>> clerk: sorry, commissioners. i'm calling the roll. [roll call] >> clerk: i have a script that i will read now before we move on. good afternoon and welcome to the june 21 san francisco health commission meeting. this meeting is being held in hybrid format, with the meeting occurring in person at 101 grove street, broadcast live on sfgovtv, available also to view on webex or to listen by calling 415-655-0003.

before we begin, i would like to remind all individuals present and attending the meeting in person today that all meeting protocols must be adhered to at all times. this including wearing a mask at all times during the hearing, including when you speak. we appreciate everyone's compliance in this. hand sanitizer is available at the entrance. there will be an opportunity for general public comment towards the beginning of the meeting, and there will also be opportunity to comment on each discussion or action item on the agenda. each comment is limited to three minutes. public comment will be taken both in person and through call-in. for each item, the commission will take public comment from

meeting in person and then remote calling-in. instructions for calling in remotely can be found on page four of the agenda. please note that legislation prohibits notifying any single commissioner out for comments. >> it is time for the ramaytush ohlone land acknowledgement. the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original

inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their saffron rights as first peoples. next on the agenda is item 2, approval of the minutes of the health commission meeting of june 7, 2022. do i have any corrections or notes or, if not, i need a motion and a second.

can we take public comment. >> clerk: are there any members of the public who wish to make public comment at this time? and commissioners, a reminder that i'm going to wait about 30 seconds to make sure that the folks on sfgovtv are caught up. okay. it looks like there's no hands, commissioners. >> all right. we can proceed to a roll call vote. [roll call] >> clerk: thank you. the item passes. >> our next item is the director's report. we have director of health, dr. grant colfax. >> good afternoon, director bernal. dr. grant colfax, department of health. some items to review and report for the director's report. i was pleased to join mayor london breed, the d.p.h. team,

the san francisco health department for a new opening of a project for those with addiction and mental health problems. this is a new 75-bed facility that provides wraparound services designed to aid the transition to independent living after deals with the justice system. it deals with case management, medication management, and support recovery groups. it supports recovery through group therapy, peer support, and medication assisted treatment for substance use disorders. a really great project putting

75 beds and making 75 beds available, again, for adults in the criminal justice system who have behavioral health disorder. the next item on the director's report is an update on monkey pox, and dr. bada will provide an update in just a minute after i go over some items. just to remind the commission that we have the agricultural commission, cree morgan, and his direction in the environmental inspection branch. during a routine inspection of the fedex branch in san francisco, these investigators were investigating a shipment of plants from the state of florida. among inspection of the plants,

live suspect pests were found on the underside of the plant leaves. samples were submitted to the territory, and two pests were identified. a notice of reduction was issued for violating the california food and agriculture code, and this is just one example of the very important work of our inspectors that they do to protect san francisco from unwanted pests, including from other states. also, pleased to announce new grant funding to the d.p.h. maternal child and adolescent health program, which launched an intraagency collaborative council to center authentic engagement of youth improvements with an emphasis on youth and families from

historically excluded families. it's a collaborative that is meaningfully and financially sustainable beyond the grand funded period and build data capacity of the collaborative to better understand the needs of families in san francisco. so really good progress there. finally, just to let the commission know that there -- we continue with our focus on trauma informed systems of care and, in fact, there's a training that was held on -- or that will be held on june 27, an introduction to mindfulness training by our own janay johnson, our program innovation leader. and i do have an update on covid, as well, but wanted to turn over the monkeypox update

to our current acting health officer, as well. dr. susan philip is on a well deserved break. doctor, i'll turn it over to you. thank you. >> thank you, director colfax. i just wanted to provide the health department update on our monkeypox issue. we do have a dedicated health team working on the monkeypox issue, and that's been working since the beginning of the month. the total worldwide cases are topping 2500. they're at 2,580. in california, there's 37 -- 32, and in san francisco, there's a total of seven cases. the vast majority of cases are

in cis men who have sex with men. several california cases have been reported from having sex at bath houses in california, so that's another important piece of information that we're getting out to the public. our outreach includes information on vaccination, treatment, and protection. we want to assure that there's effective, accurate, and culturally reflective messaging for communities, and establishing and maintaining readiness for delivering medical counter measures, including vaccination as well as treatment when available. and then, we want to maintain equity and rights as well as

evidence-based approaches. we have initiated testing and contact tracing, and the department is making sure that all individuals are interviewed in a timely measure and that contacts are interviewed in a timely manner. we are also implementing vaccine right now for post exposure prophylaxis. there is a public awareness campaign in advance of pride, and it is a key strategy. this includes outreach to lgbtq and other organizations as well as other materials that are available on our website,

sfgov.gov/monkeypox. we are fielding many questions from clinician as they come in, and we are -- clinicians as they come in, and we are establishing treatment at sfgh. we are working on establishing a team for what those efforts should look like and what they will look like in the future. we know that the next few weeks coming into pride will be very important. next slide, please. here are a look at some of our resources. there's city clinic that people can go to, and there's info for community there, and then, or ccdp website has some information for providers. so stop there, and happy to answer any questions. >> commissioners, any comments or questions for dr. baba?

all right. seeing none, well, thank you for that update. it's particularly important, as you stated, going into pride weekend, so appreciate very much your bringing this all to your attention and to those who may be watching. we can move to our next item, which is -- or do we have public comment on this? >> clerk: first on the line, if you'd like to make comment on the director's report, item 3, press star, three to raise your hand. oh, and actually, commissioner giraudo just raised her hand. >> commissioner giraudo? >> thank you. director colfax, i have just a couple of questions. the first is on the grant award to the m.c. -- the maternal child health grant. are we going to see more concrete goals defined other than building a collaborative that's meaningfully and

financially sustainable? >> thank you, commissioner, for the question. i'm going to refer the question to hali hammer, who oversees the collaborative. the caveat is dr. hammer just returned from break, so if she's not able to answer your question, she'll get you answers as soon as possible. dr. hammer, please respond to dr. giraudo's question. >> yes, thank you, dr. colfax, and dr. giraudo, i will get you more specific information about the mcah grant in the next couple of days. >> thank you. my next question, i think the vaccine program is great. i'm also working with a

different ambassador program, and it's been very successful. my question is what are the specific areas that the ambassadors will target with the vaccine information? >> thank you for the question, commissioner giraudo, and i can't see everybody -- >> dr. colfax, i can answer. >> okay. thank you, dr. baba. dr. baba, it sounds like she has an answer for your question. >> the vaccine was focused on foster youth because that's where we found was a deep gap. there were focus groups about what potentially were barriers to getting vaccinated, and ucsf and their prime medical students came in on how to develop a program for the foster youth to get information out. so that's where it stands right

now. we know that especially now, a lot of the covid hesitancy, it's going to be a long game and having members of the community speak individually, and it might take several months to a long time, but this is a really innovative program, and we look forward to reporting more about it in the future. >> i appreciate it. the information would be great, because yeah, i do see it as very innovative. thank you. >> thank you. and commissioner chow has his hand up, as well. >> commissioner chow? >> yes, and this is more i think to director colfax. recently, there has been information in the papers concerning the closure of the tenderloin center. its success was highlighted as much as you had reported last month or last meeting that hundreds of people were using

that center. so you've talked about new beds, so i'm just thinking, where in fact are those services going to go? hopefully, it's not just a pilot that goes away, and then, we create more different pilots, but that we're able to take the opportunity from the experience and transport it or have it transported to that level of one-stop shop that seems to be successful for the person that you've seen. >> thank you, dr. chow, for that question. so just to also emphasize, the project is part of the expansion of the many beds --

our capacity is part of mental health s.f., and work continues in that regard. as you pointed out, the tenderloin center is now in the current proposed budget. the tenderloin center is budgeted to continue to january 1 of 2023, dr. hillary bonitz and the behavioral health team are continuing to work to determine what the next iteration of services will look like. this will potentially include -- as you know, we've been working hard with other stakeholders in the community on safe consumption sites and working to possibly establish those where people can go to receive safe harm reduction supplies and use.

