so thank you very much. >> supervisor campos. questions? >> thank you. i am wondering if we can ask about the consortium and the work of the consortium? i don't know who the person to speak about that. >> sure. so the consortium started -- it really came out of the world aids forum we had a year ago so that included supervisor wiener, the san francisco aids foundation, department of public health, ucsf and project inform. we started talking about the possibility at that forum of getting to zero. >> >> and they said "why are you guys working together and talking to each other?" so we started a series of meetings and have been adding people to the

group as we have gone and right now i think -- [inaudible] we have -- you know, we have engaged the folks from the hiv providers network so they have been participating. we have several folks from the department of public health, from ucsf, san francisco aids foundation. the fabulous folks from [inaudible] joining us. thanks ted and matt. ms. chung is participating, the health commissioner. we also brought in kaiser. what is important is that 2/3 of the patients are seen in the private sector for hiv and most by kaiser in san francisco. having brad here the director of hiv services at kaiser has been critical. we have genie to bring in the private docks. we had their voices at the table but it's

been bringing people in. we had adam taylor from scott's office, laura lane from your office has been participating and it's very open, and just everybody has been very enthusiastic about moving forward. we meet about every two months and focus on working collaboratively to come up with some ideas to actually make a difference in the course of the epidemic. we have the science that supports it. we have the community infrastructure to do it and it's imperative that we take some action. >> i think it's really important to have that coordination and i appreciate the work and i think it's really critical that we do that. i will be honest one of the concerns that jumps out from looking at -- well, who is in the room and also looking at the roster including the steering committee it doesn't reflect the diversity of san francisco nor does it reflect the diversity

of the communities actually having the hardest times so i am wondering how we can effectively reach out to those communities if the people crafting the policy and the strategy do not reflect the population that we're trying to target? i mean that's just from a latino gay man i can tell you that's a concern that i have as we're talking about this. >> well, we would welcome assistance from your office. the doors are not closed to anybody, but we welcome assistance from your office in identifying people to participate in the consortium. i mean everybody is donating their time to do this. >> i mean if you're trying to eradicate infections in the african-american community and the latino community and the transgender communities and other communities it's important to have people from the table from those communities as well, so that's my suggestion.

>> and i think with any effort you can always broaden the tent and proactive making sure that the diversity of a community is represented. i will note that api wellness is part of this coalition and just mentioned that cecelia chung is an active member, and the cbos that are doing this work are organizations that do work in a lot of different segments of our community. it's not just about one segment but with that said we can always do more to make sure we're reaching everyone, but i don't think it's a fair criticism to suggest that this consortium is not reflective of the community. >> let me just disagree with that. i don't think it's just something that would be a good idea to do increase diversity. i actually think it's not just

a good idea it's always critical to being successful. i appreciate the work that has been done but i think if we're really going to tackle this issue head on we have to make sure that from the moment that we start talking about the issue that the right people are in the room and at least based on this presentation, based on the roftster that i see i don't think the diversity of this community, especially the people disproportionately impacted is represented here and have an obligation to point that out. that's not to take away from the important work that people are doing and points out that we need to address that issue and unless we do that we will find ourselves talking to communities that need the help without being connect in the way that is needed in a meaningful way and that requires that they themselves have a role in being a part of the solution.

>> and i would be -- i think there maybe more diversity within the consortium than maybe evident from just presenting the pie chart. we are happy to get the roster to you if that would help. >> thank you. >> thank you. okay. so thank you to the consortium for that very helpful presentation. i have actually seen the presentation several times and have participated in giving it and every time i see it it gets better and deeper and extensive and it's terrific and i hope you're sending it all over the country to teach other people what we're doing. now we will hear from the department of public health. greg wagner is here to present, and i hope you have really good news for us about the money. >> i will do my best. good

morning supervisors. greg wagner chief financial officer with the department of public health. i don't have good news for you, but i don't have the bad news that we have had in some years past. unfortunately as you pointed out at the beginning of this hearing it has been an annual ritual for many years for us to have this discussion in the board chambers about what the funding picture for our programs looks like a the change in the grants that we received from the state and federal governments for these programs. we are early in our budget cycle. we're still in our deliberations and awaiting information about what the funding picture will look like

