i am just really delighted that we in san francisco, since the 1980s, have been at the forefront of pushing for innovative ways to change policies, new sciences and technologies to help us get to this milestone that we are so excited about today. we are showing progress, real progress, in fact. in 2018 for the first time ever, not only have we dropped diagnosis by 13%, but we have finally seen this number go below 200 for the first time ever. that is significant. [ applause ]. >> mayor breed: it's progress that we should all be so proud of. this shows that when we work together with the community, with our policy makers, with our public health experts, our

non-profits, we can truly make a difference and save people's lives. i'm particularly proud of the department of public health. they continue to show their commitment to innovative and ground-breaking health solutions. i also want to thank ucsf and getting the goal coalition and all of those with us who continue to show their commitment to addressing this issue as well. even though we've reached this incredible milestone here in our city, we know that there are still disparities that exist, specifically by race and ethnicity, by age, by gender, and, sadly, by housing status. these disparities highlight the work we have to do to continue to get to zero and really trying to remove the barriers, the stigma, the discrimination, so that we can truly end new

infections, which is our ultimate goal. in fact, in 2018, african-american men had the highest diagnosis rate. african-american women also had the highest diagnosis rate. fighting this should be our focus and we are taking steps to do so. this week the department of public health will launch a competitive bid process where we will allocate $8 million in additional funding to community organizations primarily serving the african-american, latino, transgender and substance-user communities in order to strengthen the work that we are already doing. [ applause ]. >> mayor breed: we have programs right here at ward 86

that others will talk about to really continue to help those that, sadly, we know are homeless. just last week, we announced our new initiative to help those suffering from mental health and addiction who are homeless on the streets. this initiative, our heal our city initiative, will help us to serve, treat, and house those living with h.i.v. and help prevent new h.i.v. infections. again, i want to thank everyone here today who is doing work, including dr. graham cofax who has been an advocate and working in this field for so many years, your incredible leader of the department of public health. i want to thank the positive resource center for their work. the san francisco aids foundation which had an incredible event and continues to raise money to invest in this effort. the transgender law center. aids legal referral panel.

the lgbt center. all of the leaders of the getting to zero coalition. your work is truly appreciated and the value of what you do makes a real impact, as we can see by the numbers that we're presenting here today. it is something that we should be proud of. and yes, the work and the investments will continue to be made. this is a milestone for our city. i want to thank each and every one of you for your work and advocacy to get us to this point. with that i want to take this opportunity to introduce a champion in this effort. this and so many other issues that we need to address in san francisco around mental health reform and others, supervisor rafael mandalman has been an incredible force in addressing

this issue as well. the supervisor for ward 8, supervisor mandalman. >> thank you, mayor breed. thank you for your tremendous leadership on this and so many other issues. as i walked in today, i had a couple of thoughts. one is every time i walk into ward 86 i get a little bit ver clempt because of the amazing work that has been done here for decades and then the amazing work that continues to be done to chart a new path to actually get us to zero. i am such a fan of dr. gandi and of all the folks who gave me a tour early this year or last year, i don't remember when it was. this is an extraordinary place. walking in here and seeing this collection of the city's public health talent, i am just -- we are very, very lucky.

[ applause ]. >> yeah, they deserve some plaza for the work they do each and every day to keep this city healthy and make it healthier. this report has fantastic news. dropping under 200 reminds me a little bit of 20 years ago, 21 years ago at this point. i am old enough, as some of you are as well, to remember when the bay area reporter had its first no abyss issue. now we are trying to get to the next step of no deaths and no new infections. to the folks who conceived that several years ago and have been pushing for that goal, i want to extend profound thanks and congratulation on the success that we've made. some of the data -- i mean, my aide got me some of the amazing statistics. overall in the city, 94% of the

people living with h.i.v. are aware of their infection. that is an extraordinary number. that is not true in the rest of the country. you know, there were no children under the age of 13 were diagnosed with h.i.v. since 2005. babies are not being born with h.i.v. in this city. that is an extraordinary accomplishment. we are getting people tested. we are getting folks into treatment. that is how we got closer and closer and closer to zero. that leaves the bad news in the report that we're going to hear more about, which is the persistent challenges and, in fact, the increasing rates of infection among african-american, latin max, folks on the street, folks struggling with substance use disorder, and mental health issues. i want to thank dr. cofax and mayor breed for the creative thinking they have brought to that issue. we know we will not get to zero

