environment. >> the meet willing come to order. this is april 3, 2019 regular meeting of the budget and finance committee. i'm joined by supervisors, catherine, stefani and mandelman. madam clerk any announcements. >> please silence all cell phones. items acted upon today will appear on april 9th board of supervisors agenda.

>> please read item number. [agenda item read] >> supervisor fewer: thank you very much. i believe we have a speaker. supervisor hillary ronen. >> supervisor ronen: thank you colleagues. i was running from career day elementary school, very sweet. as you know, we passed a law unanimously over year ago to change the name terminal one to harvey milk terminal. in the last year, they have not

made -- moved to change the design of their sign accordingly inside or outside the terminal or in the airport at-large. their plan was to keep referring as the terminal as terminal 1. this is not in line what the board passed a year ago. my proposed ordinance clarifies all new signage after renovations are completed at terminal 1, must reflect its new name harvey milk terminal. the words harvey milk must appear in greater height. my legislation makes it clear that the large sign in front of the terminal should state harvey milk first and terminal 1 underneath. they strike the right balance ensuring direct signage and honoring the intent of naming

terminal 1 after naming after slain harvey milk. it's shame i have to legislate such detail. the refusal to comply with the law have left me with no other way. within the context of $2.4 billion renovation, the additional moneys they will need to appropriate is minimal. i want to note that the airport willingness to comply with the law pass by the board have not come out ramification. an award they were due to receive statewide lgbt advocacy group was taken away because of their unwillingness to carry out the law to rename terminal 1 after milk. i want to thank the mayor's office and specifically the mayor chief of staff as well as my colleagues on the board for

standing strong in our right to make this name change meaningful. with that, i'll turn it over to talk about the shore. >> chair fewer: colleagues you have have any comments? let's hear from the b.l.a. please? >> good morning. legislation before you today, the airport would add signage to the naming harvey milk terminal. the airport is previously budgeted $4.7 million for signage and artwork related to the terminal 1 named after former supervisor harvey milk. if you look at the fiscal impact of our report, the addition of interior signs will be an additional $1.3 million. these funds will come from the

airport capital program. i recommend approval. >> chair fewer: thank you very much. let's open up for public comment. any members of the public like to comment on item one? public comment is now closed. you like make a motion to move this to the aboar board with a positive recommendation. thank you. please call item number two. [agenda item read]

>> chair fewer: thank you very much. >> good morning chair fewer and members of the budget committee. thanks for having me here and for considering this legislation that we're cosponsoring with supervisor brown. proposition c, to support homelessness and housing services is currently in legislation. w-- litigation.while it's possie courts will decide in the city's favor that two thirds will not affect what's required. it's also possible that the court will vote against the city's position and invalidate proposition c. for now, over the next number of years, nobody knows exactly how long litigation will take. it could be three years or more

before that litigation is resolved. in the meantime, the city is collecting this tax from businesses but the controller is not authorizing the use of those funds given the litigation risks. funds are sitting in a bank account while people are suffering. we will get to use those funds down the line. if it's not, we'll be retired to refund all those funds back to the taxpayers. the legislation before you today is simple and straightforward. the individual experiencing homelessness today need our help today and they can't wait for three years. the legislation allows individual taxpayers to voluntarily sign an agreement with the city waiving their rights to a refund if prop c were to be found invalid down the line. in return for that voluntary agreement with the city, we would give that individual taxpayer a 10% deduction in their prop c tax liability.

with this agreement in hand, the city -- controller will certify the funds to use them immediately. the funds need to be use with the allocation that's in prop c percentage bucket have been honored. just to frame it another way, if we do prevail in court, we would have been able to use 90 cents on the dollar for each company that participates in this. 90 cents on the dollar today is better than a dollar in three years time. if we don't prevail, we would have been able to keep the 90 cents. the legislation offers two ways for companies to participate. one is through a tax credit which happens in the year to year basis and other is through

a tax credit through a gift. from the city's perspective, it means no difference. it's the same dollar amount. we provided with the goal of trying to provide as much encouragement. we offer these two options because they have different tax ramifications for the companies a the state and federal level. again, it does not impact the city in any way. again, this is about flexibility, encouraging people to participate. it's voluntary. we have talked to lot of individual taxpayers. people are looking at it. there's interest, no one is committed to participating yet. we hope that once legislation passes it becomes effective that people will come to the table quickly. i do have one minor amendment that i like to distribute that has to do with gift side.

