to biweekly or biweekly to monthly. one of the other initiatives that we've done to try to address the problem is our tenderloin clean program. we had some significant issues with keeping it clean. we've developed a workforce development program and a non-profit partnership for staff to come and clean the sidewalks early in the morning from i think it's from 5:00 a.m. to 9:00 a.m. so four hours a day, monday through friday. really they are doing manuel street cleaning; sweeping up litter, collecting large debris items and if they are identifying areas where they need to call in public work staff that's what they are doing. if they say urine or feces on the street they will reach out and call the public works staff and then we'll come in and our staff will come in and do the steaming as

needed. >> when did this start? >> approximately 18 months. it started at the end of the prior fiscal year and carried into this one. wrapping up real quick, we talked about the community corridor ambassador program. these are workers through the obama jobs now program. that's when the program started. it's people who do manuel cleaning throughout the city in the busiest commercial corridors throughout the city ranging from chestnut and union street to the castro and market, mission, bay view and evans. throughout the

entire city. this is a job opportunity for at risk population. we have talked about this ever be. we have some troubles in terms of keeping this staffing level full. as part of our analysis we decided to improve the hiring process but doing it internally ourself. those are the efforts we want to do. we partner with our community benefit district, those staff that help supplement our cleaning district. there's several of them throughout the city. as well we have our monthly clean team events. once a month each of the 11 districts are out there with a group of volunteers cleaning. those are a big success. i wanted to just highlight some of the other n h initiatives that we are doing that are helping to address the over all cleanliness of the city. finally i want to bring up the fix it team, which is also a new program. they are assistance with all of the other city departments. they help

identify problems, talk to residents to get a good understanding of what is going on in the neighborhood. then they coordinate with public works with the other city departments as needed to make sure that any coordination efforts are happening and that we are absolutely eaching every critic -- identifying every critical item that needs to be cleaned. it's an expansive effort. we continue to think out of the box in terms of how we can improve the cleanliness. it's a tough battle and we continue to try to make progress. with that i'll be happy to answer any questions. larry stringer is here to provide any further clarification you may have. >> supervisor cohen: thank you. colleagues what you just heard is the example of our very first budget priority hearing. this is the first in a series of

hearings regarding those issues facing our city that the board has identified as priorities for this year's budget cycle. as you can see from the numbers this is absolutely a priority. so today we are going to hear about the state of our streets, we've heard complaints, about cleanliness regarding everything from needles to human waste and trash and dumping, flood, 311 calls have increased dramatically. so we heard a presentation and we will continue to hear several more presentations because it's important to begin to understand this budget priority and all the elements. it's not just a dpw issue. thank you, bruce robertson from the public works -- where did he go? oh, there he is. thank you, bruce. thank you for opening up the

conversation. colleagues, i want to just acknowledge that we've got larry stringer here from dpw as well to answer questions. we have ilene and somas here from the department of public health. what i was looking to hear when i provided direction to the department head on what we wanted to hear in today's policy discussion is we are looking for metrics. we are looking for key indicators about street cleanliness, how it has changed over time and i think you gave a thorough prose -- presentation about the changes. i'm grateful that we have a department that's flexible enough to make those types of changes. it's not ridged. i've spoken with colleagues to understand their concerns around this issue and i'm going to put out some information here. they have expressed the following specific concerns to me. first,

what we did was we polled supervisor's offices and here's what my colleagues have listed as important to them, human waste, needles, geographic equity in street cleaning across the entire city, addressing the causes of dirty streets, trash can be accessible -- trash cans accessibility and location, concerns about people recycling or, quote, canning. going through other people's recycling bins and pulling out cans. then also trash dumps -- dumping n the streets. bruce, i have a fe questions, specific -- few questions, specifically on the zone strategy. how many hours per week do the zoned teams work? >> i'm going to turn this over to larry who has a much more thorough answer. >> the zones are six zones that

operate seven days a week from 6:00 to 3:00. >> supervisorer cohen: six zones seven days a week. what are the six zones? their location? >> so you have zone a which is basically districts 2 and 3, zone b is district 6, zone c is 3 -- excuse me. 5 and 1. zone z the mission which is the mission and burnel and then zone e is -- >> supervisor cohen: sf gov tv, if we turn on the over head we can get map of the zones. perfect. so i see zone a is on