until we get a handle on really getting care to the folks on the streets who are living with so many challenges, who you see every day in ward 86. i think what the mayor has recognized -- thank you, madam mayor for recognizing it -- it is going to require cross-departmental collaboration, non-profit government, private actors all working together to really solve these challenges. everybody can do their part. here at ward 86 you've come up with a pop-up, innovative program to give folks the care they need. they don't have to make the appointments. they come in and you'll wrap around them and give them everything you can in each of those encounters you can. monica gandi moved out of this ward, so i'm not happy about that. i'm happy you're still in san francisco. all of you who have gotten us to this milestone and going to get us to zero, thank you so much. [ applause ].

>> mayor breed: thank you, supervisor mandalman. now to talk a little bit about the report is the director of the department of public health, dr. grant cofax. >> thank you all, today. it's great to be back in ward 86. i worked here for over a decade and i'm looking forward to returning to the clinic to be a clinician as well. i experienced, as with many of you, the grief and the sadness and advances that we've made with h.i.v. i started as a medical student and we've seen the progression that we've made and the progress that's been accomplished. whether you're a community

provider, a clinician, a researcher, a member of the press, i think the legacy teaches us that it takes a collective vision, a collective effort. priority-setting, and understanding what are the priorities in the system to help us do better. that's the san francisco h.i.v. model. that's our home-grown model that got us here today with h.i.v. it will get us to zero. getting to zero has the department's full support going forward. i think as importantly is the san francisco model for what we do with h.i.v. will also be the model for how we address what may seem like intractable health problems today. think about where we were 20, 25 years ago. think of where we started. who would have thought we're getting below 200? we still have much more work to do. we must be bold. we must be innovative, both and

h.i.v. and with mental health and with substance use and with addressing the intersection between health and homeless. speaking of both vision and innovation and getting us to where we need to be, one of the key people in this city who's doing ground-breaking research, dr. hyman scott of the public health department. dr. scott. [ applause ]. >> thank you, grant. thank you for inviting me to say a few words about some of the work that we're doing, and the focus on really addressing disparities in our epidemic in san francisco. i'm a clinician here at ward 86. i came to san francisco because this was the model of how you take care of people as they come. i think our focus on disparity has to focus on ensuring that we reach people where they are and that there are no hard-to-reach populations. there are just hard-to-deliver services and we need to rethink the way that we approach some of those services. i think pop-up is a great

example of that. some of the other street medicine and other opportunities to expand prep and treatment outside of the four walls clinics. although my focus has been on prep and we've seen overall increases in prep use and continuation in san francisco, we have seen lower rates uptake among black m.s.n., for example, 10% in other race and ethnicities. in 2017, that was the case. in 2018, it does look like that gap is closing. we've also looked at some of our data across our primary care clinics. it does appear when people start prep, they don't always stay on prep. the average duration on prep is eight months, despite continuing risk for h.i.v. acquisition. we take care of individuals after they have been on prep and stop prep. some of the barriers people have are related to access, costs, insurance changes, perceptions of risk, and discrimination.

i think we really want to support people as they initiate prep in their communities, with their providers, to ensure that people who want to access prep can stay on prep. we also have a focus in ensuring that the systems in which people receive care particularly for prep and treatment are affirming places and that we address the structural issues, including structural racism that a lot of our san franciscans are experiencing in the health systems. so we're really excited about the opportunities of these new efforts to really address these social determinants of health which are driving many of these disparities and preventing us from closing those gaps. i think if any city and jurisdiction in the country can do it, we can do it here in san francisco. thank you. [ applause ]. >> so thank you, dr. scott. i just want to emphasize the focus on health equity. we must make sure we drive down

the inequities that we're seeing in san francisco. it's been a privilege to serve under mayor breed and this is a priority of the department going forward. i also know we can't do this alone. the health department is a key piece of this work, but it also takes partnership. one of the great things of san francisco is the partnership we've had historically with ucsf. it's my great honor to introduce a leader, an internationally known leader in h.i.v. research. she really brought the model that was being used internationally and successfully. i was able to be part of those early conversations about what's going on locally and how do we turn the tide locally? what do we need to do? i think that key commitment of ucsf and the key commitment of professor diane havlier in her team, making sure we're looking locally, she has been an amazing