any tax credit that's amassed extra credit, expires as in the current drop to the ordinance in 2023. we're proposing to extend that to 2025 just to give little bit more incentive for people to participate. we think having little bit of text tra -- extra time for that credit to work would help. >> chair fewer: i have one credit. the 10% tax break is that ongoing or is it reevaluated annually? >> as yo -- as i mentioned, on e tax side it's a yearly

agreement. every year it has to be renewed. that has to do with the function of the way that companies file their taxes in terms of changes year to year. it's only way to attract things. on the gift side, the gift amount doesn't necessarily have to correspond directly with the tax obligation. for that reason, there's some people who may want to pay a couple of two years in advance today. we want to encourage that because we want to get as much moneyed as money as possible. it expires in 2025. any extra credit that's gathered on the gift side would expire automatically in 2025. the city would take that money and no longer be eligible for credit for tax purposes. the construct of this ordinance expires sooner end of litigation

or 2023. the idea is that is not an ongoing thing. it expires. >> chair fewer: thank you very much. can we hear the report from the b.l.a. please? >> to follow-up, this ordinance would grant a 10% credit to businesses that waived their right to collect or refund on the gross receipt tax for homeless services. then it would provide irrevokable gift. we don't have a specific number in terms of cost, reduction in taxes that would result from

this ordinance. it depend upon how many businesses were participating in it. in terms of the prop c it's estimated to bring in about $300 million per year. 10% reduction will be about $30 million. we don't have estimate how many businesses will be part of that. we consider this to be a policy matter. >> chair fewer: thank you very much. thelet's open this up for public comment. any members of the public that like to comment on item number two? seeing none, public comment is closed. supervisor stefani. >> supervisor stefani: i have a question for the deputy city attorney. i'm wondering if there's any legal impediments doing this whether or not this is

ground-breaking legislation and somebody can waive this in this manner? >> deputy city attorney, their work confident legally that this ordinance and this proposal is workable as to whether it's ground-breaking, i leave that to you and mayor to describe. the ordinance works as written. >> supervisor stefani: thank you. >> chair fewer: thank you very much. it is a shame that prop c did not pass with two thirds in majority. what was the percentage again? 61. that was so close. i like to make a motion to move this to the board with a positive recommendation.

as amended. >> can we adopt the amendment first? >> chair fewer: i make a motion to adopt the amendment without objection. then make a motion to move it to the full board as amended a positive recommendation. thank you very much. please call item three. [agenda item read] >> chair fewer: i believe we have michael mitten from the controller's office here. >> thank you supervisors. in 1978, the anti-tax activists succeeded in passing prom 13 which happe capped our property. there was all these all taxes out there. they couldn't pass constitutional amendment. they came up to cap total tax

revenue. it took appropriations from a certain base year and they inflated them from a population factor and cost of living factor. which is california per capita income and measure of nonresidential new construction. crucially, if we exceed the limit on average over two years, we need to cut taxes in order to bring ourselves back down below the g.a.m. limit. that cost of living factor which could be either per capita income for california or this nonresidential construction, we found in our research that -- well, laws are not always crystal-clear on what was meant. the language used in the constitution area is kind of vague on what they mean by this nonresidential factor. we found that we have not been

calculating it the way l.a. county, san diego and marin county. they were riding on guidance from county standards and procedures from 1990 when prop 98 was passed as well as the league of city's guidance. we've gone back to the past five years and we recalculated the cost of living factor using those updated methodologies for the nonresidential new construction. that change raises our g.a.m. limit to $760 million. we can do voter overrides and our recent taxes have all included voter overrides. the tax revenue that comes in from them does not count towards

our g.a.m. the child care tax and the parcel tax for the school district, those also included provisions to exempted. since those revenues are not recognized, it doesn't matter right now but the four-year clock is running out on those measures. here's the limit. $3.7 billion with the revised cost of living factor. 1.1% for the san francisco population increase and 14% for the cost of living factor that represents there's been lot of new construction in the city lately. we can all see by the cranes.