we're having conversations about what other facilities and options there may be starting in january 2023, which is the day where the tenderloin center is budgeted to, so i'm happy to have dr. clemens come back to the commission to present on the services that the center continues to provide because it has prevented many overdoses since it has come into assistance. >> i think it would be nice to get further updates and how the lessons learned from the tenderloin center will also get carried out, so i appreciate that very much, director. thank you. >> commissioners, any other comments or questions? if not, we'll move into the covid-19 update. back to director of health, dr.

grant colfax. >> thank you, president bernal, and thank you again, commissioners. just a quick update on the covid-19 status in our city. next slide, please. you are familiar with the formatting of these slides, so i will run through them relatively quickly. as you know, our swell of cases continues, cases that recently levelled off. they've been bouncing between about 55 and 50 cases per 100,000. you see our latest data point is at 49.8 per 100,000. remember, the caveat here is this only represents cases reported by our testing providers and do not represent the home testing kits, which is one of the reasons that we're filing hospitalizations as the metric going forward and i.c.u. admissions especially. next slide. you can see that we had over

100 -- 100 -- 150,000 cases of covid-19 reported. unfortunately, we've had 897 confirmed deaths due to covid-19, and certainly, this is really tragic, and our condolences to the families of the loved ones that have died from covid-19. next slide. you can see on the far right of this slide, the more recent peak of unfortunate deaths peaking at 74, consistent with omicron surge, and deaths have fallen since then. and of course, remember, there's delays with reporting deaths, so the numbers will go up as cases are confirmed and

reported. next slide. case rates by vaccination status, very, very, very high by people who remain in san francisco. nearly four times the rate of people who have received their initial vaccine series. next slide, please. our hospitalizations, we've peaked at just about 100 hospitalizations in the city, and this includes all hospitalizations, including representing between 30 and 40% of our hospitalized cases are out of jurisdiction. and remember, in addition, these cases represent the total number of people with covid in the hospital even if they've been admitted for noncovid related cases. so you can see that these numbers have levels off.

the numbers are still high. they've been between 85 and 100 the last couple weeks. next slide. in terms of vaccine administration, you can see we're stable here, in terms of 84% of the population has had their vaccination completed, and you can see our booster rates remain extremely high. and among our five-to-11-year-olds, extremely high. 85% have completed an initial series. next slide. in terms of the booster, all people who are eligible for a booster dose, we've boosted nearly three-quarters of people, and you can see those people increasing percentage when broken-down by age with 85% 65 or over.

next slide. >> clerk: excuse me, director. i apologize. it's time for the two of you to walk over. >> okay. thank you. i will just finish up to say that this is a big day. c.d.c. and f.d.a. have authorized children as young as six months old to start getting vaccinated today. we have about 40,000 children in that age group. you can see the posters that we've created and are sharing with our partners. they will be shared with the providers and pediatricians, and we're working across the city to ensure that six months to four-year-olds know where to get the vaccine and get the vaccine as quickly as possible. and you'll excuse me. dr. baba will be sitting in for

me when i have to exit to the mayor's office for just a bit. thank you, commissioners. >> clerk: and as a note, commissioner bernal is leaving temporarily. a quorum is lost for the health commission, and for the time being, this meeting continues as an information session. no decisions can be made without a quorum, but the meeting can continue. just want to make sure i clarify that with everyone. dr. baba, is there anymore information? >> i think that was the end [indiscernible]. >> clerk: commissioners, any questions? it looks like commissioner chow has his hand up. >> thank you. i'm wondering, as we're looking at the data in regards to booster doses, and i know it's rather difficult probably to work on this, but is there any information about the fourth

booster and how well that is going in the population? obviously, we don't know what the denominator is, i guess, but at one point, there was some discussion that there would be the ability to track the update of the fourth booster. >> [indiscernible] there we go. so yes, you are correct. the team is working on this. as you're saying, the data is a lot more disburse, given that the information is not quite as consolidated as it has been in previous vaccines and boosters, but we are looking at getting some updated data in the coming weeks. >> and i assume we will be

following how well the over five block are doing? >> and i believe the team does have the data set up to be able to gather that. we are anticipating, but we'll see how this works, that most people will be going to their pediatric to get information as well as vaccinated there, but all of our sites are going to be offering this vaccine, so we'll see what the vaccine is, but yes, there are systems in place to try to track that. >> your public announcement or at least advisory to physicians indicate that physicians were being challenged, and i imagine that's the pfizer vaccine, that the department was making some sort of arrangements. what would that be in terms of physicians that might be challenged that don't necessarily have the pfizer and

don't have the moderna? >> i think it was the barriers. was it a storage barrier or was it other barriers in terms of trying to get the vaccine on sight and really working at the individual clinician level to see if there were other barriers that could be overcome. i think this was with respect to the age group. the team has been working very diligently to see if there are some barriers. the team can definitely work with the state to ensure that vaccines go to local pediatricians, as well. >> very good. i'm sure we'll be brought up to date on subsequent reports. thank you. >> and i also see dr. green

with her hand up. >> yeah. in terms of what dr. colfax was saying, we've gotten a lot of vaccine hesitancy from the under fives, given the idea of order of vaccines and how many to give at once has been confusing for some people. i guess i have two questions. the first would be, can you read anything into what our probable uptake would be, based on the side of the older group of children. and then, i realize the uptake may be quite haphazard and unpredictable, and we may get delivered an unknown number of vaccines, more like a clinic than an office, and we may waste a number of vaccines just because we don't know what the needs will be. so i wonder if anyone has

figured out how to best distribute doses so we don't waste doses but we also have them available. and the third thing is are we arming pediatricians to address any potential vaccine hesitancy? >> yeah, thank you for all of those questions. in terms of trying to figure out demand, san francisco has more of a demand than other parts of the country. now will that translate into the 80 to 90% of older age groups that we've been seeing, we'll have to wait and see. you point to this idea that how do you ensure that you're getting the right flow of vaccine to meet the demand?

