is san francisco the name of the saint who was so poor but helped -- who was so rich and became poor to help everybody. thank you. [applause] >> again, thank you and san francisco. only in san francisco. gotta love san francisco. nonl san francisco can you do something like provide $5.8 million for right to counsel to tenants facing eviction and have protesters. thank you, guys, for being here today. [applause]

>> good afternoon. the commission will please come to order. our acting executive secretary will please call the roll. [roll call] >> our next item, please. >> our next item is proposed action item for the approval of the minutes of the august 21 health commission. >> so commissioners, the minutes for august 21 are before you for approval. is there a motion? >> move for approval.

>> and a second? >> second. >> okay. the third item for discussion is the director's report. >> wait just a minute. >> sorry. >> okay. so the minutes that are sent out are incorrect, and you have, instead, or should have a set of the new minutes before you which actually indicated the actions on item eight, which -- or let me take it, miss chang, is the minutes that were sent out in the packets correct. >> those are the most current versions. i'm not aware if there were any edits. >> i just want to make sure it's edited correctly. i'm sorry.

i just want to take a look at it. yes. actually, the minutes under item ten did not carry the action that are in the packet. there should be new minutes available to us, and, in fact, in item ten, as the commission will remember, it should actually read that the commissioners voted to defer that action for three months. so commissioners, there was a motion and second, and i would ask that you actually consider that the revised minutes that were sent out, we don't have right in front of us, but it actually in substance had

indicated the action taken, which i believe you all remember. that would be added to the minutes, please. are there any other corrections? if not, then, we'll proceed with the vote. all those in favor, please say aye. all those opposed? the ayes have it, and the minutes have been approved. and thank you. mr. chang is substituting for our executive secretary who currently is on his honeymoon. so we will get through this meeting, and we will work with you in order to do so. so therefore, would you please call the next item. >> thank you, commissioner. the next item for discussion is the director's report. >> okay. so our acting director will please give our report. >> president, members of the commission, a couple of items

to highlight. we have two pieces of news on our overdose prevention programs. as you have probably heard, ab 186 passed the state legislature and is now moving to the governor for signature. that bill would authorize san francisco to do a pilot for a new type of overdose prevention program, otherwise known as safe injection services. it would be a three-year pilot, so that is exciting news for the efforts to -- here in san francisco to confront the substance abuse epidemic that we're experiencing, and we're awaiting the governor's action on that bill. in related news last week, mayor breed, along with the tenderloin health improvement program hosted a demonstration of an overdose prevention program as -- at glide.

that is a site that is a mock up to show what a program of that nature would look like. it was a good event with a tour of the site, and then remarks from leaders. and that type of program is one of the things that we're looking at here in san francisco along with other cities as one component, an important component of our response to the drug epidemic that we're confronting in san francisco. new generation health center celebrated the reopening in its new location last week, so that was a good piece of news. as you know, that site has been looking for a new permanent home at some time and had an event last week to celebrate the opening at the site of the homeless prenatal program very near where its original site was, so that's great news for that program, and a nice event to celebrate that milestone. in sadder news for the

department, joseph tatoui who was one of our street violence intervention program staff, also known as jungle, to those who knew him, was a victim of gun violence on august 23. it's a very sad note, but i just wanted to take a moment to mention jungle and say that our thoughts are with his family and with his friends and the community. he was an important part of our d.p.h. and our san francisco family, and we want to honor his contributions to the community and, again, extend our wishes to his family and friends and the community that he worked in. >> thank you. i also want to thank mr. wagner for taking on the roll of the acting director of health at this point. we'll have more to say about the -- about dr. garcia's

leaving us on our subsequent item. commissioners, questions, otherwise on the director's report at this point. commissioner loyce? >> mr. wagner, has the city attorney or anyone from that staff or the mayor's office spoken to what was articulated in the paper regarding the federal government's response to our efforts to have a safe injection drug site and the question about whether or not they would actually pursue legal action against the city and county of san francisco and what the implications of that are? >> yeah. we've been, commissioner loyce, in conversation with the city attorney's office and also other cities that are exploring this. there are a number of cities that are looking at this as one of the facets to their response to what we're seeing nationwide. there are still legal issues that we're working through, and