advocate. a key supporter of getting to zero. she's going to talk a bit about her vision today. thank you. diane havlier. >> it's an honor to be here today. i'm going to be talking on behalf of getting to zero. what is that? that is bringing people together from different sectors and communities with a common goal of ending the aids epidemic. it is built on the spirit of san francisco because it requires collaboration, volunteerism, and action. so the report that came out just a few minutes ago is our report card. it is how are we doing in getting to zero with our goal to end the aids epidemic in our city. one of the logical questions is, what is the getting to zero contortium's response to the report?

many of the members of the steering committee here, we want to share with you our reaction to the report. we are pleased, but not satisfied. we are pleased because we broke the 200 barrier. just to say that in san francisco over the last five years, new h.i.v. diagnoses have gone down over 50%. i don't know if you know this but in the united states it has become completely flat. we are pleased because people are starting treatment earlier. many of them on the same day with a program that was pioneered in our ward 86. a couple of years ago this was simply unheard of. we are pleased because people from all around our country, all around the worldcom -- come to san francisco and to this ward to find out what we're doing and

how we get results. what starts in san francisco doesn't stay in san francisco. we are not satisfied. i'm just going to go back to the 200. we're not satisfied because we nearly had nearly 200 diagnoses of h.i.v. in our city, and it's a preventable disease. we're not satisfied because of his disparities. you've heard african-american h.i.v.-infected male, his mortality is more than half that of his counterpart. we have many disparities. getting to zero, we're making the strategy. what are we going to do about it? so let's start with we have a double down on these gaps that we're seeing. what we need to do that is we just need to listen. that's one of the things in getting to zero, we convene people together, put the problems out there, have multi-sector discussions how are we going to work on this.

we need to listen. we need to deploy new innovative approaches with tools that we have like prep. and long-acting injectable therapy that could make it easier for some of our populations. and finally, the biggest challenge we are going to partner with the mayor's office and all areas of san francisco with the structural barriers to care. we know what those are, inadequate, gaps in housing, mental health services, and for substance abuse. that's what we're going to do. i've been working in h.i.v. i came here in 1984 committed to the aids epidemic for decades. it is a conniving and very successful virus. i know that we can reach our goals. i just want to put forward for us who have been working in h.i.v. for decades, these are the questions of our time. should we invest to end the aids

epidemic? can we end the aids epidemic? will we end the aids epidemic? on behalf of getting to zero, our answers are yes, yes, and yes. we think we can do that because we're san francisco. just look around here because we're in it together. so that's what i wanted to share with you on behalf of getting to zero. so now i'd like to turn the podium over to colleague dr. monica gandi who is the director of ward 86 and one of the huge structural barriers that we're addressing is the homeless population and monica is going to talk about pop-up. [ applause ]. >> it's really an honor to be here. just to tell you a little bit about the history where you're standing right now. we opened ward 86 in january of 1983. so this is the oldest h.i.v. clinic in the country. then across the street simultaneously opened an inpatient ward 5 b and 5 a.

and many innovations in h.i.v. care have come from this clinic. so a lot of the investigational therapies in the 1980s and 1990s were tested here starting way earlier than the rest of the country and the world. a rapid program, as diane mentioned, and a prep program. we know that many elements that are key to success for people living with h.i.v. are challenging if you don't have a place to live. that would be making and keeping appointments, particular set of appointment times, where do you store your medications and keep them safe, that they're not stolen, safe sex, healthy eating. all of these barriers are amplified 100-fold if you don't have a home. in addition to all these treatments we have here, we started the pop-up program and that was in january of this year. i'm going to tell you about the pop-up program, but mention one statistic from this report that was released a couple of minutes

ago that's so relevant to the pop-up program. among people who are homeless living with h.i.v. in this city, the goal of therapy is 34% and among those who have homes is 74%. that is tremendous in terms of virulogic suppression. we aim to reduce that discrepancy in virulogic suppression rate. people who are living with h.i.v. and homeless are 27 times more likely to die than those who have homes. what does pop-up do? the people who were coming here were not just coming for the appointments, but for urgent care and to get food or to be warm for a minute or to come in for a minute. the idea was to have a pop-up clinic form around this clinic.

