we will

be at some point we'll be introducing is supplemental next tuesday and the supplemental at least is a work in progress at this point, we're talking about following the model of washington state that began, you know, funding a similar effort and we'll talking about 8 hundred one thousand dollars that is 5 hundred thousand for a assistance to insure that co-pays and payment are as slow as possible and then to hire navigateors to help so that to the extent we're paying for this we minimize the impact of the general fund we know that insurance companies cover it but it's hard to navigate the

process to get approval so just wondering in terms of the department of public health per speed up do you have a sense of you know how you see this effort to make sure we increase the availability of preparing and how do we do that and do you have any thoughts about the challenges that we're facing as we move down this path. >> certainly thank you. thank you supervisors for having me today, we support increased access to prep and are interested in partnering with you and with the other members of the board to figure out how to do that in contrast our discussions we've reviewed the washington state program and think it provides a good example for public health it has a whole infrastructure they had statewide and we're a local

outlet that has others issues it's not a perfect fit but lessons we can learn any program we design as dr. phillip's said maximize other resources for access to prep so reduce the resigns on the necessary cases to get this through private and public insurance company we think there are ways to do that. >> thank you very much and i want to thank also barbara garcia and supervisor yee. >> a quick question i think san francisco has been involved with the research and so on and so forth and seeing positive results so i'm curious has san francisco d b h

dedicated any resources towards this vision we're talking about thus far? >> yes. all of the ways in which we're working to provide prep currently are 2rikd towards this and they're several of the hiv leaders within sf dp had example that are actively involved we're providing expertise and learn from the group and prepared to implement the recommendations of the group once they've been fully approved by the health commission in the department we're poised to augment what we're doing to achieve the vision of zero in san francisco. >> do you know budget rios wise how much has been dedicated you don't have to give me an answer

today and i'm sorry, i do have that number. >> can you get that number. >> yes. and okay. thank you very much. >> supervisor mar >> thank you, dr. phil and dr. grant are there side effects of preparing and can you elaborate on the cost effectiveness in san francisco that provides it for free. >> so there's currently one medication that is approved for preparing it's a co- formulateed drug it is a high toshl ability there's a startup symptom a few week people usually have a gastro upset that goes away most people can handle that but it's

important to have a physician for that and as far as the cost effectiveness to provide it free for everyone i don't have those numbers colleen do you have those numbers about providing it for free no, i'm sorry we don't have those numbers. >> dr. grant may have more to add. >> dr. grant. >> there the cost effectiveness depends on who uses prepare and people that need it the most use it the mothering most san francisco overall as a new snaps people taking home prep have a higher instance of hiv this can be cost effective prep is cost saving if the hiv

incident is higher than 6 percent we see cases like that in young people and young people of color in particular young color but, you know, at saving and was appointment hiv prevention saves money in long term

remember. >> this will save lives here in san francisco and the example we set here about save lives across the nation and world in honor of all those who have lost lives and as a gay man, i ask you not to place a think others lives of the trance community on low income san franciscans on people who spelling needs this medication i ask you to do what everyone is asking you to do please, please pass this supplemental a small amount will help people in the

city and across the world. >> thank you. i'm to read a few more names (clapping.) so we keep the meeting going forward instead of clapping show our support without clapping that would be great and appreciated (calling names). >> good morning. i'm shannon weber the program at san francisco general hospital where we care for hiv pregnant women we began offering this to women and this year we're celebrating a decade of all babies born in san francisco of being hiv free this is polyp because of the anti medications given to the mother that acts as a preventions to the infant we believe that any hiv attraction is possible this is the first

prevention method it's a game-changer how we talk about how women can protect themselves and consecutive with their male partners we've going adopt a survey with the people and 53 percent want to take prep but women face challenges educating prep and providers unwilling to provide preparing for women woman including trans women need this and their providers included in the education effort there's a lot of we can learn from the anti needle protection and real dialog we can move towards the end of hiv attraction as well. >> thank you very much. next speaker. >> thank you very much for allowing mia me to speak you may

wonder why someone from la is here in san francisco (laughter) i just minded to say aim mr. lang we know the history being series leaders in hiv and right issues i stand before i here as as 28-year-old hiv negative man that has been in tourism for 20 years i'm seriously enforcing prep reading the data and the studies rpg this works that is the key point your soon to cast the historic vote here today, this is not only change how we deal with hiv but social equality and it's the only hiv prevention that gives control to the hiv partner or person involved in the game and

not only does it protect you locally but protects you all over your body that's over 99 percent the other speakers said it's not about cost of living this is about seriously providing something for the community and also native americans to occasion al risk over 60 percent even if people living in- had are in la and san francisco as such we're leader communities and the l.a. county hiv commission i work with we have assigned one to $1.5 million for education i believe that san francisco, california do the same i ask you today to support this for the people you represent and seller change the face of hiv not only in san francisco but cor