that's really tricky. i think right now, we have right now, the amount of vaccine coming into san francisco will meet the demand, but we'll have to see week by week if the vaccine demand goes down and match our orders do that. and i apologize. what was the last point? >> i think it was what are we doing to give pediatricians to deal with vaccine hesitancy. the correlation is a lot of families had covid very recently, since the beginning of this year, and so do we have advice to give to people when a family had it in january? what do we say about they should give their three-year-old a vaccine in july? >> right, and i think this is where these individual discussions, because this is where you mentioned the timeline is going to be varying across many different families, and so that's why the

individual discussion is so important. we have clinicians that are helping provide technical assistance as needed, and we do send out health advisories as needed, but i think it will be as we get questions from clinicians, developing those f.a.q.s and hearing from the ground itself. i think some of the things that you're saying, we can preempt, but until the vaccine is out, we'll have to see where we can potentially help with some of those answers. >> great. because i think it is confusing for some of the clinicians because people think with omicron, once they've had it -- there's confusion over whether you've already had the disease since, let's say, december of

2021, so the more you can provide on that, the better. >> thank you for that. >> any other questions -- oh, i'm sorry. commissioner greene, i didn't mean to interrupt you -- >> no, that's all right. we can go to general public comment. >> clerk: if you're on the line and you'd like to make comment, press star, three. again, that's star, three, and i will wait about 30 seconds. all right. i don't see a hand, commissioners, so i believe we can move onto the next item. >> all right. gender health san francisco update. >> clerk: jenna, please pull

the slide update for item 6. great. thanks, kenya. >> good afternoon, health commissioners, dr. baba. great. thank you. good afternoon, health commissioners, dr. baba. i'm jenna rapues. i'm the director of gender health s.f. what a great time to provide an update with pride march on sunday and some of the month's pride celebrations. i am joined by some of my colleagues, barry zephen, and

we'll cover some of the program metrics. just a little bit about gender health s.f. before i dive into the presentation itself. we were established in 2013 by the san francisco department of public health to provide access to gender affirming surgeries and services to eligible uninsured trans and nonbinary individuals in san francisco. i do want to take a note that we are a program of behavioral health services, and as part of the package that we all sent to the health commissioners, one of them is an updated program brochure that provides updates information around our program and services which covers eligibility, services, and the peer navigation services

program. we covered three stories, which unfortunately we won't be able to premier because of technical difficulties, but we encourage people to watch them. last but not least is some of the evaluation efforts around health care access around some of the people that we serve as well as navigation services. next slide. so one of the things that i really want to highlight as

part of our program as gender health is we are peer led, and we provide peer services that are congruent. how do we provide services for a population that has been traumatized? we become essentially the program that really coordinates with all the systems of care in our public health system to ensure that patients have access to good health care but also access to surgical access. we have patients that count on us who are referred through

primary health teams, so our patients are not just patients that have come through the program and are referred but also the coordinating care with all the systems of providers that makes sure that trans folks get the support that they need to to ensure good outcomes. next slide. this is a really good diagram that highlights our priorities. the board of supervisors recognizes that transition related care is medically necessary, and that was back in 2012, and that's actually ten years from now, so really, when we think about when we started as a program, it really highlights our tenth year anniversary in terms of where we came from and where we are today. i also want to point out that when we started, it was a collaboration between various

stakeholders but really something that provides a sense of support for folks and it was something that the community members advocates for. it's -- advocated for. it's not just hiv. i came in in 2018 at the program. really, my role, when i first came in was really to really build the peer navigation service at gender health s.f. so much of our work because we

do land in traender health services is gender and non -- transgender health services is -- in 2020, as we all know, we experienced covid, and in march, we went into shelter and place and really pivoted our navigation services to remote telehealth navigation services, so during that year, we were quite a busy year in 2020. we migrated over to epic e.h.r., and that really allowed us to integrate our services and data with our host system and really wraparound care for our patient population.

as you can see in 2021, we had new staff, particularly a clinical director that joined us and a new practice manager. and 2022 really, again, signifies the tenth anniversary of our program, really highlights some of the things that are important to the program, such as reevaluating the way that we hire and frame living experience of our staff and living system. there has been a lot of effort and work that has been done to advocate and look at trans and nonbinary lived experiences in our hiring practice with h.r. similarly, that same year, we had our lead patient navigator, karen aguilar, who was promoted into a lead national navigator position. in the value, we'll be really

busy with this collaborating with castro mission health center. the idea is really land be able to be accessible to patient populations. last but not least, we're going to have a physician that's part of ending the hiv epidemic, peer opposition navigation, to really lend in this idea of folks that have been referred for care or access to gender health s.f. next slide. so much what i'm talking about is this idea and concept of a unique program to the department, which is integrated system wide access for trans

and nonbinary folks. a couple of things that i really highlighted was culturally congruent care for the population. it's important because trans and nonbinary folks have had issues with being able to trust their providers, so we have folks that they can connect to and lead them through surgery access. as mentioned earlier, a bit of the work that we do through b.h.s. and workforce act is service development for trans and nonbinary folks, so we're not just providing navigation services for patients that have been referred to us but also providing workforce development for folks who have come in who are from the community and are

able to be hired as peers and do really employable work stills in the public health setting. so much of our work is in behavioral and public health, so there's primary care and beverly health to unsure -- ensure that patients get the wraparound services that they need. we provide presurgical assessments and supports, and we do this to ensure they're able to navigate surgery access in a supportive environment. last but not least, so much of our work lands in education and

surgery access. so much of our work is provide peer health education and really changing the systems of compare and the ways that we support trans and nonbinary folks through the system. next slide. so i always think about -- when i think about the heart and soul of our program, it really is where the patients get the support that guides them through the process of accessing health care. so much of that is being able to connect on a one-to-one basis, patients who may feel daunted by the complex nature of our health care system, particularly with health care and insurance having someone

from point of referral and postsurgery and after surgery does affect the outcomes that transpeople have with their surgeries. and last but not least, assisting and assuring patients before and after surgery, so just having that one-on-one contact with someone who's going to be their advocate through the process. next slide. and this is the slide that i'm going to have seth talk about. >> good afternoon. thank you for having me here.