for this year, so we don't have as much information as we often do when we hold this discussion a little bit later, but i will just to highlight some of the concerns that supervisor wiener and supervisor campos made about the history how we got to where we are today, show a little bits of the past, and what the outlook looks like. i have a chart here that shows the percent of our programs for hiv prevention, health services, and epidemiology and research that shows what portion of those programs are grant funded. as you can see hiv prevention is about 50% and health services 39% and reflective of the changes that we have seen over the years. >> >> if you go in the past those percentages are significantly higher and the fact that we

have low ball general fund dollars in the program is really a testament to what this board of supervisors and the mayor of san francisco have done to step in and support these programs and it really has been critical to maintain the innovative response that we've had in the city in the face of the declining funds. a little bit more on the history, but this is going back over the most five recent years of adopted budgets where 15, 16 as in year two of the adopted budget but you can see the redeclaration to the programs on the prevention side and the hiv prevention side and the ryan white grants. we had $14.6 million of reduced grants that the city stepped in to back fill

and maintain these services. >> just to be clear and tell me if i am wrong this is cumulative, so when you have 1.5 followed by seven -- >> yeah. >> so it was 1.5 million in 2011-2012 and -- so we back filled that and part of the baseline and another 7.1 million at 2012-13 and cascading so i think really more than 20 million. >> you're right. the way that this number is added up under state cumulative impact over time. you're correct. >> yeah. it would be good i suggest adding in the future as additional because showing the true impacts what we can do locally with the mayor and the board working together i think would be helpful. >> that is very fair. yes, we will do that and as you said it's been a very large change

in the mixture of funding for those programs, and the city has stepped in. in terms of where we are looking forward for the budget again we're early in the process for both our internal planning and our information about what our grant funding allocations will look like. we do have preliminary notification that we will have a reduction of about $150,000 in hiv prevention for fiscal year 15-16, so we're incorporating that into our thinking for the upcoming budget process. we do not have a notification or a preliminary award for ryan white, so that's still to be determined. we usually learn about that later in the spring. although you can see from the pattern over the last several years that i think

it's fair to expect that we will see a reduction. i don't know if it will be at the size we have seen in previous years, but it's something that we are assuming that we will have to grapple with over the next four months as we go into the budget process. so again we expect -- we received our prevention award in december and we expect fairly high level certainty by may on the ryan white funding amount, and obviously as we go through that process we will be in close communication with the board and the mayor's office to discuss how our response to that is going to look, and how we're going to make sure that we maintain all the great efforts that you heard about prior to -- prior to the financial discussion. >> supervisor campos. >> thank you mr. chair. thank you mr. wagner. i really

appreciate the presentation, and again i want to thank the department of public health and director garcia for all the work on this issue. mr. wagner one thing that i think feel that i have to say is in looking at sort of where the issue of prep is, and i am very grateful to the department for working with my office, with supervisor wiener to get to a point where we started a program where we're hiring navigators to facilitate access to prep and i also want to acknowledge that supervisor farrell who is not here as chair of the budget committee was really instrumental in making that allocation happen, but the concern that i have is that if you look at the presentation from the consortium and everyone who has spoken there is a huge

reliance on making prep accessible throughout san francisco, and that's an integral part of the strategy and as important step that we took in sort of beginning the process of hiring nose navigators the. >> >> department of public department of public health in the city we're only talking about an investment of $300,000 for prep and when you think really about the significant role that prep is supposed to play in this strategy that is a drop in the bucket if you will, so that's one concern that i have, you know, and so i am wondering if you can address that issue and sort of how you're looking at that as you're thinking ahead for your next budget? because if getting to zero relies so heavily on the

accessibility of prep then have we really made the commitment to that that is needed? because $300,000 in a budget of hundreds of millions of dollars may not necessarily reflect the level of commitment that is needed, so i am wondering if you can address that issue? >> yeah thanks for that question. i would like to also offer the program -- the participants here a chance to respond to that. first of all i want to thank you for the work that you did and taking that step to appropriate those funds, and that has really allowed us to start the process and advance that program forward and we are moving on that. we are in our current budget deliberations working with the coalition here to look at funding options and requests to enhance the programs. this is something