the event last week was not really to address that aspect, but the purpose, and i think it serves really well to do so, was allow people to envision and experience what a program like that would be like. you can kind of see how it would work, how it would provide a positive environment for people to come inside and get engaged with services, really kind of envision how a model of that type of program might work. so it was very inspiring, the remarks from the mayor, and the others, including dr. barry zevin from the department of health spoke at the event, and the director of glide, and it was a very inspiring event. so we're continuing to work through the legal and citing and logistical issues, but i think that was a step forward for that community to think about what that type of a

program might look like in san francisco. >> thank you, mr. wagner, and i was there, as well, so i appreciate your comments. >> yes, and thank you for coming, as well as commissioner bernal. >> thank you. commissioner bernal? >> yes, director wagner. first of all, thank you for this extensive report and writing. i just want to make sure the minutes and records reflected two awards that were received by the department of public health just so it can be known that the thomas aragorn won an award and that the d.p.h. trauma systems was recognized by the association of state and territorial health officials. just wanted that known in the open health commission. >> thank you. and there were other items. i didn't read the whole report in the meeting, but it's available to the public in front, as well. >> thank you. >> thank you, commissioner bernal, to again, point that out in public for us.

thank you. any further questions to the director at this point? if not, then, we will move onto our next item, please. >> item number four, general public comments. we haven't received any public comments. is there any at this time? >> we have not received any public comment for public comment. is that what you're saying? >> correct. >> okay. so then, we'll move onto our next item. >> item number five is for discussion. it's the finance and planning committee. >> commissioner chung? >> commissioner chung? >> good afternoon, commissioners. the finance and planning committee met just before this commission meeting, and it was a short agenda to approve the consent calendar. so right in front of you and on the consent calendar, and hopefully, you have the contract report, as well, that we have made some changes, including the first contract,

which is the regents university of california family and community medicine has been withdrawn for now and will be resubmit later on. and also, i think i need to talk to -- dr. chow and commissioner bernal to help me with the second one, which is the san francisco unified school district. >> commissioner bernal, proceed. i think you caught the proposed annual amount change. >> right. it was to amend the proposed annual amount without contingency to reflect the amounts that are in the unduplicated -- or the units of service section, if that's correct, i'm looking at -- where's michelle?

is she here? yes. >> that's correct, commissioner, there were some of the numbers that were included in the first set of documents that went out that needed to reflect the correct numbers, and that was the modification. >> yes, and i think the clarification for that was while an equivalent f.t.e. was being added, that in fact, there were existing health workers who were then going out and being trained, given additional opportunity, therefore, to help when the disparrate district that's have dental health in the -- several districts. there was not just simply hiring one person who had spanish or cantonese, so i appreciate the opportunity, commissioner chung, to help elaborate on the contract, r. we increased the capacity of the health educators at the public school district to get into the schools in those areas

that have disparities. >> basically represent a bunch of the workers that have hours that were equivalent to one f.t.e. and then, some contracts that had some changes in the number is on the last page. that is for the san francisco community health authority. so the proposed total amount with contingency is supposed to be 3,552,821, and the change in total contract amount is 8,107. and the proposed annual amount

without contingency is 3,172,162. and the only difference is 7 -- 7,238. and those are the changes to the contract on the consent calendar. >> commissioner chung? >> yes, commissioner bernal? >> i believe there were two more changes. the first was to remove the first page for further clarification. and then, also, page four, e. clinical works was under requested action and new amendment, and not a new original, all the way to the right-hand side of the chart. >> yes. we'll also note that as being corrections to the type of contracts. sorry. >> no. so the first contract was withdrawn. there's no change to the second

contract. the third contract, the change is to -- to reflect that that higher bilingual health worker is actually hired at a full-time f.t.e. but consists of, like, multiple bilingual part-time health workers. and then -- can you repeat the fourth -- oh, it should say amend -- amended, not original. >> correct. >> okay. and then, the last change was on the last page, which were some of the typos in. so it's 3,552,821 for the

proposed total contract change, in total change, 8,107. and proposed annual amount without contingency is 3,172,162. and the annual difference is 7,238. >> so commissioners, although, normally, the consent calendar is somewhat clearer, commissioners, do you have any other questions to be sure on what you're voting on? >> yeah. yes. keeping in mind that there were multiple changes to the original contract. >> yeah. >> seeing none, are there any extractions anyone wants to