the northeastern part of the city. >> and zone e is bay view and parts of the accessier that represents districts 10 and 11. zone f is district 7 and a little bit of 11 as well and 4. >> supervisor coor cohen: how workers do you have in the zone? >> it varies from 19 down to 10. that's based on the volume of service requests their generated for that particular area. >> supervisor cohen: i'm going to move on. i know that you have a program to staff some of the corridor projects. is it supervisor 2? soup 2 programs? does that ring a bell? no? >> no. >> supervisor cohen: i heard

that this is frequently understand staffed. what's the name of the program? >> through hsa. you have a lot of people that are returning to the workforce and they're not always ready so we do a lot of hires. we may hire 10 to 12 people but we may lose 20% in the first month or two. >> supervisor cohen: what do you need from a budget perspective to achieve full staffing? >> so i think fundamentally we need to make a decision if that's going to be a priority. we need to staff and hire people that are ready to go to work and that we can put to work on the streets. we are not having to turn around and hire more to replace them. >> supervisor cohen: do you have any questions for mr. stringer? supervisor fewer?

>> supervisor fewer: yes, thank you. thank you very much. around your partnership with hsa and the readiness to work, so are they also the work fair hours that recipients know? >> so that was one of the slides that we showed. the alternative workforce was ga, project 20. a large supplement for manuel cleaning. that's dropped over the last 4 years. there's not -- the ambassadors from hsa are strictly for the corridors, commercial corridors throughout the city. the others did sweeping everywhere, not just in commercial. >> supervisor fewer: so it's

down to zero now? >> no, because it's because we don't have the reports. >> supervisor fewer: but there was a reduction? >> about 40%. >> supervisor fewer: where does that pipeline come from? >> welfare to work. project 20 was parking tickets and the like and the swat was alternative program to work on streets. >> supervisor fewer: are we turns them into full time jobs? >> no. >> supervisor fewer: why don't we? >> most of them have jobs. they are paying off tickets, doing community service or avoiding being able to stay out. >> supervisor fewer: so if we look at the workforce that might have employment that pays less money or employment that is not

full time, for example, uber drivers or something, would this be a pipeline for workers then? >> well, we use the hsa. we try to use hsa workers as a pipeline through our apprenticeship into more permanent staffing. some of the alternative work programs -- there have been a through that ended up in our apprenticeship but over all in general, no. >> supervisor fewer: thanks. >> supervisor cohen: any other questions? supervisor yee? >> supervisosupervisoosupervio budget request, i forget what it's called portable potties or -- >> pit stops.

>> supervisor yee: it seems to be an effective tool for reducing the need to steaming these streets and steam cleaning and other things. it seems like the cost of having another pit shop or staffing -- does this save any money versus not having it and having people steam cleaning and so forth? >> yes, it does. you saw that there was a reduction in the over all number of steam cleaning requests in areas that were adjacent to the pit stop. that allows us to go into other areas and as you noticed the volume increased. so there's a definite savings. it helps to contribute to cleaner streets. >> supervisor yee: do you have it in your budget to purchase a

few more? >> there's a proposal for more i believe and we have a proposal to expand the hours in some locations where we've seen that potentially we probably need to start a little earlier in the day. >> supervisor yee: do you know how many many? >> i think that's based on what we are -- what you appropriate for us. >> supervisor yee: i mean, right now what are you asking for? >> supervisor yee, we gave multiple options. so in our budget submittal there's a targeted reduction and then we give a laundry list of expanded pit stop programs, expanded equipment. we just gave a multiple list of the process of what we get, look at the data and then identify the perfect place for either expanded hours

or a new location. >> supervisor yee: what's the cost? >> it depends on whether it's portable or jcco. >> supervisor yee: staffing it is included? >> is included. >> supervisor yee: thank you very much. that's something i would certainly support. i think it's twofold as you mentioned that you do save in regards to your workers, maybe being deployed somewhere else. to me it is a sense of respectability of people using them versing having to use it in the street. >> that's correct. definitely. >> supervisor cohen: sheehy?