my name is seth pardo. it is a pleasure and honor to continue to collaborate with jenna rapues on gender health s.f. i'll speak a little bit more about the breakdown per year of the program, but far as demographics go, the program, when compared to the 2015 u.s. trans survey, which is the only other national sample we have for this population, we can see the difference that is served here by the department of public health compared to a sample that are surveyed nationally. our population compared to usts is mostly trans women, people of color who are really to

middle age, educated less than a high school diploma. most of them are unstably housed and have some degree of -- a significant degree of underemployment or unemployment. next slide, please. when looking at the gender health s.f. surgeries and surgery completions in the year since the program's inception, we can see a steady trend, mostly flat, starting in 2014 through 2016. in 2017, new staff was hired toward the end of 2017. that's jenna right there. and some of the staff in 2019 left for permanent positions both in the department of public health or, in one or two cases, the staff had some term limits on their employment as peers, so they went onto other opportunities, but it's really

important to note that the peer staff that have come through gender health s.f., because of their opportunities through the program, were able to find permanent employment elsewhere in this program, which is a key part of this program and its workforce development. in 2020, as jenna mentioned and as we all know, covid showed up on the scene, and what i want to point out on this slide is where most places closed down or we had shelter in place orders, gender health s.f. did not. we saw to the completion of 182 surgeries during that on set of covid and still fielded about 130 referrals. once they brought on a field director and manager, their capacity increased again back

to more average lefrl. they went back up to -- level. they went back up to 191 referrals and 130 surgeries. next slide, please. the next two slides breakdown the number of surgery referrals by femininizing or masculinizing the type. they go back to 2021. the average referrals received annually total about 188. that is a significant number of referrals for any clinic, and these are not just any navigators. they are peer navigators who

have experience navigating the program from their referral through to their surgery completion. a majority, approximately 85% of the patients are for femininizing procedures. okay. when compared to the national

sample that i mentioned before, at program intake, based on the program intake, the patients reported better overall health, and we used a brief survey from the w.h.o. the patients on average reported better overall health than the national sample, less psychological distress, less alcohol and tobacco use, but more cannabis use than the national sample. next slide, please. when we established this program evaluation, we were very clear on the outcome that we wanted, and we were primarily interested in their quality of life, and we saw that these data are, for 855

unduplicated patients served, these are based on about 155 qualitative interviews conducts over the course of these years, since 2016, so that comes out to about 18% of the unduplicated surgeries served. those were significant in terms of statistical significance, not just felt importance. also improved quantitatively but not statistically significant mathematically, we saw lower distress and better social quality in their lives. next slide, please. this is my favorite part.

we have a qualitative portion of our program evaluation, and i'm going to read some of the feedback that we experienced. in terms of the care quality, a majority of those had reflections that commented on how the surgeons and staff for those who we worked with for those within the department services and those that we contract with outside of our network are respectful, affirming, and attentive to the needs of our patients. for example, somebody said, this was an interview conducted in spanish, to be truthful, they help you from the beginning to the end of my experience. from the beginning of the program to the time i left the hospital, i have nothing to say but thank you. one of the challenges in the care quality, which i'll speak

to again in a moment, was that dates were moved frequently, particularly during covid, when hospitals were prioritizing the most ill. despite these surgeries as being medically necessary, for those who had been waiting for more than two years for these appointments, having any date postponed multiple times is a real challenge to their emotional, financial, and relational examples. for example, my surgeries were moved four times, i think. i had prepared everything for my surgery dates, and i had to ask permission in my job, and then, when they cancelled the surgery, i wasn't going to have permission for a new date, so the impact is serious. some patients felt that they were discharged from the hospital too quickly, but overall, a majority of those

felt that the surgeons and the care staff met their needs. despite the intense challenges of the covid-19 pandemic, the gender health s.f. program has maintained a high level of support for community members who face multiple forms of oppression. there were a minority of patients who were dissatisfied, and their dissatisfaction was rooted in the wish to have more contact with their navigators. but as we know, during 2020 and 2021, that was a very difficult challenge. some of the patients reflected that they felt that their staff at gender health s.f. were over worked or understaffed in general, and they wanted a more follow through and a faster follow through. that is a general answer that we received in 2020 and 2021,

but i shared it here to reflect the feedback. i'll share some of our feedbacks that we liked best: it's so nice to have that firsthand experience. my navigator was invaluable in having to push things through to get it covered through insurance. it was so nice not to do it myself. there's a whole system set up. my counselors know what paperwork to submit, my gender health s.f. navigator knows what i'm going through and that i don't have to go through it alone. the support is so nice. another patient says, thank you to the san francisco health

plan, gender health s.f., and lion martin. this is so important to me. you really cared for me and helped my dream come true. if you didn't help me, no one else would have. when i was in hospital, i was crying. i was so happy to see these dreams come true in my life. i know it's step by step and not immediate, but it's one surgery here and one surgery there, and you have to give it time. but i'm happy because without gender s.f., it would not have happened. i'm so glad that gender health s.f. exists. you make a big difference in our lives. most of what patients like best is that the surgery was even able to take place. most said i cannot have even having had this opportunity without gender health s.f.

the moral and emotional support from the navigators is bar none. with that, i'll hand it back to jenna. >> thank you, seth. next slide. so i'm just going to highlight some challenges and needs of the program. as i mentioned earlier, there's a lens of, like, advocacy in our program, and one of the things that we're advocating right now and thinking through is for folks thinking about genital surgeries, that causes sterilization, is fertility navigation for folks.

that is a major issue when folks are thinking to have sterilizing surgeries and cannot have access to medically necessary fertility preservation because there's a host of medical discriminatory practices not allowing these folks to have access to those options. the next two challenges and needs, they kind of relate together, the out-of-network

surgical providers and access. one of the providers that we work with, the san francisco health plan, so ensure coverage for medically ensured folks to have access to covered surgeries, many of the surgeons that we contract with are out of network. they're good, but it causes programs in care, so i think that has been a barrier, and also, costs, too. i just want to put that out there, and so much of that is related to the hope and the wish that we have to build surgery network and access at

zsfg. the other challenging need is healthy san francisco limitations, so just want to put that out there. our patient populations that utilize gender health s.f. are of latina and latinx. when you think about the cost of surgeries and then the facility fees and, you know, revisions and complications that may arise out of surgery, that's about $100,000 for individuals just to have, for example, vaginoplasty. so when you think about having to manage a small pot of money for a large group of folks to access surgeries, we've had to create an extensive wait list

to utilize the program. similarly, the budget hasn't increased with the demand over the past ten years. it's something that we're truly reflecting on and how to manage, and last but not least, it's support around utility management with health s.f. program. we are charged with, you know, managing the $350,000, but again, we are a small program and department, and just trying to maximize our efforts given the demand of our h.s.f. participants. the other thing is we talk so much about this idea of workforce development for trans and nonbinary folks, but what does it mean for me or particularly for us when we've had peer navigators who have been with our program for two or three years, gone through our skills development program to be employment in our system.

so much of what we envision is a pipeline to the city services. that hasn't materialized, but that's what we would hope would develop as part of our work with gender health s.f. i mentioned h.r. and just how to figure out lived experiences for gender and nonbinary folks. we know it's important to have culturally congruent programs for different folks to ensure good outcomes. so much of our work is really trying to partner with h.r., trying to figure out how we can create really special conditions, trying to capitalize for the population that's being served by gender

health s.f. -- after surgery and what are the risks for hiv, for example? so i think there's a lot more areas and research that can be developed if we had the

supports and capacity to do so and be a leader in gender and transgender health nationally and internationally, as well. next slide. so to close out our presentation, initially, we were going to show a digital story video of jazmine g. jazmine is a patient of our program. her quote is transition is ageless. what matters is that i am. i continue living m -- in my truth. we are going to be continuing these presentations at pride. so important around the stories. they're important about who we are and experiences.