talk about any of these any further? if not, we'll vote on the consent calendar. all those in favor, please say aye. all those opposed? the consent calendar has been adopted. go onto the next item. >> item number seven, it's the overview of process for the d.p.a.'s director of health. >> thank you. commissioners, as you know, two weeks ago we were surprised and saddened by the resignation of our director, barbara garcia. as you know, barbara has served as director over seven years and previously spent several decades here in the department first at tom wooddell and rising to director. during her time as director she oversaw the completion of the san francisco general hospital and the completion of the san francisco health net work along with really driving the integration of the medical and

mental health services together, and then, helping to create the ability for us to move into epic and assisting with the funding from the mayor's office and the supervisors to allow us to be able to actually acquire epic. along with that, she also advocated and pushed for the accreditation of the public health department, which we achieved several years ago. we know her as a champion for the health care of all san franciscans, rich and poor and in particular for our most vulnerable populations, and our city has been well served by barbara's service which was benefited so many, and which we are all grateful. our task today is to select for the mayor three candidates as a new leader to maintain the position of this department as a cutting edge and one of the

best county departments in the united states. our goals and the goal of our mayor our aligned as address homelessness, mental health, substance abuse, and continue our efforts to get to zero in h.i.v. infections, traffic deaths, along with other very important health initiatives. our may i don't remembor has h confidence in our department by naming our chief financial officer as the acting director of health. and as -- and as we carry out our charter duties to help select repetitives to the mayor, we met with the mayor promptly after the resignation with a plan to help fill this very important position.

it was clear from our meeting with the mayor that even the progress that we have made towards finding a new director are also in alignment. the charter calls for the commission to submit up to three names to the mayor for her consideration and selection; and she can accept any or none of them, and then, we would start again. we are believing that we actually will be able to help service the candidates for this very important office within a time frame which is somewhat aggressive, as miss calhlahan has told us, but very important for us to continue to move along because of all the important things, even some of which you heard this afternoon

are in progress. this department cannot suddenly stop and wait until we are able to find a suitable candidate, and i know that all of our executive staff has been working very hard in order to maintain our momentum. as the mayor herself as noted, this is an enormously important department for this city for which we must find the best talent possible. miss callahan's department has assisted several other commissions including the police commission, the park and rec commission, and the library commission, which i understand is continuing right now. and your officers have been working hard with mr. wagner and our staff here to come and recommend to you a proposed schedule in which we would then

try to identify and have three candidates for our mayor to consider within the next several months. that schedule is before you, and miss callahan has kindly come to help explain the process that her department will be assisting us with, commissioners. so miss callahan, thank you for coming and proceed. >> you're very welcome. thank you very much, president chow, vice president loyce, acting director wagner. mickey callahan, acting resources director. as commissioner chow indicated, our department has been working with a number of departments for the last ten years or so such as yours to find top candidates for the positions. we have meet with the mayor and your officers to find out how

to proceed, and we have come up with basically a framework. you will see before you kind of a graphic chart that talks about the steps, and what i'd like to do is kind of walk-through that a little bit and provide a little bit more detail if that's acceptable. >> yes, please. >> first of all, recruitment proposal, we are -- we haven't finished it because we need to get the high sign from this commission that we're going in the right direction. but we have definitely an outline of dates which cull minu -- culminate as early as december december would go to the mayor or potential sending us back to the drawing board, but if we do a good job, and i'm sure that we can, we would be able to identify top candidates, and the mayor will have the difficulty of choosing from a number of excellent candidates.

so we will be -- the proposal before you will involve having a public meeting where the public would be invited to provide input. if it was overflow, the commission could decide it needed to do more, but it would be at least one meeting to hear from the constituents, and the information that comes from that meeting in terms of desired profile and desired characteristics would come in the form of a job announcement which we would present to the commission for approval hopefully by the end of september. it is our plan to use a contractor that we think highly of that specializes in health recruitment called berkeley search consultants to help us do part of the work which would be basically publicizing the announcement, sourcing the announcement, and collecting the applications.