>> supervisor sheehy: thank you. first i want to thank you for the great job you do. i feel like you're pushing boulders uphill all the time just to have it roll back on you. the responsiveness of the department of public works to my office has been amazing. i'm grateful for that. my question is one of the things i hear a lot is the technology we use for our trash cans, they are open, sometimes people don't put the trash in or take trash out. are you looking at alternative technologies for trash cans? >> we are looking at alternatives and we have a couple of designs. we have worked with a couple of the cpds. we do believe that we will become coming up with a different design and different type of can that's more tamper proof that people can't reach in and pull the stuff out. is that also leads to the dirtiness of

the streets. we are definitely looking at that. hopefully we have something within the next six to nine months that when he can roll out. -- that we can roll out. >> supervisor sheehy: great. i note of a packet for budget indancement -- enhancement so we should all take a careful look at that. >> supervisor fewer: thank you so much for your presentation and all the work you do. washington alum. i just wanted to know about the pit shops because actually i think, you know, when you travel even throughout over cities in the world like there are public bathrooms available. in particular i am looking at my district quite frankly because we have a lot of areas that don't have any bathrooms they are frequented by everyone in san francisco. i am looking at

whether or not your priority for expansion is your pry -- are you priortizing the expansion of the program or are you talks about dollars for increased hours of the existing pit shops? >> it's both. it's both. we recognized with the existing pit stops that there's a need to expand the hours. we also realized there's a need to have more. it's a combination. >> supervisor fewer: great. i know there was a pilot program about putting more trash cans on some commercial corridors and whether or not that would reduce the amount of trash on the streets. request can you -- can you tell me what you found out? >> we did that in a mission for a period of about 6 months. the one thing that we noticed that we didn't -- that didn't occur was there was not a lot of additional illegal dumping that

we seem for that part that was a positive. the other part was pretty negligible in noticing whether there was an over all reduction for cleaning service requests. >> supervisor fewer: thank you. i wanted to know about your resources and programs for clean streets. how are they contributed by neighborhood? >> the tl clean? >> supervisor fewer: i think i'm talking about the manuel street cleaners also and also about the cleaning and mechanical cleaning. >> so the mechanical cleaning is city wide. it's dictated by frequency and what we determine is the amount of garage. every street gets swept at least once every two weeks, the others at least once every week and then heavier areas and commercial areas may be two to four times per week. >> supervisor fewer: so when

you're saying every street is cleaned every two weeks that's the machines that go by? >> the mechanical sweeper. >> supervisor fewer: and then we have the mechanical cleaning multiple times a week, correct? >> correct. >> supervisor fewer: the manuel are those just along the commercial corridors? >> for the most part, yes, just along commercial corridors. that is one of the other things that i did discuss. a lot of the areas was done through the draft force. we were able to put three or four of that workforce in each area of the city. it's now down to five or six workers total for the entire city on a given day. >> supervisor fewer: what's your plans to beef that up? >> we partner with the nonprofits and that started with

tl clean in order to get more resources in the area. we will continue to do more of that as well as us actually doing the hiring to get long term transitions from the corridor on into apprenticeship and permanent employment. >> supervisor fewer: thank you very much. >> supervisor cohen: any other questions for the deputy director? >> supervisor yee: one more. give me a second to see if i can frame this. >> supervisor cohen: i can't hear you. >> supervisor yee: i have a question but i'm trying to figure out how to frame it. okay. in the presentation i'm just wondering in regards to recent up stitick in the

encampments it's increased quite a bit. is there mie way we could -- have you thought of ways in which maybe that would be reduced? i don't know if we have these pit stops going by where they can use it. and then are there -- i mean, you could either have no bins there or can we put bins where you dump the garage in a bin instead of on the street? >> so my staff has been instructed and you'll see that in the encampment they go by and provi provide bags and try to do a daily clean up. we ask them to

police around their area and bag up their garage and put it on the side. some encampments do that, others don't. we come through and clean everything at least once a week where we ask them to move so we can clean everything out. we do provide them bags as well. the bins or anything else, they get abused. >> supervisor yee. >> appreciate that. >> superseiz >> supervisor stefani: i have constantly am turning turned over trash cans on my app and do you have any idea how much it would cost to over haul the

trash cans throughout the city? i know that we have very old ones that -- there's just so many different kinds across the city and i know that we have the ones that are harder to get into those, there's raccoons, all kinds of things. what's the data on 311 requests on treasure cans that are broken throughout the city? >> i don't think we provided that in the presentation. we have that data and i can provide it for you. it's one of the dash boards that we review every month. we do look at frequent tip overs and those are usually the concrete cans. the