the 18-19 limit gets up to $4.4 billion. now, there are some deductions we can make. one is the voter approved debt. it can be deducted, capital outlays can be deducted. this is just social security and medicare. proceeds is $4.2 billion that puts us $260 million under the limit for 18-19. that's all i have. >> chair fewer: any comments or questions for the colleague? could i please have the b.l.a. report? on page 13 of our report, table 3, we showed the calculation for the $4.4 billion appropriation

limit that's required each year by the california constitution. i believe it's fairly well explained. $4.3 billion is the base appropriation limit. the taxes that would be subject to the limit are shown table 2 on page 12 of the report. it's about $4.2 billion. we recommend approval. let's open up for public comment. are there any members of the public that like to comment on item number three? seeing none, public comment is closed. you like to make a motion to move this to the board with a positive recommendation. without objection. thank you very much. please call item four. [agenda item read].

>> good morning supervisors. the purpose of this resolution is for the board to indicate to the secretary of state office i have the authority to sign a contract to receive grant funds from the state. governor brown included grant opportunit--funds to use. the total grant fund is $134 million which just over $3 million allocated to the city. the city can use the grant funds to reimburse itself with the state. the city must expend matching funds to one to one basis. the mayor's office considering applying grant funds to reimburse the city with the leasing of the new voting

system. also just as far as retroactivity is concerned, that's in the text because the funds for potentially available prior to the resolution being put forward to the board. however, no funds have been expended under this contract at this time. i can take any questions. >> chair fewer: any questions? seeing none. could i please have the b.l.a. report? >> in resolution approves $3 million grant from the state for voting system. the board of supervisors previously approved the contract voting system and cost of $8.5 million over the first four years. these funds will be used to offset some of those costs. we recommend approval. >> chair fewer: thank you very much. let's open up for public comment. are there any members like to comment on item 4? seeing none. public comment is closed. i like to move this with a

positive recommendation to the board. thank you very much. please call item number 5. [agenda item read] >> chair fewer: thank you very much. >> good morning chair fewer members of the budget committee. human service agency is requesting retroactive authorization for our grant with the meals on wheels organization including the initial grant as well as subsequent modifications. meals on wheels is an important part of the department of aging and services nutrition program. it includes over 50 meal sites

as well as home delivered meals and home delivered groceries. the meals on wheels grant has three programs that are in the area of the home delivered meals. through these three programs, the agency annually serves 1.7 million meals a year to over 4000 seniors and disabled clients. the first two parts are home delivered meals to seniors and home delivered meals to disabled clients. in order to qualify these clients must have a physical or mental disability that prevents them from accessing congregate meal sites. this is for

it was awarded through an r.f.p. process. the grant was then amended in october 2017 to include add-back funds from that fiscal year. the grant was approved shortly after november 2017 to include cost of doing business and some one-time dollars. the grant was modified a third time in december of 2018 for additional add-back funds and one time only funds. these modifications were approved by the doss commission and not brought before the board of supervisors as required. this request is retroactive. it came about because agency was recently made aware of another

contract from 2014 that have been certified without board of supervisors approval. that was subsequently sent to the department of homelessness and supportive housing. upon finding out we conducted a review contracts and grants to make sure they have been approved by the board. ththis was clearly a mistake on our part. the department acknowledged that this grant should have been brought before the board. h.s.a. made changes. we conducted training for all our contract staff around the threshold for board of supervisors approval. we made changes to the three databases that we work with to make sure that there's different points within those tha -- in

regards to board of supervisors approval. we've changed how we submit our request to the board of supervisors. hichicklyhistorically we go thre commission and later board of supervisors. we trying to make that concurrent so the request goes through the board around the same time or no later than 15 days. we're also submitting a resolutions on contract by contract basis. in the past, historically, h.s.a. submitted approvals. we've added steps toth certification process to ensure