for a position of this high level, we always want to have a high level of confidentiality. we don't want curious h.r. analysts or anybody else to be looking through to see who has applied, so we would keep the applications outside of the city's regular h.r. system, and that's one reason we like to use an outside recruiter. obviously, candidates, we don't want to discourage can't dads from applying if they can't have confidence that the fact that they're applying would be kept confidential potentially until they find out they're potentially a finalist. we -- it would be our -- then, what we do internally here in d.h.r. when the commission -- when we find sufficient number of qualified candidates, we would rank them--good, better, best, is what we like to say. the commission can see all of them, but we certainly would want to show you which ones from what we think are the top

candidates, but then, the commission would decide whom you wish to interview. you can interview some of them, probably a side group who meets the minimum qualifications. when you conclude that process, you would let us know. normally we would have those outside the department of public health for confidentiality reasons, and we would facilitate that process through my office. after the commission then determines which candidates it would like to forward to the mayor, then, you will do so and advise commissioners, please,

callahan is here to explain part of this, but our proposal is that on september 18, we will hold a public meeting, i think, with -- to ascertain that -- it would be at 2:00 here in the chambers, and it'll be dedicated to receiving public comments in regards to anything the public would like to let us know in terms of the jobs that we are now going to be filling. in the meantime, i've worked with mr. wagner, and we also will be able to receive public comment by written e-mail through, what is it, healthcommission.com? >> it is

healthcommissiondph@sfdph.org. it's a lot of d.p.h.'s, but we'll send that information out for anybody who does not wish to come in person. >> so i would ask that the commissioners also receive a copy of that exact address because a number of commissioners have been receiving inquiries. so that comment on the part of the public can be made on september 18 or even prior to that, they can begin once we also post this, and then, allow our commissioners also to be able to distribute that to those that wish to. yeah. following the 18th, just to reiterate, we would then complete -- we'll have been in the process, working with staff and the officers to develop a draft job description. the input of the public from the 18th, and also any e-mails would then be incorporated, and

on our meeting of october 2, we would then accept the -- or modify and -- and then accept the job description, which would be that, which would then be used in the application. at the same time as miss callahan noted, we'd also be looking at a series of key questions that should be also an alert to candidates as to what we were looking for. for example, if somebody really felt strongly that they did not believe in safe injection sites, this may not be a good match for the city's agenda. so there would be a series of those that would be worked out with the director and with the officers for you, and with your

input in terms of areas you thought that would be kind of key that we could ask. so you should provide that to mr. chang during this period of time so that we can always simulate that. the hoping that on october 2 after we have agreed to the job description, then, the applications would be processed, right, by -- they'll be available -- not here at the department, again, for that confidentiality that we were talking about, but over at the city's department and in miss callahan's office, and she's been kind enough to see that all of her staff is able to do this for us. >> if i can add, also, one piece that we're going to need to do, we don't just say fill out a job application. we want obviously an interest letter, and i think we want to ask some questions. when we put the job description

out, we want to say here's an additional questionnaire. what is your opinions on the safe injection site. tell us your experience working in the public arena, tell us your experience working with the homeless. we would like to you to provide us with what some of those screening questions are, too, and that would allow us to evaluate the applications. >> commissioners, mr. chang is going to remind you of that because we believe we should try to move expeditiously, so please get those in this month because next month, we begin to work them into our application package, right. then, again, just to reiterate as we get the screening and find these groupings of candidates, at some point

within perhaps the month of november or very early december, we would then make a decision as to who might be the candidates for interviews. this is somewhat dependent upon how the pool goes and the availability of candidates at this period of time. our goal is the first part of the year or hopefully the first part of the year, to bring the mayor a proposal. may jar very much wants to find the best candidates, and while she is anxious to have a leader that she can work with toward a number of th veuu@ss@?rr= the best candidates, and while she is anxious to have a leader that she can work with toward a number of t veuu@ss@?rr=q the best candidates, and while she is anxious to have a leader

that she can work with toward a number of t veru@ss@?rr=q the best candidates, and while she is anxious to have a leader that she can work with toward a number of tveru@ss@?rrqqúe best candidates, and while she is anxious to have a leader that she can work with toward a number of to veru@ss@?rrq the best candidates, and while she is anxious to have a leader that she can work with toward a number of tr very much wants t the best candidates, and while she is anxious to have a leader that she can work with toward a number of the -- with -- with the candidates, and it's important time to find the very best candidates for our city. >> thank you, mickey for taking the time to describe this to us. i am a bit concerned about the timeline. this seems a relatively short time frame, particularly if we are going -- if we're considering a national search, as well, to give folks time to -- one, to give us time to sort of develop the criteria, agree on that criteria, provide you with the input, along with the public input so that you can develop an appropriate job description, and then, the duty outreach and especially if you're going to -- it's not going to be as simple as fill out the job application. and then, considering that we will be in the middle of

holiday season, i'm just wondering whether you have that high degree of confidence that we're going to be able to complete this as -- as hoped. >> thank you for the question. as dr. chow alluded, i felt this was an ambitious timeline. what we'll have to do is see how we do. for example, when we bring you the job announcements, is it going to be ready in time after the public input? i hope so, but we're going to ask for your flexibility in terms of calendaring things for approval. one thing is how long should the application period be? if you're being very aggressive, you might assume -- people at a certain level are going to know about this job and be interested in it. they're not going to need to take two months to decide to apply.