it's like a pop-up restaurant where it is care that is designed especially for them. the pop-up clinic is composed of two or three designated m.d. providers, a doctor, social worker, nurse, and nurse manager. it is a certain group of people who pop up around the patient, provide primary care, vaccinations, provider vouchers, food, warm clothing, hygiene kits. all of that is done in the context of no appointments. it doesn't make sense to have a tuesday, 3:00 p.m. appointment, when you're living in an encampment. they can come any time of the day. if they're a member of the pop-up clinic, our group forms around them and does this tender-loving care. it has been successful so far, and i hope to tell you about that in a later forum. there is no way that reaching

this last 10% and these last 197 people and reaching the group that we need to reach isn't going to be resource intensive. it is resource intensive. but it's worth the resources to bring all the innovation and care to this last group of people who need it. we hope it's going to be effective and we'll tell you more about it later and thank you for supporting pop-up in ward 86. >> mayor breed: again, thank you to all the incredible non-profit workers, organizations, and the folks right here at ward 86 in general for your hard work and commitment to get us to this point. really proud of the work that you have done and also appreciative of the fact that you recognize that we need to be more deliberate in how we target specific groups that are disproportionately represented in these new numbers. we still clearly have work to do, but i do want to celebrate and appreciate the milestone set

here today, because the fact is we got to a place that was not -- someplace that anyone ever thought was possible. just like getting to zero, people were thinking, is that really possible? it is possible because of the work and the investment and what we're planning to do right here in san francisco. i can't think of better city to lead the way in this effort, and i'm positive that we will get to zero. thank you all so much for joining us here today. [ applause ]. >> we just started in january. so at this point there is about 65 patients in the program, and we need to reach about 180 to 200 in our own clinic, let alone anyone who is homeless living with h.i.v. that we would like to reach with pop-up.

still a ways to go. we're doing this on a shoestring budget. >> [ indiscernible ] -- >> they did not change at all essentially. last year was 33 and 70. we haven't made that dent yet, yeah. thank you. >> i meant to say that. so we had this goal of 90% reduction in five years, around 2020. so when we started, somewhere around 300. we have to get to 30. so we are -- the climb is going in the right direction, but in order for us to continue, we're

going to have to address what everybody talked about today. i want to emphasize, in the united states it really is shocking that the curve is flat. okay. that's because there hasn't been the investments and the innovation that we've been making here. >> [ indiscernible ] -- >> we will try. [ laughter ] [ applause ]. >> [ indiscernible ] -- >> so i think that you have heard during this press conference many of the themes from all the speakers, okay. so we have to be able to deliver care in a way that addresses the cultural -- the disparity that we have in population.

that's number one. that intersects with three things that i know the whole city is working on. housing shortages, mental health services, and substance abuse services. i probably think -- we'd all probably agree those are the main things we need to do going forward. >> [ indiscernible ] -- >> thank you for that comment. i just want to emphasize that the san francisco department of public health shares the concern about providing trauma-informed care. that's been a commitment for a number of years. we strongly believe that you can't fully address someone's h.i.v., substance abuse, mental health issues, or in some cases their life on the street to get them into shelter or navigation center or housing without bringing a trauma-informed approach to care. that's a key part of what the department has been working on. we've actually trained over 8,000 people in the departments

and some community providers in trauma-informed care. i also want to link the broader question of how do we approach the disparities in h.i.v. infections. if you look at the mental health, substance abuse, the housing inebbingiquities, this about the system. if you look at the focus on the 4,000 and the same principles and issues around inequities, the same focus on data and driving down the numbers, it takes hard work. sometimes we think, oh, there should be some fancy fix overnight and we should be able to reach into the sky and bring something. this is a 30-year path for h.i.v. if we focus on the populations that matter the most. invest in those resources, follow the data, and bring collective effort forward, we will be further ahead. we will be closer to zero, but

also making progress in those tracks. thank you. [ applause ] [♪]

>> mayor breed: thank you all so much for joining us at ward 86 at san francisco general. sorry to keep you all waiting, but there are always so many exciting things happening in san francisco. today we are really here for an important milestone, the release of our annual numbers of new hiv -- h.i.v. infections. while it is still challenging in terms of talking about some of the issues that so many people in our community face, we know that the work that's being done by so many amazing people right here in ward 86 in san francisco general and other incredible

organizations which i'll mention shortly will truly help us to reach what we know is a goal that we all have, and that is getting to zero h.i.v. infections in san francisco. i am just really delighted that we in san francisco, since the 1980s, have been at the forefront of pushing for innovative ways to change policies, new sciences and technologies to help us get to this milestone that we are so excited about today. we are showing progress, real progress, in fact. in 2018 for the first time ever, not only have we dropped diagnosis by 13%, but we have finally seen this number go below 200 for the first time ever. that is significant. [ applause ].