contracts are not certified without the approvals. our apologies on behalf of the department for oversight. i'm available to answer any questions you have. we have sarah chan who is the nutritionist from the office only aging. >> chair fewer: any questions? supervisor mandelman. >> supervisor mandelman: it is surprising to me that a contract did this. i'm a big fan meals on wheels. it's little surprising in getting rooted through, there's not a checklist. i assume there is now a checklist. >> in our database there's a

checklist. >> supervisor mandelman: i'm surprised it was approved without that, without a similar review. i assume it's attorney office does a check on that. >> deputy city attorney again. our office did approve the original agreement and the amendments as to form. our office's policy is not to sign an agreement approving as to form until the board has approved it. except in limited circumstances where the department need to sign, you have to run it up the chain and get certain approvals in our office. over the years, different teams in our office advising different departments have adhered to

policy. in light all the discussions here over the last few months, we've reminded everyone and being more vigilant making sure we never sign before board approval. >> supervisor mandelman: it's appropriate that they raised this issue. >> supervisor stefani: thank you chair fewer. along those lines in terms of these contracts going to the commission, the aging and adult services commission, are the commissioners aware of 9.118b? >> they are in general area. over the years, they were separate processes that we needed board approval and commission approval. one the changes that we're making to our contract documents, we prepare commission memo that summarizes it.

we're including in our procurement section when a contract is required to go through board of supervisors. our executive director spoke to h.s.a. commission earlier last week regarding this. >> supervisor stefani: thank you. >> chair fewer: i think there's b.l.a. report. if we can hear that. that will be great. >> proposed resolution would approve the original contract with meals on wheels and the first three amendments to the contract. the contract is for three fiscal years from fiscal year 17-18 through 19-20 on page 22 of our report. we summarize the expenditures under the contract including the contingency. we do cover in our report about the retroactivity. this first came up when we reported on the housing clinic contract that have been transferred from h.s.a. to the

department of homelessness and supportive housing. it never came to the board for approval. this is the second one. as we discussed our understanding is only other one out there that did not come appropriately for approval. we do talk in our report that's been discussion about steps that the agency is taking so this doesn't happen going forward. we do recommend approval. >> chair fewer: thank you very much. are there any members of the public that like to comment? public comment is closed. we will caution you that you should be prepared to speak at the full board meeting as supervisors have called these retroactive contracts out, especially the ones that did not get necessary board approval. i guess before us today, you're telling us that there's systems in place that this is not going to happen again? >> correct. >> chair fewer: okay. we can take his word for it. i like to move this to the full

board with a positive recommendation. can we take that without objection. please call item 6. [agenda item read] >> chair fewer: thank you very much. >> thank you. chair fewer and supervisors. good morning. as it was read, the purpose of this resolution is to extend the current three-year term as a contract by an additional seven years so the current term goes july 1, 2016 through june 30, 2019. this would extend it through

june 30, 2026. the extension is authorized under the authority, time period under enabling solicitation. you'll notice it was a question that we received but also it's in the report that the funding from 1920 through 2526, it assumes the same budget with the assumption any growth that may occur cost of doing business or whatever would be covered through the 12% contingency placeholder. the purpose of this contract is to provide syringe access disposal and health also and wrap around services such as counseling, low barrier, substance abuse treatment and hiv testing. the structure of this contract is that the department contracts directly with the san francisco aids foundation. they serve as the lead agency. the r.f.p. that enabled this new

program model required a lead agency to provide coordination of services, mapping of locations, centralization and distribution of supplies as well as regular meetings to accord the services and problems. prior to this, the department had six separate contracts with six separate agencies. this is consolidated. it was a joint agreement which is why when we went out to bid, they were the only responders, san francisco aids foundation is the lead agency. we went into the negotiations with them. right now all the partners have increased their services under this model. all syringe programs in san francisco is part of this umbrella contract. the models has been successful

wall the partners fully engaged is why we're requesting the exercise remaining options or the full possible contract term. there's four partners in this program. homeless use alliance, drug users union, glide and st. james infirmary. that's the basic structure. i want to invite tracy packard the director of the community health equity and promotion grant to our department to provide more program specifics and answer any questions you have about syringe collection numbers. >> good morning supervisors. i'm tracy packard. i also have with me three of my colleagues.