renaissance cans are $1,200 a piece. we have to discuss whether they will be the same or whether we will have different types given the location and the area. i think that's a discussion still to be had. >> okay. and then also you mentioned that mohamed found the smaller con packet sweepers in barcelona or got the idea from that. we only have four? >> that's correct. >> supervisor stefani: is there a desire to have more than that? >> there is. those are primarily used for the narrow alleyways and areas -- and different areas of the city where it's not as easy to get a regular sweeper in. also there are areas as well where it's changed from mixed use to residential. so there is a plan

to get more and expand that. >> supervisor stefani: any other commitment that -- equipment that other cities are using? i just put in a request to look at what other cities are doing. i know that's going to inform how we go about discussidiscus discussidiscus discussing this? anything else that other cities or doing or internationally as well? >> no, we frequently go to out there and look. we purchased a few sweepers because of the bike lanes because our normal sweepers don't fit. we do review what is out there. we either pilot it or have the demonstration of it. >> supervisor stefani: thank you. >> supervisor cohen: thank you

very much. i'm going to pivot to the budget legislative analyst to hear their presentation. thank you department of public works. >> good afternoon. my name is dan and i'm here to provide a brief eapresentation or our fir budget priority report that focuses on clean streets. it was a top priority of the board as provided to our office. street and sidewalk cleanliness in san francisco is a top concern for city residents and received significant media attention. this ofs the fourth

most -- this was the fourth most sited issue after homelessness, housiing and cost of living. the volume of service requests has increased considerably in recent years. as you heard from the department of public works, the street environmental services bureau is the primary provider of street and sidewalk cleaning across the city. the bureau has zone teams that provide scheduled street sweeping, steam cleaning, manuel cleaning and litter removal on redetermined rooutes as well as in response to service requests. there's crews that focus on hot spots, encampments, alleys and swing and shift operations. the bureau is responsible for the 18 staffed public restroom facilities known as pit stops. together these crews are detailed in the report. as you've heard detailed description from dpw i won't go further into that. programs

include the mayor's fix it team started in 2016, community benefit districts that are established for quality of life improvements in neighborhoods. many of these cbds funds street and sidewalk cleaning already provided by dpw. in addition, several community based organizations provide street cleaning services as part of workforce development programs. some of these organizations received city grants as was described by the department. the current year budget for the street environmental services bower row is about $65 million. which is an increase of 47% over the last five years compared to $44 million in fiscal year 2013-14. the amount of jen fund money is going to the bureau has more than doubled in the last five years from $15.5 million in

2013-14 to $35 million in the current year. the general fund and gas tax make up two-thirds of the bureau's budget, other sources include department work orders, garage rate funds and cigarette litter abatement fees. the city auditor has published reports each october or november following fiscal years using several performance measures. due to the increasing det deskrep -- descripency we decided to revisit the methodology with the department although it is available on data sf. i know there's a representative from the controller's office that can speak to that process if you're

curious. on this slide we have included table four that summarizing over all scores for streets and sidewalk cleanliness. as you can see over all scores have shown improvement since 2013-14 and, again, the city services auditor can speak to why they decided not to issue a report for last year due to the increasing service requests. our report has a more detailed summary of performance measures including the areas of illegal dumping, hazards and landscaping. we have provided data for the first four months of the current year, fiscal year 2017-18 and two highlights include that dpw met its goal of responding to street and sidewalk cleaning requests within 48 hours, 76% of the time. it's target is 95%. second the dpw goal of

responding to from -- graffiti on public profperty 94% of time you'll see budget enhancements that we incruluded in our repor these are also in the appreciation ordnance that's been pending before the board. so the first option that we included was to administrative leave decisional public service aids. these are temporary positions with 6 month terms to expand the community corridors program which you heard about from the department. we put a range of 250,000 for six positions to $1.6 million for 40 positions. additional option that we included was to expand the tl clean program that's a five day a week program to a full seven days a week which could cost approximately $230,000 for one year. we also

added additional materials that's would apply if you exp d expanded and 2 new street sweepers that would cost $280,000 each or $560,000 for two. i just wanted to describe some other options available to the board. one is to expand pit shop hours or locations. this would be so the cost of one pit shop to purchase and staff for a full year is about $189,000. we don't details on expanding the hours of the pit stops but the department could probably speak to that. another would be to initiate a south of market program for additional cleaning services, via is community-based organization. that would cost about $805,000 for a year. finally the board could make