that's the optimistic view. it's also my experience is that whenever the deadline is, pima ply the day before or that afternoon at almost every level, so i don't know -- i think what we will be doing is communicating with the commission and letting you know whether we feel there is a rich pool of qualified candidates or whether we host them longer or do more looking. so that would be a circumstance which we recommend pushing the date out. to your comment about the holidays, i agree it's very difficult to have people come to their views in december. what i anticipate is setting up, the interviews will be done by this week. if we can't get it done by the early part of december, then, we would recommend waiting

until january because of the very difficult holiday travel, air fare and everything else becomes very difficult. i would ask the commission to maintain some flexibility given that it is a fairly optimistic timeline. >> thank you. yes, we -- we are concerned, but we thought, and i believe the mayor also thought we need to move forward, and she would understand if we needed to take a little more time. so we appreciate, also, your important notice to us that it may take longer, and we're aware of that. >> particularly as if you say or as we all know and want to be able to have the best pool of candidate that's we possibly can for this type of job. and the uniqueness of this department, i don't imagine

there are too many other departments across the country that reflect the breadth and the depth and the innovation that is characteristic of this job. >> i would say we can't assume we're going to find a candidate who already does everything this department does and has done it. i think you're going to be faced with priorities and varying ways that people become qualified for the position, and which of those you think are the ones that are going to tip the scales for you. >> commissioners, further comments on the process that your officers have put before you? if not, then, we will then proceed with this process, certainly, as i say, and as commissioner guillermo as pointed out, we are going to be mindful of the need to have the right pool of candidates, and

we'll bring that information back as we see it and also keep the mayor updated in terms of our progress. so we believe that that will fulfill our obligation. any further questions to miss callahan? we thank you very much for assisting us with the search. we're looking forward to working with you, i guess, over the next several months very closely. >> let me also introduce kate howard, our managing deputy director who's here today with me. she'll personally be overseeing the process. you may know kate from her time any time mayor's office. >> okay. kate, thank you very much. >> thank you. >> thank you. we'll now move onto our next item, please. >> all right. item eight is for discussion. it's an update on h.i.v. and s.t.d. data. >> okay.

please, thank you. >> thank you, commissioners. i am here to give an update on h.i.v. and s.t.d.'s with my co-workers. i'm going to -- [inaudible] >> -- and nicole trainer who is getting to zero prep coordinator, and then finally, dr. susan phillips who will be

giving the update on the s.t.d.s. so what we're going to do is -- one thing we're going to do is pause between sections because they're really long. so any time you have questions, please ask. we're going to give some updates from the recently updated h.i.v. report. we're going to talk about getting to zero including progress, and talk about the new you equals you campaign. [inaudible] >> we'll talk about programs from getting to zero and from department of public health that address the challenges of housing, mental health, substance abuse, and then, finally ending on the s.t.d. page. so this first slide shows trends and new diagnosis steps improvements for the number of people live with h.i.v. in san francisco. in 2006 to 2014.

so the first thing to note is that 94% of the people living with h.i.v. in san francisco are aware of their infections. that compares to about 86% nationally, and that really reflects efforts in san francisco to have frequent testing and targeted testing of people who are at risk for h.i.v. next thing to note is this blue line that shows declining new diagnosises over time. you can see it's a pretty steep decline. we're at 229 new diagnoses, which is the lowest number ever in san francisco, just as it was last year. the number of new cases continue to decline, but you can notice here the decline here was 5%. the previous two years it was more like 14%. i'm going to show in a minute some particular data on