part of the stories that we embarked on this year was one in english and one in spanish to ensure that we have a fair amount of folks and their voices. since we couldn't provide the video, we're going to leave fans for the commissioners. happy pride, everyone. >> thank you so much. we'll make sure the commissioners get them. >> thank you. happy pride. >> before we go into the commissioner comments, can we go into public comment. >> clerk: yes, we have one

person on the line. remember to press star, three to make public comment. i don't see any hands, commissioners, but i do see that commissioner greene has her hand up? >> commissioner greene? >> well, first of all, this was such an impressive presentation, and to look back at what you've accomplished in ten years is nothing short of remarkable. just looking at what san francisco does best is bringing peers to support one another, and the vision of where the program is and where it's going to be taken is really commendable. in particular, i wanted to ask about the pipeline and you

mentioned the people that have been put off from surgery. can you give us a sense of the number of people that are not only ready for surgery, and how you face those bottle necks, but how you help them to stay kind of grounded. never mind the complexities of what you're dealing with, do you have a program or how do you think about that, and can you give us a little more information about whether the barriers are actually physicians able to do the procedures or plans willing to pay for them or procedures in terms of the manpower you have, can you bring individuals into your program and give them the full benefit of your skills and ability? >> yes, thank you so much, dr.

greene, and excellent question. b.m.i. and smoking are main considerations for moving forward with surgeries, and so much of what we do are ensuring that we wraparound care. so much of what we do is not just access but ensuring good outcomes. what we do is coordinating with referring physicians and providers to make sure that there's a plan for their recovery, that they're -- you know, particularly for our higher needs patients, we have

a clinician along with the peer navigator, so we're able to do so. along that, we wrap them so that they're kind of walked along the path of surgery. >> and do you have any specific programs for younger adults and teens? do you have any programs for those or particular resources geared to the particular challenges they face? >> excellent question. we have standards of care that we follow to ensure that folks meet the criteria to be referred to our program.

i'm with the child and adolescent youth centers, and what they do is work with folks 12 and under to provide clinical consultation and supports for families and for young individuals who are thinking about medical transition. there's a lot of considerations for younger folks, right? particularly with folks who might need to move in with parents or guardians

something? >> -- that there was a question, how it would function, and it sounds like you've all put a lot of effort into it, and i think the -- a

use of peers, as you pointed out, is one of the great things to bring about confidence and acceptance of people seeking these services. so i actually was curious about the surgical intervention. we've been looking at zsfg to build this out in-house, but it doesn't look like this has happened or perhaps you could tell us in the last ten years what has happened because it sounds like you're still using outside providers for this, so that would be my first question. my second question actually

relates to what your actual overall budget is for staff and how many people actually work at the center, which is, i guess, moving, and whether it's moving from san francisco general to castro mission, whether that's good for those who don't want to identify in the castro mission. [indiscernible]. >> thanks. so at san francisco general, the breast and chest surgeries are done, hysterectomies, are

done there. other surgeries, vaginoplasty, and facial femininization surgeries and masculinization surgeries are done there. the rest are done with a range of specialized surgeons that are out of our network and the ucsf network. the other surgeries that we're doing are gender affirming surgeries, and those are out of network.

challenge of san francisco general is complicated. it has to do with o.r. rooms and o.r. staffing. it has to do with the expertise of the surgeons and the ability for them to have both clinic time and o.r. time, and as jenna said, we seemed to have some momentum building before covid. it's one of, i'm sure, a million issues in which momentum kind of stalled, and we're trying to get it going again, and i think that's what i can report on the surgeries. i agree, i would have hoped that, ten years in, we really envisioned us doing all of these surgeries within our network, budget, and i don't know what else. >> and commissioner chow, you had mentioned, what is the size of our team, and i forget the second part of that question? >> well, the extension of that has also been how are finances

arranged? that is, especially since we're using out-of-network providers for a number of these? where are we getting the funds or are they insured, and if they're not insured, are they able to partially pay for these services? the reason that came out is you were trying to focus on the healthy san francisco allocation of several hundred thousand -- $350,000, but i wasn't sure what that was supposed to be covering, if that was supposed to cover the surgeries. so it's this kind of wondering what the financial package is and what you might be needing and whether or not you even have a -- well, it couldn't

be -- well, i guess it would be an average cost of what an individual would need to complete their treatment for their needs so that then, they feel that they have a new completeness that just allows, like the folks said, that they can be themselves. [indiscernible]. >> so i can talk about -- a little bit about the funding for our program. so just in context, so we are a program of b.h.s., behavioral health services, and so much of our funds to support staff and operations are under the mental health services act. and again, this idea of the model that we have is part of b.h.s., and as i say, would increase engagement of trans

folks and one of those is workforce development. in terms of how we partner with san francisco development and health contracting -- >> sure. just to clarify, the $350,000 is for uninsured patients who are eligible for healthy san francisco. it's unusual to have that thing as a carveout, and the history of that gets lost in historical budget, i'm afraid, for me. some are medi-medi, and when they go to san francisco general, they are paid for in the usual ways through our system. when it comes to the private

surgeons, san francisco is negotiating a rate, ideally, a universal rate for that surgeon, but sometimes on a case-by-case, and that's coming out of the allocated medi-cal funds for the -- our network, and it's -- we haven't done a financial analysis for quite a few years. it's quite a lot of money, and if it was kept in the network, we felt gee, we could be doing these at san francisco general, but it's not all these other factors that oh, our time and staffing that become complicated and honestly beyond -- beyond my tend.

but there's a lot of goodwill on trying to get that to happen. i hope that clarifies it, commissioner chow. >> commissioner chow, you're on mute. >> i'll unmute you, commissioner. sorry. >> oh, i appreciate the explanation, and understanding the historical aspect of these ten years, still understanding what is the counting the behavioral health costs, do you have an idea as to what your overall [indiscernible] for surgery -- or not for surgery but for the individual? in other words, you know, what average numbers of surgeries are needed for that individual and how much it may be costing?

>> yeah. i don't think we have that information, commissioner chow, but we can try to get that, if that would be something that would be helpful. >> i think it's important to see what's being spent for our residents here. we're doing a very nice job in responding to their needs. certainly probably better than other major areas of the country, but just to understand the cost, i'll put that into context. we have a very large budget, but it would be helpful to know what the overall [indiscernible]. >> absolutely, and we will try to see if we can get that analysis for the health commission. >> okay. thank you very much. >> thank you. >> commissioners, any other

questions or comments? >> i don't see any other hands, commissioners. >> well, first of all, thank you so much for this presentation. just seeing the extraordinary work that you're doing, i think i speak for the entire commission fills us with pride and gratitude, particularly from what you were able to accomplish. i think that anything we say about your work just can't compare to the gratitude that was expressed in the surveys. thank you, again. you're a model for the nation. you're part of the tradition that san francisco has in providing kplenlt care, particularly in the public arena.