as michelle described, this is a syringe excess and dispoal contract. also included in is funding for the centre. which estood up couple of years ago which provides access and drop-in services for people who are experiencing homelessness as well as people who use drugs. that's part of that which is a model for linking people to care. overall, i wanted to comment on the importance of syringe access services here in san francisco. as you know, we started syringe programs early in the early '90s. started funding them in the early '90s. we have low rates here in san francisco. we can attribute our low rates among people who inject to syringe access a disposal. we can talk about getting to zero new infections.

hiv prevalence remains low and stable among people who inject. we're grateful for the support of the city leadership over the course of the hiv epidemic and san francisco has led the nation in syringe programs. it's really important to note that syringe programs offer more than syringes. it's gateway to care. they provide access to substance abuse services, medical care. we've been testing some outdoor models of substance abuse treatment at some of our sites and which are proven to be successful. i think it's also important that we have an ongoing effort to shine that services are meeting the needs of the population at risk but also residents, business owners, etcetera. we have an on going community engagement process to ensure

that. i bring that up because we do recognize concerns about syringe collection and issues around disposal. these are relatedded to issues we're dealing with here and housing and displacement. it's more difficult for people to dispose when they are unstably housed. we put a huge focus on increasing our disposal effort. you probably know about these. we have seen some improvement in our data on returns. we did send some data to you to show the increase in disposal. various methods is centing to that. he's syringe site is a disposal site. each person has an opportunity to dispose and get education about importance of disposing. we have kiosks throughout and

syringing boxes throughout san francisco. huge success has been the pick-up crew also funded through the san francisco aids foundation. we've seen an increase in immediate response to reports of discarded syringeses. they do proactive syringe pick-up seven days a week from 7:00 a.m.l7:00 a.m. to 7:00 p.m. there's syringe access collaborative. we meet with the providers monthly to focus on disposal and show the programs are following our policies and guidelines and to address hot spots. we do unannounced monitoring visits to the sites to ensure they are following policy and procedures. we do go to police meetings,

other community meetings, to ensure communities concerns are addressed to learn how to better improve the program. i'll take any questions or concerns that you have. >> chair fewer: colleagues any questions. >> supervisor stefani: thank you chair fewer. i have a few questions about access to substance abuse services. can you talk about more about that? what does that look like and what services? >> thank you. our most recent innovation is working with street medicine and others to offer a drug which can be administered on site outside. which is low threshold. it's right there when people are ready for it. we do have access to behavioral

health services through our syringe sites and people can be linked up. provide group and support that leads to substance abuse services. >> supervisor stefani: anything other than that harm reduction? >> all of the services that the health department provides, we have a system of behavioral health services. all of those are linked to the syringe states. when people are -- the staff at the syringe sites talk with people about what their needs are and if they are interested and to be referred to substance abuse service. we have the connection with behavioral health. >> supervisor stefani: do we have any success rates of actually getting people into recovery that come through these programs and so they no longer need syringes? >> that's a great question.

i don't have the the data for what the percentages -- numbers are. i can get that. i can tell you that cities with syringe programs are more likely to link them with cities without them. >> supervisor stefani: are we aiming for a certain idea with that? i figure if we're supplying a syringe at that point in time, we have a moment in time to actually offer services. are we trying to set our sights to certain level of success with that? >> that's a great question. what's so important that we have to recognize is building relationships and building trust with people is the most immediate need. over time when we do that, people people are ready to access services they will. not everyone is ready. we have to respect that. we do focus on building the

trust and also the low thresho threshold, you might know about the help that we've been holding throughout the city. we find that's also another way that people can have access to medically assisted treatment and build the trust. i'm not answering your specific question. i recognize that. >> supervisor stefani: in that moment in time, when people are coming and seeking not just the syringe but maybe services, is there anything that you feel that you are lacking as a department or you wish you had to offer? >> that's a great question. i feel like we are working really closely across city departments. certainly access to low threshold housing is an important part of services for people who are injecting, people who are accessing our services.