population groups that aren't benefiting from on the decline. [inaudible] >> you can see that deaths over time has been pretty level. we're at 244 deaths. also, it's interesting to note that in the last two years, the number of deaths has been higher -- just slightly higher than the number of new diagnoses. the survivalal rate with h.i.v. is improving -- survival rate with h.i.v. is improving. we have an ageing population, which 65% of people living with h.i.v. are over the page of 50 and 28% are over the age of -- [inaudible] >> late diagnoses have also declined and late diagnoses is defined as somebody who

develops aids within three months of their initial h.i.v. diagnosis, so they're getting tested late. that's declined from 22% in 2012 to 11% in 2014. again, compare that with national data, 21% nationally. another good piece of news in san francisco is we have not had a perinatal case in the - [inaudible] >> nationally there was he about 15,000 pediatric cases diagnosed in the united states. this slide shows the continuum of h.i.v. care or the care cascade from newly diagnosed people from 2012 to 2016. that's where we look at people who are newly diagnosed and

then we follow them over time to see how well they do getting linked to care and getting suppressed. so the first set of bars shows the diagnosis, and the second shows the proportion of those diagnosis who are linked to care. the second set -- or the third set show people who are retaining care, and that is having another care after that initial linkage care, and then, the next is vital suppression after 12 months. in the earlier years of -- the earlier years, linkage to care was about 72, 73%. it's up to 83%. retention has improved up to 71%. and vital suppression is now much improved. now 85% newly diagnosed with h.i.v. are violation suppressed within a year.

in addition to those proportions increasing, the time to each of those care indicators are getting faster. so this shows the care indicators from 2013 to 2016, and it shows medium days. so days from diagnosis to care decreased from eight to five days. time from care to treatment went from 27 days or about one month to a median of zero days, so that same day, a treatment starts, which is the goal of our rapid programs. treatment to vital suppression decreased from 71 days to 39 days, and time from diagnosis to vial suppression, ultimately what we're trying to get to has been cut in half from 145 days to 66 days or about two months. this slide shows under lying causes of death among people with h.i.v. for three time

periods, so across each of the time periods, h.i.v. related causes of death have been decreasing. so in the most recent time period, about 38% of deaths were related to h.i.v., and that compares to 52% in earlier years. and so as we have few you are h.i.v. related deaths, and we have an ageing populations, deaths that are associated with age related causes, such as cancer or heart disease, are increasing, and that is exactly what we're seeing, so nonaids-related cancer are the second leading cause of death in all three time periods, and heart disease in those most recent time period is the third leading cause of death. we're going to show some data from a supplemental surveillance that we did

related to premature death in san francisco. so while the overall numbers are declining, if you look at new cases by race, you can see decline among whites was the most pronounced. whites also have a decline in number of new diagnose cases, but the other races have been low and steady with no decline -- no significant declines in recent years. and so what i wanted to do is point out six populations where we're not seeing a decline in new diagnosis in recent years. so from 2005 to 2017, if you look at this time period, all six of these population groups had somewhere between 20 and 40 new diagnosis, and they've been pretty level during that time. so african americans, the first group here in purple, after a period of decline, they're now between these three years, somewhere between 35 and 40 new

diagnoses a year, so there's kind of a flat. for asians, again, a decline, and then have levelled off in these recent years, between 30 and 35. women never had that decrease in the number of new diagnoses, and again, they're flat in this time period at about 25 new diagnoses a year. same sort of pattern with people who inject drugs, no decrease over time, and we might even be seeing a slight increase, up to about 25 new diagnosis in 2017. and then, for m.s.m., who also have a history of injecting drugs, they have levelled off and maybe slightly increasing in these recent years, and the homeless, too, after a period of decline, are level. so these are the populations that, going forward, we will be

working on so that they can experience the same decline, and we can get that overall decline and new diagnosis on the path that these have been in the past. another way to look at disparities and diagnosis is to look at rate. so a rate takes into account the number of new diagnosis but also the population size. and this slide shows rates among men. so while whites had the highest number, african american men have the highest rate per-100,000 of new diagnosis at 116, followed by latinos at 68 per-100,000, and white men at 39 per-100,000. the rates are declining among latinos and white men and are fluctuating with high among african american men.