that our director, barbara garcia, is very involved in and committed to. we have been having discussions with this with the mayor's office and continue to have with your offices on this committee and on the board, so we are definitely looking at the bigger picture as we go through our budget process and trying to think about what do we do to take the next step? how do we make sure we're leveraging our existing resources in the best way, but also is there a next step that we need to take through the budget process? and we want to make sure that's a conversation that is not only internal at the department and at the health commission but it's something that we have collectively with all the policy makers here. >> well, i appreciate that, and i know i have spoken to director garcia. i know she's very committed to this issue so i know as we look forward to the next budget that's something

that i really would like to see and sort of hear directly from the department of public health in terms of what the next steps are? and by the way it's not just about the city also doing what it needs to, but also if we can hear about what is happening in terms of communications with gillad. they have done some things and the fact is travatta is more expensive in the united states than in other parts of the world, and the point of this is to make it accessible, not necessarily to line the company's pockets so i would like to hear more on that. >> thank you supervisor and i would like to offer -- >> thank you so much supervisor campos and thank you for your support in initiating that initial infusion of funds which i think is going to be critical to moving forward. we do have a

comprehensive plan for all of these programs and we believe all three are required to get to zero and we believe it's needs to be a city, public private partnership so we are approaching both foundations as well as private industry including gill yad to support in this move forward and we have received positive responses. we're in the fairly early stages but we don't expect this is solely a public funded initiative. this is going to be a broad consortium. >> great. thank you very much. >> thank you supervisor. >> thank you supervisor campos and this raises a point that i mentioned at the beginning and i will reiterate that we in addition to playing budget defense against the continuing federal cuts we really want to play offense this year and make sure that all the great things we're hearing about today in terms of getting to zero that

we're translating that into budget support in addition to working to reduce the cost of the drug and all of the non budgetary things that we need to do and i know we will move forward a proposal during the budget process. great and next i want to invite up bill hirsch from happen, hiv provider network and you continue to do a great amount of great work in this area. >> good morning. thank you supervisors for the opportunity to talk. it's exciting after years of budget badges to talk about expanding capacity so we can meet the need for services in san francisco. >> >> we were hearted when the mayor asked for no cuts in the budget instructions and we want to make sure in that vision of no cuts we're talk about no cuts and that includes a pretty broad array of things on the table and supervisor campos your concerns

about kind of the broader impact on vulnerable populations is something that we share as well, so we want to make sure that the -- we know there is going to be about a million cuts in care and prevention from cdc. we know there will be cuts to housing and opportunities for people with aids. we know there are cuts to the community development block grants which fund a number of supportive services for associated with housing. we know there will be cuts to mental health programs. we are concerned that the budget as anticipated will impact about a million dollars in cuts for the next fiscal year, and we need to make sure that the city includes all of those cuts when we say that there will be no cuts. we are also committed to working with the partners in the community to ensure there is an expansion of capacity and we prevent homelessness in every

instance in our community and we're very dedicated to working in collaboration with our sister agencies to make that happen, so we're excited about the opportunity to talk about expanding services. before we can talk about that we have to make sure that we don't experience any cuts, and this plan is exciting and once again positions san francisco to show the world how things should get done, but this is a plan that involves stages. we know there are great unmet needs in the area of housing, mental health and substance use and will take cares to ramp up to meet the unmet need so thank you and we look forward to the conversation. >> great. supervisor campos. >> thank you supervisor wiener. just going back to the issue that i raised with the consortium. what are you doing to address this specific needs of some of the most vulnerable communities where you see

infection rates continuing to be high? can you talk a little more about sort of the work that providers are doing around that? >> sure. there are a number of providers here that work with specific communities. we have folks here from api wellness and those folks have been part of the consortium, both as individual organizations and as representatives from happen. there have been representation from the hiv health services planning council, so there has been a pretty inclusive nature in the effort to get community voices and to hear from people who are directly impacted from the disease. >> great. thank you very much mr. her ish. okay at this point we're going to move to public comment -- or i'm sorry. yes come up. my apologies.