i think that's what i would say. >> supervisor stefani: thank you. >> chair fewer: supervisor mandelman. >> supervisor mandelman: i really appreciate that line of question. what we've been hearing from this committee is a real interest in thinking, systematically. even if it's currently beyond our capacity as a city and our financial resources, i assume from the demand for substance abuse, you have a certain amount of services that you can provide. somebody comes forward and they want to get into treatment, you probably can work with them to get them in treatment. you can't be terribly aggressive about getting everybody in treatment. you don't have the space for

them. there's the problem for people who diagnosed and what happens after 90 days. it's kind of like it's great to hear that we're making services available. i think we're all desiring to have a system that actually does actually get closer to treatment on demand and looks like appropriate treatment on demand and it's more focused on moving. people into better situations. i really appreciate it. the other thing that i want to -- you alludedded ted to this. one of the things that hear about needle access and disposal

services for folks who see the proliferation of use needles out on the street. it's sort of -- there's a narrative out there this is because we have moved away from needle exchange. somehow we're doing something wrong by not requiring in order to get a clean needle, somebody brain dirty needle back. you have suggested that we have achieved tremendous success in this city in reducing hiv transmission rates and other diseases up. i want to applaud department of public health and aids foundation and nonprofits for doing that. what you're suggesting, there's a connection achieving those good public health outcomes and having ready access to clean needles for people. that sort of moving away from that for public health perspective would be very troubling. i want to give you the

opportunity to maybe say that. >> i appreciate that very much. it's true there are often suggestions that if it was one for one system we continue see the litter. we don't think that's true. we also know that data shows that needs-based programs that allow people to get the number of syringes they need at that moment to get them to the next 10 day visit, are more effective. people use more than one or two syringes a day. it varies from person to person and type of drug. people may use up to 10 syringes in a couple of days. weapon want to make sure that everyone has it. it's a needs based based on community needs and individual need. we have had actually that policy and process for really since the beginning of syringe access and disposal programs. it's in the last four or five

years now, we've seen an increase in the litter. it really is attributable to other things. unstable housing and also opioid use has increased. there are more people who inject in the city than there has been. other social determinants of health that creates those problems. thank you for allowing me to share the research-based approach that we have. we always ensure we're using evidence. may i comment briefly? i wanted to note on the services for behavioral health. we have been working very closely with our behavioral health department and the syringe service providers and others to work on recognizing those needs, and how can our system change to meet those. that's an important part of this conversation. we've had meetings there's a

different kind of recognition what the immediate needs are and how can we improve our system to meet the needs. >> supervisor stefani: thank you chair fewer. while we're talking about this, are there any other type of needles out there. i recalled a conversation i had with catherine dodd a while back. she mentioned to me another type of needle that once used, it would anthony be -- without predict anybody. >> they are retractable needles. when know retract, they can continue to hold on contain some of the drug. they aren't fully effective for people who ic use spirings.

it prevents use of a new syringe each time. they are not useable. we do need -- we've been using this other type. >> supervisor stefani: thank you. >> chair fewer: could you tell me how many syringes are distributed annually? >> in 2018 it was 5.8 million syringes. that seem like a large number. it's important for us to think about when you look at the number of people who inject times the number of syringes they need. it's probably around 11 to 12 million that would meet the need. we're somewhere in there hoping to meet their needs. >> chair fewer: how many syringes do you collect? >> we're at about 62% return and that includes returns through

syringe programs, kiosks and cleanup program. we need to improve on that. it has improved quite a bit. we continue to need to improve that. at this point, if there are syringes that are inappropriately discarded, we have mt.ed ons ted on -- methodo clean them up. hopefully the city is seeing a change in that. we'll continue to work on that. >> chair fewer: i noticed that san francisco aids foundation pick-up crew began in july 2018. what was happening before? there wasn't a pick-up crew before? >> we didn't have specific pick-up crew. each of the syringe programs picked up their own syringes. they do a clean up before the sites. they had crews that went out which we also include peers, people who are services as well