>> mayor breed: it's progress that we should all be so proud of. this shows that when we work together with the community, with our policy makers, with our public health experts, our non-profits, we can truly make a difference and save people's lives. i'm particularly proud of the department of public health. they continue to show their commitment to innovative and ground-breaking health solutions. i also want to thank ucsf and getting the goal coalition and all of those with us who continue to show their commitment to addressing this issue as well. even though we've reached this incredible milestone here in our city, we know that there are still disparities that exist, specifically by race and ethnicity, by age, by gender, and, sadly, by housing status. these disparities highlight the

work we have to do to continue to get to zero and really trying to remove the barriers, the stigma, the discrimination, so that we can truly end new infections, which is our ultimate goal. in fact, in 2018, african-american men had the highest diagnosis rate. african-american women also had the highest diagnosis rate. fighting this should be our focus and we are taking steps to do so. this week the department of public health will launch a competitive bid process where we will allocate $8 million in additional funding to community organizations primarily serving the african-american, latino, transgender and substance-user

communities in order to strengthen the work that we are already doing. [ applause ]. >> mayor breed: we have programs right here at ward 86 that others will talk about to really continue to help those that, sadly, we know are homeless. just last week, we announced our new initiative to help those suffering from mental health and addiction who are homeless on the streets. this initiative, our heal our city initiative, will help us to serve, treat, and house those living with h.i.v. and help prevent new h.i.v. infections. again, i want to thank everyone here today who is doing work, including dr. graham cofax who has been an advocate and working in this field for so many years, your incredible leader of the department of public health. i want to thank the positive resource center for their work. the san francisco aids

foundation which had an incredible event and continues to raise money to invest in this effort. the transgender law center. aids legal referral panel. the lgbt center. all of the leaders of the getting to zero coalition. your work is truly appreciated and the value of what you do makes a real impact, as we can see by the numbers that we're presenting here today. it is something that we should be proud of. and yes, the work and the investments will continue to be made. this is a milestone for our city. i want to thank each and every one of you for your work and advocacy to get us to this point. with that i want to take this opportunity to introduce a champion in this effort. this and so many other issues

that we need to address in san francisco around mental health reform and others, supervisor rafael mandalman has been an incredible force in addressing this issue as well. the supervisor for ward 8, supervisor mandalman. >> thank you, mayor breed. thank you for your tremendous leadership on this and so many other issues. as i walked in today, i had a couple of thoughts. one is every time i walk into ward 86 i get a little bit ver clempt because of the amazing work that has been done here for decades and then the amazing work that continues to be done to chart a new path to actually get us to zero. i am such a fan of dr. gandi and of all the folks who gave me a

tour early this year or last year, i don't remember when it was. this is an extraordinary place. walking in here and seeing this collection of the city's public health talent, i am just -- we are very, very lucky. [ applause ]. >> yeah, they deserve some plaza for the work they do each and every day to keep this city healthy and make it healthier. this report has fantastic news. dropping under 200 reminds me a little bit of 20 years ago, 21 years ago at this point. i am old enough, as some of you are as well, to remember when the bay area reporter had its first no abyss issue. now we are trying to get to the next step of no deaths and no new infections. to the folks who conceived that several years ago and have been pushing for that goal, i want to extend profound thanks and congratulation on the success

that we've made. some of the data -- i mean, my aide got me some of the amazing statistics. overall in the city, 94% of the people living with h.i.v. are aware of their infection. that is an extraordinary number. that is not true in the rest of the country. you know, there were no children under the age of 13 were diagnosed with h.i.v. since 2005. babies are not being born with h.i.v. in this city. that is an extraordinary accomplishment. we are getting people tested. we are getting folks into treatment. that is how we got closer and closer and closer to zero. that leaves the bad news in the report that we're going to hear more about, which is the persistent challenges and, in fact, the increasing rates of infection among african-american, latin max, folks on the street, folks struggling with substance use