>> [inaudible] supervisor wiener supervisor campos -- >> more than one. i apologize. >> thank you for both championing this issue. it's really important. i just wanted to add additional information and clarification. we privileged to be laying the tracks of the train that is running and should be proud -- >> can you identify yourself. >> i'm sorry. i am bill bloom, the operations officer for dph and director of hiv health services. yeah, i skipped over that. just to say we're in the process of collaborating and work that is being done. just a couple of clarifications. the first is that there is the availability of prep. it is covered by medi-cal. the trick is being able to access it. the second piece is that healthy san francisco does enable participants to have access, mostly done throughout compassionate use program so i don't want people left with an impression we can't get it and

it's an imperfect system and we have advocates getting it out there and this is just a start. i want let you know in services we are looking at the funding and the service lines in the contracts and what is allowable to look at shifting of that. in addition to the money question we also need to be able to train all of our primary care providers to be comfortable to do it and understand how to do it, and that's a process that we have already but gun. positive health practices have taken on the initiative and they have a lead physician developing protocols as well as how to get trainings to get providers up to speed so we can push it out through the whole system and people don't need to go to special access points. >> thank you. it's an informed point also to keep in mind in terms of access to prep that the main challenge i think is really the folks who have bronze plans

or other plans that are not as fully covered as they need to be people who like we are lucky enough to have good insurance or people who are on medi-cal or some other programs for lower income people have better access if they're able to access the benefits and we need to help them, but sometimes as often happens the people in the middle end up getting cut out, and i think another point that's important is to make sure that medical providers know -- not just know about prep but really are up to speed on it. i was lucky when my physician when i inquired about prep although he doesn't have a large lgbt practice and i was lucky he was knowledgeable and incredibly helpful and supportive. i also know people who have had

different experiences with their physicians. okay. at this point we will open it up to public comment. public comment will be two minutes. i don't know if we have any cards. if not people can just come -- we have one card. i will call tmatt sharp. >> >> but everyone else if you just want to line up on this side of the room, and just state your name and we will go from there. mr. sharp. >> hi. good morning. thanks for this incredible opportunity for me to speak today. i am matt sharp. i'm a citizen from the bay area for 25 years off on and now living in berkeley which i love by the way. i am an hiv advocacy and educational consultant. the bulk of my time is as a manager of hiv in aging

special projects at chanty which prothirds is supporting let's kiss ass aids survivor syndrome a grass-roots organization and social advocacy organization which i am co-founder. i am also on the "getting to zero" consortium, and interestingly i was on the fda advisory panel and gave a yes vote to recommend prep for approval. i am very proud to have been a part of that. it's really almost surreal for me that i am standing before everybody here today to advocate a new initiative to get hiv infections to zero. now but now we know we have the tools to do this, and but we know it's going to take strategies, support from all the stakeholders and obviously the resources that we have been

talking about today, but the reason i am honored to be able to speak to you today is ensure that long-term survivors who have fought for their survival for over 30 years must not and will not be left out of any major initiative where we fight -- where we might just possibly end the infections in the city of san francisco. they demand to be at the table and part of the strategy and we are so far, but it needs to happen. it needs to be strategized and spoken b i want to thank the consortium and jeff for inviting let's kick as to the table. this is y long-term survivors deserve to be there. they held the

torches and buried friends and lovers and suffered and had lifelong therapy and some are isolated, still stigmatized and homeless and financially insecure because the priority is shifted to other matters of hiv matters besides treatment. the treatment strategies work though and that's nothing short of phenomenal. i just want to say that definitely is true, but in no means say -- i don't want to say that we should silo people with hiv who gets the resources, who gets the support, and who gets the attention. i only mean that in order for this exciting initiative to be successful long-term survivors must be brought into the focus. they have practical and lifetime

experiences and wisdom in living with hiv for all these years. they have -- we're seeing early onset of aging in these folks and age related complications and many have become isolated and alone. tragically some are committing suicide. so i am a 27 year survivor of aids. i am 58 years old. i never thought i would live to see my own survival. let alone at the time like this that i can talk about a strategy and initiative that's happening here. san francisco was a model for hiv and today must want forget long-term survivors, many of whom without consistent care and retention will remain in that sro alone