when you look at rates for women, the first thing to notice is the scale are different, so the rates are much lower for women than they are for men, but the same kind of pattern. the rates for diagnosis are highest among african american women which is 43 at 100,000, which is just slightly higher than the rate for white men. we also see the disparities survival on the red line. 86%, which means somebody that's diagnosed with aids, that 86% of people diagnosed with aids will live for five years or more, but not all groups are experiencing that same high level of survival. the african americans are lower, al 80. people who inject drugs and m.s.m. injectors are lower, and women have a poor survivalal

rate at 81%. you see disparities in vital suppression. this slide shows vital suppression among everybody living with aids in the city, so overall 74% of people living with aids are vitally suppressed, but the populations that fall below that red line have lower vital suppression rates. so women and transwomen are 67%. people in all age groups under the age of 50 are less likely to be virally suppressed, and people who inject drugs and m.s.m. injectors are 67%, and the homeless has a very low rate of viral suppression at 32%. so given that we're not seeing declines in the number of new diagnosis among homeless people and whether they have poor care

and prevention out comes, i wanted to compare the characteristics of homeless people who are diagnosed compared to everybody else who is diagnosed with h.i.v. in san francisco. so if you compare homeless to the other cases, homeless cases are more likely to be women, transwomen, african americans, people who inject drugs, including m.s.m. injectors, and while there's no significant differences in age between these two groups, i do think it's interesting to note that about 34% of the homeless cases are diagnosed with h.i.v. before the age of 30, so they're being diagnosed very young. and this is my final slide. so this shows time from h.i.v. diagnosis to viral suppression between the homeless population and the half. so the time to viral

suppression is shown in red. what you can see for each year from 2013 to 2016, it takes longer for somebody who is homeless to reach viral suppression. but as we go over time, the time for both groups is getting shorter. by 2016, the time for both groups has been cut in half, and the difference for the two groups is getting closer. there's not that big of a gap. so i can pause here now before i turn it over for the next part and take questions, if you'd like. >> are there any questions at this point? okay. do we have public comment, by the way? >> no. >> okay. so shall we go onto the presentation of your next section? >> okay. thank you. >> thank you. >> thank you. >> thank you, commissioners.

so i'm going to be talking about the getting to zero effort with any colleagues, tracey packer, who's also on the steering committee, and nicole trainer, who is the getting to zero coordinator. i'm susan bucklinder, and i'm also on the steering committee. so just by way of introduction, just to remind you, getting to zero is this multisector consortium, where you get multiple sections of society together all aligned working on a common solution. we have this getting to zero effort that we launched at the end of 2013 that includes members berz of the health department, ucsf, kaiser, lots of community based organizations, activists, industry, all to come together

to work towards getting to zero. what we did was begin to launch these four different initiatives. you can see the four pillars. prep, which was to expand our capacity to deliver preexposure prophylaxis, which prevents almost all h.i. vichlt infections if it's taken on a daily basis. rapid, which is trying to get people same day diagnosis onto treatment, which is important for their own health, but it's been shown to actually improve the health of the individual themselves as well as to reduce the risk of transmission to sex partners. reengagement and retention in care, to try to make sure that people who are in care stay in care and people who are not in care get reengaged and treated and also virally suppressed,

and to reduce stigma and discrimination. now none of this would be possible without this decades long basis of support, which are these community based organizations which you as the commission have supported and the health department has supported as well as some of our federal funders by providing a brought spectrum of prevention programs and treatment programs. we've done a lot of different work in these committees, and there are just a couple of notes here. for instance, in the prep program, we've got a number of community programs. you're going to hear about some of these later on, navigators who help people to both utilize existing benefits programs and their insurance to get access to preexposure prophylaxis

pill. and also, an innovative pharmacy delivered prep program. you've seen the progress that's made with rapid. some of this's the result of this getting to zero program that we launched that had providers, clinicians go out to other provider's offices and train them on how to provide same day treatment. there's a protocol on our website where asked for repeatedly. it's been distributed around the world. the c.d.c. has also asked for that, to distribute it nationally. in our reengagement and retention in care, there's been great support for a number of community based programs, including intensive case management, a jobs program, providing food support for people who are food insecure. and ward 86, our signature program at zuckerberg san

francisco general hospital has a number of programs, including one that particularly serves our ageing population. and then we're working to introduce stigma through trauma involved care. so now i'm going to briefly go through a cup of data points to indicate where -- couple of data points that indicate where we've been taking the program. so by 2014 in san francisco, we had over 4,000 people on prep. up through 2017, we believed that number had increased four to five fold in terms of the number of people on prep and that's again an outgrowth of the work of the prep committee that's increased the capacity of providers to provide prep as well as to get the word out to individuals who might benefit from using pre