additional grants to other cbos for other manuel street and sidewalk cleaning city wide. of course that amount could be discretion of the board but maybe a range of $10,000 to $500,000 for that option. moving forward, just want to mention that there are three more planned presentations for the budget priority process. next thursday we are planning on providing a presentation on homelessness and affordable housing. on april 26th we are planning on providing a presentation on public safety. on may 3rd we will provide our final presentation on other priorities that have been mentioned by members of the board. the goals of this process are to provide a set of budget priorities to provide to the mayor for the two-year budget, to enable our office to provide more extensive analysis to the board to understand the city's performance, challenges

and opportunities and critical policy areas and to provide a frame work. as i've mentioned before, the budget policy process is new this year and we appreciate feedback to make improvements. that's the end of my presentation. thank you for hearing me out and we are available for any questions if you have any. >> supervisor cohen: any questio questions? >> no. >> supervisor cohen: i have a question. you made a

recommendation to have a one time expense. the recommendation that you have made is for a one-time expense in terms of the policy priorities. can you clarify why you're not recommending any operational increases for what seems to be a problem? >> yes. so there's a couple of reasons. one is that the department's budget has gone up by almost 50% -- or actually not the departments. the bureau street budget has gone up by 50% over the last five years. we do recognize that there has been significant investment in the last few years. in addition to that, it's unclear what is going on with the performance measures, the performances have shown improvement but there's some concerns over the methodology because service requests have been going up. we thought that a one-year

augmentation might be more appropriate so the controller's office and the department of public works could figure out what is going on with the performance measures and then from there decide -- the board and the mayor could decide whether more operational investments are needed. >> supervisor cohen: what? say that again in a simple short sentence. >> sure. >> supervisor cohen: you made a recommendation for a one-time expense. i feel like we all know that you can infer from the presentation, the first presentation that there's a lot of things that need to be done. you're recommendations don't reflect that. you're telling me that it doesn't reflect because why? >> so, again, the department -- the bureau's budget has increased by 50% over the last five years. the general fund investment has gone up, has doubled in the last five years.

so we know that the city has been putting more and more money into this service. at the same time, service requests are going up. that's not showing reflection in the performance. i think the idea was -- i think that the city services auditor needs to think about what -- is the department actual performing better and where is it falling short? that's why we decided to recommend one time. we did in the presentation include some other options that were not in the report. it's totally up to to discretion of the board what options make sense. >> supervisor cohen: music to my ears. of course it's up to the board. we are looking to you to tell us what exactly --

like a full menu of our options and you only gave us one. i'm looking for more options. like if you have this much you can do this, if you have this you can ebbi -- you can have this they will expand. >> the department could not make any recommendations where they saw the gaps were when we were speaking to them. we actually understood there were gaps and concerns about -- especially with the increase in service call and the increase need for service and walking down market street we see it. our idea was that -- what we did understand was that the department actually participate in looking at the increase in public service aids and some of the other increases and they themselves knew that there was an area where they could increase. we thought that was an idea important. the reason we didn't -- when you talk at on going resources, what we didn't recommend were new permanent positions. there's probably a really major reason

for that, which is we are hearing that they're not actually filling the positions a they have. the idea was to move in immediate resources, assess what they need. there's some other things such as pit stops which are on going. that's why we presented the recommendations we did. >> supersizerr supervise -- supervisor cohen: i want to talk to natasha. >> i have a presentation with graphics or i can answer the question. >> supervisor cohen: answer the question. >> sure. that's fine. we have as part of our mandate the

responsibility of creating maintenance standards for park and streets and sidewalks. in the streets and sidewalks program that's been going on for about 10 years we have revamped o one time in major way. this last year we look ed at data mae sure that it comports with what other data sources are showing. through that work we found that our day d -- data was coming back not showing similar friends to other data out there. what we decided to do was take a look at what the standards are, what the quos are, what the sampling method looks like and to work with the department to better come up with a way to evaluate the condition of the streets to a member of the public's perspective. we are reporting at a high level like on the score card site, monthly updates