that did clean up. we have a small team in the health department that also does cleanup. we didn't have what we tale needed which was that seven day a week, 7:00 a.m. to 7:00 p.m. >> chair fewer: thank you. could we please hear the b.l.a. report? >> this resolution approved second amendment to the contract aids foundation. the contract is for $9.8 million. it started fiscal year and goes end of fiscal year 18-19. this resolution would increase the contract amount from $9.8 million to $35.6 million. we summarized that in table within on page 25 of the report. it would extend the contract total of 10 years which is consistent with the original

r.f.p. because it's consistent with the standards that the city uses for contract, we recommend approval. >> chair fewer: thank you very much. have there any members of the public like to comment on this item? seeing none, public comment is now closed. i believe that you have some information that you're going to actually get back to the supervisors with. i think supervisor stefani requested some impact information. is that correct? >> we thought we provided it with the powerpoint. did you receive that? on behavioral health. i'm sorry. >> chair fewer: thank you very much. >> supervisor stefani: i want to follow-up too. the 62%, that's like a d, right?

what are we doing to improve the return rate? we have an opportunity, we're contracting with somebody. in that exchange of, i'll do this for you do this for me. what are we asking them to do in terms of return rate. i feel like given the million dollars that we're turning over here, this is our number one complaint in the city that we get all the time. definitely it's a need. the fact that we have such low rates of hiv is excellent. we obviously for health reasons we have to keep that up. our return rate 62%, what are other cities doing? are you thinking about this-in a way that gets that up to 100%? >> thank you. yes, we are.

we recognize that's a collateral factor of this good program. ensuring people have access to clean syringes. there's a number of things we're doing. if you look at the data that we sent to you. we have seen an improvement in disposal. we've seen an improvement in proper disposal which we define as people who injected bring the syringes back to syringe programs and putting them in kiosk and disposal boxes. we do directly with each individual that comes into the sites. we have also done focus groups to help us understand how can we improve syringe disposal with our participant. we listen to those and consider new ways of addressing them. one thing that we can say as 100% of the syringes that we know about get cleaned up.

that's an improvement. we have lot better communication i think now with them pick-up crew as a number that people can text. we get information through 311, etcetera. we've improved that side of it too where people can make their concerns known and clean them up immediately. in some ways we're at 100%. we have the capacity to do that now. you're also bringing something up that is really important. we need to continue to improve. we do have pattern partners. we really try to upstream factors. how can people dispose of their syringes in ways that fit for them and daily lives. that's why increases in the kiosks and syringe boxes are a result of that. >> you ever hand out syringe

boxes to individuals? >> we do. every person who gets syringes is offered syringe disposal box. people like to have them. we also are outreach team. when they clean up syringes, they provide syringe boxes so they are provided through the syringe program through the outreach and through the pick-up crew. >> chair fewer: supervisor mandelman. >> supervisor mandelman: i'm not sure that in this context. i do think that we're very significant population unhoused people, percentage of which are using drug who are being moved throughout the city regularly by public action. it is going to be very hard to get that with the best effort.

all the needles that are given. i don't think we should be giving out fewer needles. we're making it harder to access those needles. i do want to applaud the aids foundation for creating a second government, public works does this, u311 a needle and get public works to come pick it up. but the aids foundation independently established, recognizing this problem, second alternative way of getting needles disposed of and getting a rapid or within an hour of response. it's not acceptable that i'm not sure that there's a way to -- you should try to get that number higher than 62%. the way to get it higher is to get more folks off the streets and into programs and into housing. that should increase their

ability to get dirty needles back. >> thank you for that. we take any input and suggestions. one thing i didn't mention is the navigation centre also have disposal opportunities there too. >> chair fewer: the 62% of the 5.8 million that you distribute? they are telling people, these pick-up they're approximately 4 million needles that are picked up on the streets. i agree that i think 62% you could approve upon. we're seeing unprecedented numbers in san francisco of people who use injection drugs. can you tell me how that scope has changed throughout the last couple of years?