disorder, and mental health issues. i want to thank dr. cofax and mayor breed for the creative thinking they have brought to that issue. we know we will not get to zero until we get a handle on really getting care to the folks on the streets who are living with so many challenges, who you see every day in ward 86. i think what the mayor has recognized -- thank you, madam mayor for recognizing it -- it is going to require cross-departmental collaboration, non-profit government, private actors all working together to really solve these challenges. everybody can do their part. here at ward 86 you've come up with a pop-up, innovative program to give folks the care they need. they don't have to make the appointments. they come in and you'll wrap around them and give them everything you can in each of those encounters you can. monica gandi moved out of this ward, so i'm not happy about

that. i'm happy you're still in san francisco. all of you who have gotten us to this milestone and going to get us to zero, thank you so much. [ applause ]. >> mayor breed: thank you, supervisor mandalman. now to talk a little bit about the report is the director of the department of public health, dr. grant cofax. >> thank you all, today. it's great to be back in ward 86. i worked here for over a decade and i'm looking forward to returning to the clinic to be a clinician as well. i experienced, as with many of you, the grief and the sadness and advances that we've made

with h.i.v. i started as a medical student and we've seen the progression that we've made and the progress that's been accomplished. whether you're a community provider, a clinician, a researcher, a member of the press, i think the legacy teaches us that it takes a collective vision, a collective effort. priority-setting, and understanding what are the priorities in the system to help us do better. that's the san francisco h.i.v. model. that's our home-grown model that got us here today with h.i.v. it will get us to zero. getting to zero has the department's full support going forward. i think as importantly is the san francisco model for what we do with h.i.v. will also be the model for how we address what may seem like intractable health problems today. think about where we were 20, 25 years ago. think of where we started.

who would have thought we're getting below 200? we still have much more work to do. we must be bold. we must be innovative, both and h.i.v. and with mental health and with substance use and with addressing the intersection between health and homeless. speaking of both vision and innovation and getting us to where we need to be, one of the key people in this city who's doing ground-breaking research, dr. hyman scott of the public health department. dr. scott. [ applause ]. >> thank you, grant. thank you for inviting me to say a few words about some of the work that we're doing, and the focus on really addressing disparities in our epidemic in san francisco. i'm a clinician here at ward 86. i came to san francisco because this was the model of how you take care of people as they come. i think our focus on disparity has to focus on ensuring that we reach people where they are and

that there are no hard-to-reach populations. there are just hard-to-deliver services and we need to rethink the way that we approach some of those services. i think pop-up is a great example of that. some of the other street medicine and other opportunities to expand prep and treatment outside of the four walls clinics. although my focus has been on prep and we've seen overall increases in prep use and continuation in san francisco, we have seen lower rates uptake among black m.s.n., for example, 10% in other race and ethnicities. in 2017, that was the case. in 2018, it does look like that gap is closing. we've also looked at some of our data across our primary care clinics. it does appear when people start prep, they don't always stay on prep. the average duration on prep is eight months, despite continuing risk for h.i.v. acquisition.

we take care of individuals after they have been on prep and stop prep. some of the barriers people have are related to access, costs, insurance changes, perceptions of risk, and discrimination. i think we really want to support people as they initiate prep in their communities, with their providers, to ensure that people who want to access prep can stay on prep. we also have a focus in ensuring that the systems in which people receive care particularly for prep and treatment are affirming places and that we address the structural issues, including structural racism that a lot of our san franciscans are experiencing in the health systems. so we're really excited about the opportunities of these new efforts to really address these social determinants of health which are driving many of these disparities and preventing us from closing those gaps. i think if any city and jurisdiction in the country can do it, we can do it here in san francisco.