now, i'll hand it over to director colfax, who i think wants to say a few words. >> thank you, president bernal. just a -- some more deep appreciation for leadership in this room and services in terms of that have expanded the challenges and commitments. i expect in five, ten years, we will be reflecting on this day and being able to celebrate progress there. also wanted to celebrate the leadership and prior leadership of the department, barbara garcia and colleen chala who

supported the work going on in this room. thank you very much, and thank you very much, and it makes me really proud to be in this room. >> thank you, dr. colfax. >> thank you, doctors. thank you. >> happy pride. >> thank you. >> thank you. we'll move onto our next item on the agenda, which is hiv funding overview. we have bill blum, director of hiv health services, tracey packer, director of community health equity and promotion branch, and nyisha underwood, community health equity and quality improvement manager, community health equity and promotion. i thank you all for joining us today, during our last pride month meeting, as well. >> good afternoon, everybody. can you hear me all okay? >> yes. >> excellent. so i'm the first of three speakers here to educate you

about the hiv funding in san francisco. i just want to start with some gratitude and recognition. you're going to see, at least particularly on the care side of the house, it's been a story of initially the federal government providing the program. on the whole, the bulk of the funds have decreased, but i want to thank this health commission as well as previous health commissions. our current director of health, dr. grant colfax, as well as previous directors of health, the hiv board for all their advocacy, and frontline providers because, really, we're presenting on the work that they have done. i'd like to give a shoutout to

house speaker pelosi. a lot of people to thank. it's kind of incredible to think of over 30 years of ryan white funding, but here we are. >> it's kenya thomas, who's doing the slides, by the way, and she's not here. >> do i just call out -- >> yes, and she'll do it. >> i'll start by apologizing. i'm in my late 50s, so my vision is not good. if i lose contact, no respect, but i'm trying to read stuff here. so you can kind of see, this is our current state of federal funding. that's our light blue line. we're currently $17 million from federal funding. state funding, we're a little bit less than 3.5 million. and san francisco general fund, over $22 million.

and our total for hiv care services is a little over $42 million. so if you look to the right, that far graph, you can kind of see the general trend downward over the past 22 years in terms of what comes through federal funding in y.n.y. programs. i do have to say, this is the first time in 23 years we got a $300,000 bump in our ryan white funding. on the right-hand side, you can see the different categories of funding, kind of that top quarter there, like from a little after ten to 12 none.

just shows the breakdown of the different parts of ryan white. you can see the variety of different parts to it, a, b, c, and f. next slide, please. so this is the kind of overall pluses and minuses and what's happened. and i think the key statement here is, on the left here, is thanks again to the work at a local level, there haven't been reduction in services since 2010, so we've kept the services due to peoples' hard work. this is just kind of some of the pluses that happened and then the minuses. and then, the hiv epidemic, this is a ten-year grant. san francisco is phase one. the idea is to end the epidemic, and we just got an announcement of our award after this presentation, so an award of $2.4 million for that for

this year. a good work of my colleagues and getting to zero funds, that's happened, a lot of that goes through care contracts, hiv care contracts, and then, of course, the work of the board of supervisors to backfill the reductions as well as new funding for behavioral health for long-term survivors, which i'll talk about briefly because i understand there might be some interest in that. there was one point, about 15 years ago, now, where we took a huge hit of $9 million, and you can see there was some service categories that we were no longer able to fund, and i can talk about these, but that's also 15 years ago, and the system has adjusted to make most of these services happen in different ways. next slide, please. okay. so just to kind of restate it,

you can see here the bar going up on the right-hand side, that orange thing kind of shows how the san francisco general fund has gone up over time, so kind of the reverse of the third slide, and then, you'll see the pie chart here just breaks out the general fund versus other funding sources. next slide, please. so this is -- i was asked to speak a little bit about mental health funding. so the way that ryan white funding works on the care side, there's different service categories, so if you look at the pie chart on your left here, you can see that about 8% of the overall funding is -- goes to mental health services, whether it's psychiatry, medical case management, short-term therapy, evaluations for different things. we're about 8%, almost $3.5 million. on the right-hand side, you can

see locally there was a question from -- request from the community for more funding. we started in 18-19 with $500,000 that was increased to 700,000 when we got to 19-20. what we did was use existing organizations that had been using mental health therapists for a long time rather than trying to put it out to r.f.p.s. and then, we have had an additional cost of doing business. if you could switch to the next slide, it should be there. we're at a little bit -- that was a 3.2% increase, so we're at a little less than $750,000 focused on survivors of hiv/aids treatment services. i should give you the caveat

that this is not the entire population, this is people who get services through something that's funded through public health. okay. next slide, please. this is a comparison, which i have to say, it's not a great comparison because both the numerators and denominators are different, but that said, i'm a little self-congratulatory because once you see we get people into care in d.p.h., we do a better job than the national average, which we should do. but we're about 80%, and as you see different presentations, you'll see that number fluctuate a bit, and we're happy to explain it more, but some differences in how these numbers are calculated.

next slide, please. i think this is just to give you a sense of the services that we provide and a snapshot looking, again, ten years ago and ten years now for populations that have experienced kind of different health outcomes that ever the overall population. so you can see in the middle, upper middle area. when we look, this is providing services. in 2022, we provided services to almost 400 individuals, and medical services to 3,200 individuals. as we know, the overall hiv is an aging epidemic. you can see how much it's jumped in san francisco. i think perhaps next to the v.a. we probably have the oldest average age of people living with hiv of any metropolitan area. you can see it's jumped almost

8% in 2022. women, a different case in san francisco. a slight increase of about a percentage in the last ten years. people that identified as a person of color, bipoc, we have gone from almost 49% to 54%. no stable and permanent housing, from 20% up to 24%, and then, finally, people living below the poverty level, in this case, we're defining it below 200%. we have 82.9% were living with that in 2022, and we're up now to almost 86% -- i'm sorry, 2010, and we're almost 86% in 2022. okay. next slide, please, which actually is my last slide. and maybe it's going to do some magic there. it kind of looked like it had a coffee stain coming through. you see the different locations where we fund and we, in this

case, being both funded prevention services and funds for care. when you see that color coming through, that's a distribution of folks living with hiv in san francisco. you can see very much concentrated on the east side of the city as well as kind of more towards the north. so we're actually 34 sites that provide services that we fund, but also just want to clarify that this may or may not include the hiv presentation sites. when you look at the southwest part of the city, there's ocean view health care, so don't want

to leave people with the idea that they can't get care in certain parts of the city, and that's my presentation. i appreciate you guys staying focused. it's a hot afternoon here. >> thank you. happy to be here. >> good afternoon, commissioners and dr. colfax. pleased to be here today. i'll do sort of a matching presentation for hiv prevention funding and incorporate hiv and s.t.i.s as i talked about the committee meeting earlier this evening or whatever -- early today. so this slide shows you the hiv prevention funding in 2021, and you'll see that the majority of the funding is general funding, general funds, and that wasn't always the case. but because of some decreases in c.d.c. funding, there was general fund added back to support, to close those gaps.