to response of public works to street cleaning requests this is 95% of requests abated within 48 hours. as you have seen in the charts, both that bruce had as well as you have -- i have provided volume is going up and response is declining which is what the department was talking about. >> supervisor cohen: thank you. colleagues, do you have any questions for any of these presenters so far? if not i'm going to keep moving. next i'd like to call up the department of public health. we have them available here for questions. so i understand you guys don't have a presentation, right? or you do? >> we do have a short presentation. >> supervisor cohen: well,

present. that would be great. >> good afternoon. thank you so much for having us present briefly. i'm going to give a brief over view of how we think about this from a public health perspective and then we are going to jump into the issue of needles because i know there's a lot of questions about needles, why so many needles, what is the difference between a one for one exchange and it's important for us to understand from a public health perspective why that's the case. i'm the health officer of san francisco and i direct the population health division that does public health services for the city. ilene will follow me. we try to value

equity and compassion. we work a lot with the department of public works. an example that happened not too long ago is we had an out break among the homeless. we had hepatitis out breaks among the homeless in other parts of california but not san francisco because we activated our emergency response system and vaccinated close to 6,000 people. one of the things i want to get to is the whole distribution of needles is an important part of our strategy with getting to zero and hiv. what i want to do is share with you an info graphic that just summarizes why a syringe access so so important. i'm going to

walk you through it. when you have so many needles people become concerned about becoming infected when there's needle sticks because there's so many needles. you get complaints from the public, from workers, et cetera. you can think of it in three different ways. one is we are trying to diminish the contact between people for susceptible and needles. at the time you -- top you can see that. what we are most interested in is the middle circle, the prevalence of blood born diseases for people who share needles. the needles that become contaminated then put the rest of us at risk, not just other persons that injections drugs but healthcare workers also become at risk. so we all have this shared interest. the more clean needles we have out

there the more we risk infection. that's the first thing. the second thing, ilene will cover that quickly, we need a needles a needs based syringe access program, not a one to one exchange. what i want to let you know is that is a standard practice globally. it's recommended by the u.n. and any movement away from that would be moving in the wrong direction. so i just want to emphasize that as well. we've been so successful with keeping the prove -- prevalence of blood born pathogens done that we have not seen the infection that we have seen in other parts of the country. the last thing, in the diagram here you can see persons who inject drugs. you can see

here health workers. on the bottom are these two different boxes. it's public and non-healthcare workers. the nonhealthcare workers are going to be for example the department of public health workers. one thing i want to emphasize is the risk of becoming infected from a contaminated needle is very high if you're a drug user or healthcare worker. that's the population where the risk is high. when you go down and talk about disregarding needles in the community the risk drops so small that the estimate is around one per one million. the risk is so small that uc berkeley did a study looking across california because this is needle sticks across california and looking at the global literature they could not find more than ten cases of hiv or hepatitis b being trance

mit -- transmitted by a needle stick. the volume of blood is much smaller and they -- the virus viability degrades by hour. by the time someone would get sticked and the needle has been out there for days to week the risk has already gone down. those are the major things i do want to cover. i do want to acknowledge that the workers that do get stuck with needles even though the risk of infection is very, very small being stuck with a needle is emotionally draw traumaize -- tra ma -- traumatizing. whether it's a healthcare worker or -- >> or little kid. >> anyone, when you get stuck with a needle it's emotional traumatizing. we have to acknowledge that. that's the trade off that we have. we also

have to recognize that syringe access keeps the prevalence down and that's what keeps the needles -- the risks from infection from the needles down as well. i'm going to let ilene go through the disposal program. that's the other part of this equation. we talked about syringe access but it's really the disposal program that ilene will cover. >> we are still going to circle back to you. thank you. >> good afternoon, supervisors -- >> supervisor cohen: before you go we have a question. >> supervisor fewer: i am wondering if anyone getting stuck -- my husband who is a police officer was stuck with a needle from an iv drug users. we know that it's dramatic. i want to ask about the persons who inject drugs. have we seen

that number grown, the actual individuals injecting drugs? >> the current population is around 22,500. i'm not sure how much it's grown. >> supervisor fewer: do you have numbers from last year and the year before? >> the numbers that we have been using for the last year and a half, two years has been 22,500. data prior to that showed around 16,000 to 17,000. we also know that most of the people that inject drugs inject several times a day. it's not just something like they're injecting once. some people inject upwards of four, five days a day or more. so i'm prepared to answer any questions or i could just jump right into talking a little bit about the efforts that we are taking and the efforts of disposal.