thank you. [ applause ]. >> so thank you, dr. scott. i just want to emphasize the focus on health equity. we must make sure we drive down the inequities that we're seeing in san francisco. it's been a privilege to serve under mayor breed and this is a priority of the department going forward. i also know we can't do this alone. the health department is a key piece of this work, but it also takes partnership. one of the great things of san francisco is the partnership we've had historically with ucsf. it's my great honor to introduce a leader, an internationally known leader in h.i.v. research. she really brought the model that was being used internationally and successfully. i was able to be part of those early conversations about what's going on locally and how do we turn the tide locally? what do we need to do? i think that key commitment of ucsf and the key commitment of

professor diane havlier in her team, making sure we're looking locally, she has been an amazing advocate. a key supporter of getting to zero. she's going to talk a bit about her vision today. thank you. diane havlier. >> it's an honor to be here today. i'm going to be talking on behalf of getting to zero. what is that? that is bringing people together from different sectors and communities with a common goal of ending the aids epidemic. it is built on the spirit of san francisco because it requires collaboration, volunteerism, and action. so the report that came out just a few minutes ago is our report card. it is how are we doing in getting to zero with our goal to end the aids epidemic in our

city. one of the logical questions is, what is the getting to zero contortium's response to the report? many of the members of the steering committee here, we want to share with you our reaction to the report. we are pleased, but not satisfied. we are pleased because we broke the 200 barrier. just to say that in san francisco over the last five years, new h.i.v. diagnoses have gone down over 50%. i don't know if you know this but in the united states it has become completely flat. we are pleased because people are starting treatment earlier. many of them on the same day with a program that was pioneered in our ward 86. a couple of years ago this was simply unheard of. we are pleased because people from all around our country, all

around the worldcom -- come to san francisco and to this ward to find out what we're doing and how we get results. what starts in san francisco doesn't stay in san francisco. we are not satisfied. i'm just going to go back to the 200. we're not satisfied because we nearly had nearly 200 diagnoses of h.i.v. in our city, and it's a preventable disease. we're not satisfied because of his disparities. you've heard african-american h.i.v.-infected male, his mortality is more than half that of his counterpart. we have many disparities. getting to zero, we're making the strategy. what are we going to do about it? so let's start with we have a double down on these gaps that we're seeing. what we need to do that is we

just need to listen. that's one of the things in getting to zero, we convene people together, put the problems out there, have multi-sector discussions how are we going to work on this. we need to listen. we need to deploy new innovative approaches with tools that we have like prep. and long-acting injectable therapy that could make it easier for some of our populations. and finally, the biggest challenge we are going to partner with the mayor's office and all areas of san francisco with the structural barriers to care. we know what those are, inadequate, gaps in housing, mental health services, and for substance abuse. that's what we're going to do. i've been working in h.i.v. i came here in 1984 committed to the aids epidemic for decades. it is a conniving and very successful virus. i know that we can reach our

goals. i just want to put forward for us who have been working in h.i.v. for decades, these are the questions of our time. should we invest to end the aids epidemic? can we end the aids epidemic? will we end the aids epidemic? on behalf of getting to zero, our answers are yes, yes, and yes. we think we can do that because we're san francisco. just look around here because we're in it together. so that's what i wanted to share with you on behalf of getting to zero. so now i'd like to turn the podium over to colleague dr. monica gandi who is the director of ward 86 and one of the huge structural barriers that we're addressing is the homeless population and monica is going to talk about pop-up. [ applause ]. >> it's really an honor to be here. just to tell you a little bit about the history where you're

standing right now. we opened ward 86 in january of 1983. so this is the oldest h.i.v. clinic in the country. then across the street simultaneously opened an inpatient ward 5 b and 5 a. and many innovations in h.i.v. care have come from this clinic. so a lot of the investigational therapies in the 1980s and 1990s were tested here starting way earlier than the rest of the country and the world. a rapid program, as diane mentioned, and a prep program. we know that many elements that are key to success for people living with h.i.v. are challenging if you don't have a place to live. that would be making and keeping appointments, particular set of appointment times, where do you store your medications and keep them safe, that they're not stolen, safe sex, healthy eating. all of these barriers are amplified 100-fold if you don't

have a home. in addition to all these treatments we have here, we started the pop-up program and that was in january of this year. i'm going to tell you about the pop-up program, but mention one statistic from this report that was released a couple of minutes ago that's so relevant to the pop-up program. among people who are homeless living with h.i.v. in this city, the goal of therapy is 34% and among those who have homes is 74%. that is tremendous in terms of virulogic suppression. we aim to reduce that discrepancy in virulogic suppression rate. people who are living with h.i.v. and homeless are 27 times more likely to die than those who have homes. what does pop-up do? the people who were coming here were not just coming for the appointments, but for urgent