there's a core funding initiative that san francisco's received since the 90s, early 90s, 91, i believe, from c.d.c., and in the last five years, we were provided an opportunity to have a demonstration project, which we referred to as opt-in, which really focused on people experiencing homelessness and hiv prevention. it's come to its last year. it may be extended for one year, we're told by c.d.c. and as jenna said, we had the epidemic funds. there's two components. there's the general or primary funding, and some of it is reaching gender health s.f. through a peer navigator as an example, and then comp c is funding san francisco city clinic to integrate hiv

prevention into their s.t.i. work. that is -- i see only some of the numbers there, but that's the one i need to talk about, is $450,000 comp c that's just been increased. it was initially five-year funding, but c.d.c. has just informed us that we'll have an additional five years, so that'll be ten-year funding. next slide, please. this slide shows you on the left sort of that same breakdown in general. it refers to state funding. we get very little funding for hiv. in fact, we get none for hiv prevention, but we get some for s.t.i. prevention, which is for hep-c funding. dr. colfax, you remember this.

we were working together there. c.d.c. reoriented their formula to address disparities, to move towards equity, and they moved much of their funding, or a proportion of their funding to the south, and we said that's the right thing to do, even though san francisco lost funding from c.d.c., but the city and county and its amazing support for hiv work, backfilled that funding. we also received an increase in c.d.c. funding in 2018, both hiv and -- a decrease in c.d.c. funding in 2018, both in hiv and prevention funding, and the city backfilled that. and in 2021, that's the epidemic funding, so you'll see an increase in the bars. next slide, please. so this is unfortunate because i did not bring my slides, so i

have to read that. thank you, mark. i really appreciate that. i almost have them memorized. so starting on the right, as i mentioned, these are aligned to mention some of the positives and strengths and some of the challenges. so ending some of the epidemics funding and comp c funding. we had a health fair in front of the library to reach people experiencing illness. we did hiv, hep-c, and monitoring and screening and covid vaccines. we did 14 vaccines today, and people can be linked to care through those health fairs, as well. there's recently been funding added for getting to zero, and

then, of course, the backfills that we've experienced. just this july 1, there's going to be $3 million from the mayor's office that's going to be added to hiv prevention. you might know a little bit about it. we made a big shift to our hiv approach, which nyisha is going to talk about in a minute to address the inequities that we've seen persistent disproportional effects with, and there's concerns that some programs would not continue, so the mayor's office put some funds in there that will -- we will use to maintain strong, effective programs and have them focus on equity just like the health access points are that nyisha will talk about. and then, i spoke before, the downside, we did experience a

50% decrease in hiv prevention funding. on the left is more of a slide of what has happened the last few years. we have better hiv and hep-c testing and other huge new tools in the toolg box that we believe are contributing to a decrease in new infections. we've also been given an opportunity to integrate hiv with hep-c and s.t.i., and we've really been able to reach people with hepatitis c and s.t.i. programs, which is great, because people don't

come for just one thing. we've also seen a need for building our workforce. jenna spoke about the workforce, and we have some new initiatives that are focused there, which is great. next slide, please. i'm not going to go over this slide in detail, but essentially, this is telling us that we are seeing a decrease in new diagnoses of hiv over the last several years. you will see, it looks like that pink bar goes up a little

bit it is end, and it looks like more people are accessing during shelter in place, but we'll see it more when we get the 2022 data. i bring this to you to see the decreases in our new diagnoses here in san francisco. i will highlight that we have work to do around deaths, as well, and then next slide, please. but here, you'll see that while we see decreases, there are populations such as latin americans and latinx communities where the curves are not as steep, the drops are not as fast and in fact remain parallel in some places. if you breakdown this data by gender, it's even more striking

the new diagnoses are among latinx communities.

>> good afternoon. the purpose of this is to

ensure that all san franciscans have access to care and treatment services to obtain optimal health in hiv and s.t.i. wellness, and i read that because that is our equity statement that we came up with as we started to operationalize the r.f.p. we also wanted to be intentional by focusing on disparities, and we included disparities in our criteria for funding allocation.

next slide, please. this is just to show that this is quite a long process, and we started our stakeholder engagement input in early 2018, and if you look through the timeline, you know, we had to stop -- we had a couple of road bumps due to covid and other things, but we are on target to implement programs in january of 2023. next slide, please. this just shows the stakeholder input that we got from lots of subject matter experts in the r.f.p. process so we could put forth a vision and a framework that, you know, the people that benefit and need services could -- well, could benefit

from. and next slide, please. and so what's different from this r.f.p. than the one we had in the past, so the last r.f.p. happened in 2010. so what's different about this r.f.p. is we've put together a whole-person care model based on recommendations that we got from all of our stakeholders. we have integrated hep-c with s.t.i.s so that everywhere, people should be getting an s.t.i. and hep-c services. we have integrated syringe disposal and integrated supply services. we have services going outside our four walls, involving the

community, and involving the community in every aspect of implementation and development. and then, in terms of collaboration, we required all of our agencies that applied for the r.f.p. to collaborate with other agencies to ensure that all of the services that they have to provide within the health access point, we realized that one agency couldn't provide all of the services that we are asking them to provide. this just shows the model that

we are putting together. it's supposed to be low barrier access, stigma free, status neutral, and it allows all of our community members to have access to all of these services regardless of if it's a -- through several mechanisms. next slide, please. and then these are the service categories or the populations that we are funding through the latinx, gay, asian pacific islander, and then, our black african american category. these are the seven populations that we're funding. next slide, please. and i wanted to highlight a

category seven which is the black african category, and it provides an access point for black african americans. so this particular category allows for the agency to get some training, to get some capacity building for the things they need. we haven't funded an organization that was embedded in the black community or prioritized the black african american population to do hiv prevention, s.t.i., and hep-c

work, so part of that funding will be for that. next slide, please. this is the standard -- start of care -- standard of care of all of our services, so all of our access points will provide all of these services here. the top two rows, the lead organizations and/or their subcontractors are to provide, and then, the bottom row were primary care and mental health -- where primary care and mental health services are, we know that a lot of organizations don't provide primary care and mental health services and treatments like that, we're asking that they partner with other organizations or clinics and provide warm hand-off to those

services. next slide, please. and this slide here shows who we have funded through the lead organizations, so this slide here shows all of the lead organizations that were funded, and the amount of funding that each of those received. one of the things that i wanted to highlight was our latinx health access point, and then, the health access point for the black african american community received about half of the funding that we have for r.f.p. so initially, we have $8 million in funding, and we have allocated half of that funding to the latinx and black african american community because of where the disparities lie and they continue to lie. next slide, please and then,

what we're doing next, which is going on at the moment, we're meeting with all of the vendors, all of the organizations, and the collaborators. we are in the process of negotiating contracts, so we will be providing on going technical support, technical assistance and support to each of the organizations. we'll also lastly be coming back to the health commission to present the new contracts that are in place, and i think that's it. thank you. >> thank you very much. secretary morewitz, do we have anyone on the comment line? >> no one on the comment line, sir. commissioners, comments or questions? >> i am not yet seeing hands. >> well, first of all, i wanted to thank all of you for this presentation today. san francisco is, once again, a model for the nation in how we

address the hiv epidemic in terms of care and prevention, and you've really demonstrated how well we're able to adapt to the challenges that emerge. particularly chief among them is the disparities that exist. so again, can't express enough pride and gratitude, especially someone who's been living with hiv for 31 years, since i was 19 years old. i never thought i would be able to live and work with people getting us here today. being 51 now, i'm aware of some of the challenges that people with hiv face, so again, i can't thank you again for your leadership and hard month.