>> supervisor fewer: one more question. among the iv drug users, what's the most prevalent drug? >> in a recent survey with people out on the streets people are using multiple substances. a common theme that i hear is that people are using heroin in the daytime and then using meth at night because if you're out on the streets, if you're in a camp it's scary out there. people don't want to sleep so they are staying away and then sleeping in the daytime. >> supervisor fewer: do you have about overdoses? >> i do not. tracy? >> the number of opioid overdoses that resulted in death is about 110 each year. >> supervisor fewer: in san francisco we do a really good job in that all of our programs

are very proactive in providing narcan or people who use drugs. that's one of the things that's offered at the syringe access and disposal sites. >> with the influx of fentanyl we've had to think about how we do things differently because fentanyl is showing up in other drugs that are not injectable. in crack there was a situation that happened last year. now what our sir rink providers are out reaching sros. the word is if you use drugs you should be trained in carrying narcan. >> supervisor fewer: thank you so much. >> i gave you just the executive summary from the uc berkeley report that exposing objecting nation -- exposing

injection. >> it's the second page. i just gave it. >> thank you. >> i was just told to come and answer questions. i can respond to i heard dpw speak and they touched on sweeps in the community where people go out

and clean up. we began collaborating with dpw. to date we have seven disposal kiosks placed. i know that we have one at sellby and that is empties every four to sick weeks and has syringes in it. it's next to a large encampment that's that has -- that has a lot of drug use. we see what is going on, let's

talk to drug users and see if they will use the kiosks ifwe place them. they have been really a successful collaboration with the two city departments. additionally at health department we have an out reach team that is called the community health response team. what that team does is they go out to the community where people use drugs and they clean up syringes. they are train ed to administer narcan and they have conversations with people in the community about the importance of cleaning up syringes and proper and safe disposal. they are distributing disposal supplies. that's really key. with so many people out on the streets and with encampments people are getting moved around a lot. it's really important for us and our programs to just really emphasize giving out disposal supplies so that people are able to dispose of them properly.

also dpw talked about the healthy streets operation center. the health department also has an active role in that program. when calls come in from 311 the health department is there and able to hear if it's an issue where it's just syring syringes. how can we utilize resources with our city partners to address the issues of people out on the streets. so there's multiple different avenues of safe disposal that we are working on. we are working on the sweeps with peers and that's a way for the community of users to get involved in safe clean up

and then receive an incentive. some that have volunteers for programs have been going to go and get full time employment. >> supervisor fewer: so we have kiosks that are placed throughout the city at hot spots; is that correct? >> correct. >> supervisor fewer: do you have someplaplaces where therea placed? i have friends in a park and it's green beltway. so i'm wondering do you have any of those that are in other areas where they can just dispose of the syringes? >> currently we do not have any in that area. i am familiar with the encampment that you're

referencing. we go out there to provide out reach and disposal supplies to that particular group. so usually how we place the kiosk, we look at data tone sure that it's a hot spot and then we have to do a community response. we are always open and willing to prays -- place boxes or kiosks in other neighborhoods and can spend some time assessing that area as a possible location. >> that's great. do we have any partnerships with medical facilities for syringe disposal. anyone that's an iv drug user knows if you go into medical facilities that there's a place there to dispose of needles? >> that's a very good question.

we refer people that use drugs that walgreens is an opportunity for safety disposal. i know that people can dispose at tom wadel clinic. that's a great opportunity that we can explore further as a disposal option. >> supersizer fewer: we have a lot of hospitals and health clinics all over the city in spots. then i'm wondering evangelical b even -- i'm wondering even at police stations if you can go and dispose of your needles. >> i work very closely with the san francisco police department. i know that some of the stations have taken it upon themselves to get disposal supplies from me and have disposal boxes at their

stations where people can dispose. it depends on the relationship that an individual -- people use drugs have with the police department because there's also -- that's often a barrier but i have seen out of the in the community some tenderloin police officers walk around with small boxes and give them out. that seems to be a good relationship. >> supervisooor fewer: you say the kiosks are emptied every four to six weeks but what about the other things? >> there's kiosks and boxes. the kiosk is the size of a mailbox for lack of a better term. then the smaller boxes are about the size of