care and to get food or to be warm for a minute or to come in for a minute. the idea was to have a pop-up clinic form around this clinic. it's like a pop-up restaurant where it is care that is designed especially for them. the pop-up clinic is composed of two or three designated m.d. providers, a doctor, social worker, nurse, and nurse manager. it is a certain group of people who pop up around the patient, provide primary care, vaccinations, provider vouchers, food, warm clothing, hygiene kits. all of that is done in the context of no appointments. it doesn't make sense to have a tuesday, 3:00 p.m. appointment, when you're living in an encampment. they can come any time of the day.

if they're a member of the pop-up clinic, our group forms around them and does this tender-loving care. it has been successful so far, and i hope to tell you about that in a later forum. there is no way that reaching this last 10% and these last 197 people and reaching the group that we need to reach isn't going to be resource intensive. it is resource intensive. but it's worth the resources to bring all the innovation and care to this last group of people who need it. we hope it's going to be effective and we'll tell you more about it later and thank you for supporting pop-up in ward 86. >> mayor breed: again, thank you to all the incredible non-profit workers, organizations, and the folks right here at ward 86 in general for your hard work and commitment to get us to this point. really proud of the work that you have done and also appreciative of the fact that you recognize that we need to be more deliberate in how we target

specific groups that are disproportionately represented in these new numbers. we still clearly have work to do, but i do want to celebrate and appreciate the milestone set here today, because the fact is we got to a place that was not -- someplace that anyone ever thought was possible. just like getting to zero, people were thinking, is that really possible? it is possible because of the work and the investment and what we're planning to do right here in san francisco. i can't think of better city to lead the way in this effort, and i'm positive that we will get to zero. thank you all so much for joining us here today. [ applause ]. >> we just started in january.

so at this point there is about 65 patients in the program, and we need to reach about 180 to 200 in our own clinic, let alone anyone who is homeless living with h.i.v. that we would like to reach with pop-up. still a ways to go. we're doing this on a shoestring budget. >> [ indiscernible ] -- >> they did not change at all essentially. last year was 33 and 70. we haven't made that dent yet, yeah. thank you. >> i meant to say that. so we had this goal of 90% reduction in five years, around 2020. so when we started, somewhere around 300.

we have to get to 30. so we are -- the climb is going in the right direction, but in order for us to continue, we're going to have to address what everybody talked about today. i want to emphasize, in the united states it really is shocking that the curve is flat. okay. that's because there hasn't been the investments and the innovation that we've been making here. >> [ indiscernible ] -- >> we will try. [ laughter ] [ applause ]. >> [ indiscernible ] -- >> so i think that you have heard during this press conference many of the themes from all the speakers, okay.

so we have to be able to deliver care in a way that addresses the cultural -- the disparity that we have in population. that's number one. that intersects with three things that i know the whole city is working on. housing shortages, mental health services, and substance abuse services. i probably think -- we'd all probably agree those are the main things we need to do going forward. >> [ indiscernible ] -- >> thank you for that comment. i just want to emphasize that the san francisco department of public health shares the concern about providing trauma-informed care. that's been a commitment for a number of years. we strongly believe that you can't fully address someone's h.i.v., substance abuse, mental health issues, or in some cases their life on the street to get

them into shelter or navigation center or housing without bringing a trauma-informed approach to care. that's a key part of what the department has been working on. we've actually trained over 8,000 people in the departments and some community providers in trauma-informed care. i also want to link the broader question of how do we approach the disparities in h.i.v. infections. if you look at the mental health, substance abuse, the housing inebbingiquities, this about the system. if you look at the focus on the 4,000 and the same principles and issues around inequities, the same focus on data and driving down the numbers, it takes hard work. sometimes we think, oh, there should be some fancy fix overnight and we should be able to reach into the sky and bring something. this is a 30-year path for

h.i.v. if we focus on the populations that matter the most. invest in those resources, follow the data, and bring collective effort forward, we will be further ahead. we will be closer to zero, but also making progress in those tracks. thank you. [ applause ] [♪][music] >> san francisco city clinic provides a broad range of sexual health services