and also, i wanted to acknowledge, of course, our director, dr. grant colfax who's not only been an extraordinary leader for providing care in hiv not only here in san francisco but also in the obama administration, so thank you, as well. >> thank you. >> and commissioner chow has his hand up. >> oh, commissioner chow? >> yeah, i just want to thank the presentation in regard to the h.a.p. access. it was hard to understand what the depth of the r.f.p. was, and the r.f.p. categories certainly cover all of the areas, and i think we'll be looking forward to understanding the success that you all have. instead of emphasizing one or

another, you've really taken on the issue of all the elements all the way from young adults to the latinx population and the continuation of the need for the black african american initiative and put them all together, so i really want to commend and thank you all for this exciting -- riveting and exciting presentation. thank you. >> thank you, commissioner chow. director colfax? >> thank you, president bernal. i just want to acknowledge the fact that bureaucracy, the easiest thing to do is to maintain the status quo and acknowledge the work that continues to happen in san francisco in regards to pushing the boundaries around hiv, and recognize miss underwood's work on the r.f.p.

this was very disruptive. it was the right thing to do, and the presentation was wonderful and may not have fully reflected the controversies and the back and forth and the many conversations that had to happen in order to allocate funding in a truly equitable way. the delays were there, but we are certainly getting there and just want to appreciate all the work and the challenges and the fact that in order to make progress we often need to have difficult conversations and disrupt the status quo, so thank you, miss underwood, and your team, for your support and the work, because especially during covid, this was not an easy thing to do. >> thank you, director colfax. all right. i think we can move onto our next item, which is general public comment. i understand we have nobody on the line -- >> actually, it's community and

public health committee update. >> all right. community and public health committee update. for that, we have susan andrado, and i had the privilege of sitting in on the meeting. thank you. >> actually, and it goes along with the information that you were provided through both presentations. our committee focused on two different areas. one was the programming for the lesbian, gay, trans, and bisexual communities. let me go through one of the points. one of the things that dr. hammer had shared with us to is the [indiscernible] data is mandated, and within that, there's a need for data collection, obviously both on a national and local level, but

san francisco was challenged by epic in 2018, and our previous data was lost. now, as we're even wave one, they've made huge efforts in collecting data and focusing on primary care at zsfg and laguna honda. and the capture page during registration that we saw in mock-up should help this, as well. within the healthnet work was presented a -- health network was presented a number of the clinics, as dr. hammer generically put it in the trans community. first was the [indiscernible] clinic in partnership in house with san francisco community health clinic.

it provides multidisciplinary cases management for trans people experiencing homelessness, so it's housed in the tenderloin at san francisco's community health center, and those people, 78%, were entirely suppressed. the next was the waddell transgender health clinic which started in 1993, and within the last 12 months, 177 individuals have been served within primary care, behavioral health, and integrated case management. the one that i personally was most excited about was the dimensions clinic, which began in 1998, which the focus as was

mentioned to commissioner greene was the -- commissioner green was the age group age 29 to 45. it offers care for trans, nonbinary, queer youth. it offers primary care, which i think was quite an accomplishment for dimensions health, is 275 young people have been served within the last year in over 2700 visits, so to me, that's real accomplishment of dimensions clinic as they are continuing their work and their outreach. the other clinic that was highlighted was the south van

ness adult behavioral health services which focused on gender health and hiv. the second area highlighted in the gender health prevention was the goal of the programs, and the goal of the programs is health and well-being. the focus is, as we just heard in the prevention, hiv, s.t.i., s.t.d., and hep-c. the community partnerships, briefly, on the presentation of the health access points, not only the presenters but commissioner chow said it's going to be just a real change

a change action is well needed but further focuses what we're doing to meet the needs of the community. we also had a presentation to discuss the status of the providing of health in the san francisco hiv community again, and what was extremely important was the presentation of the data improved initiatives and the studies that really make a difference not only here but nationwide as a leader in the hiv field.

to i don't know if commissioner bernal would like to add, but this was an absolutely excellent presentation and kind of a lead-in to our commission presentations, as well. so i think it was an excellent presentation, and i want to thank all of the presenters for not only their excellent presentations but helping to bring us up to date on the excellent services that you're offering us in our community. thank you. >> thank you, commissioner giraudo, and i associate myself with everything that you said in that meeting, and i encourage everyone to make themselves available to all of the materials mentioned during

this full commission meeting today. next item on the agenda is -- let's see, the other business. >> i'm sorry. >> is it other business? >> i'm sorry. it's a correct item. i was interrupting you, thinking it was not a correct item. i don't see any other items from commissioners. >> all right. seeing on, we'll move onto the joint conference committee and other committee reports. we'll hear briefly from the laguna honda joint a.c.c. meeting, and commissioner chow. >> thank you. on june 14, we had a joint

commission meeting, mostly in closed session because most of the members were working on laguna honda. in the open session, we heard various reports and the medical [indiscernible] report. commission members did request that the joint conference meetings incorporate reports on the certification, recertification efforts in addition to the necessary regulatory reports. we also accepted and recommended dr. green's suggestion that the commission report mite benefit from having the -- [indiscernible] and more

helpful for the commission in its only closed session, so that was left up to our officers to work with that administration to see if that could work, so that ends my report. commissioner green was also there, and she would like to add more to it. >> all right. seeing no one on the public comment line, is that correct? >> correct. >> okay. >> and i also see no hands. >> okay. so we can move onto our final item, which is consideration of adjournment. do we have a motion? >> so moved. >> and second. >> second. >> i'll do a roll call vote. [roll call]

>> all right. thank you, very much. >> thank you. happy pride, everyone. >> thanks, commissioners. . >> my name is kathy mccall. i'm director of san francisco national cemetery here on the

presidio of san francisco. this was designated as the first national cemetery on the west coast in 1884.however its history dates back to the 1850s along with the us army presence on the presidio itself. we have 26,300 gravesites that we maintain and thereare 32,000 individuals buried in this cemetery . the veterans who are buried here span all the war period going back to what we call the indian war, spanish-american war, world war i to korea, vietnam and then as recent as operation iraqifreedom . we have 39 medal of honor recipients. more than 400 buffalo soldiers buried here who are the african-americansoldiers who served with the ninth and 10th calvary . there's so many veterans buried

here, each withtheir own unique history and contribution . one of those individuals is all equipment prior. that's not her real name, that's her stage name and she was an actor during the civil war and while she was working she was approached by sympathizers who offered her a sum of money to cost jefferson davis on stage she did this but she recorded it to a union marshall . she was fired for doing this which made her a sweetheart to the local confederates and made her a good spy for the union. she gave information to the union until late 1863 when she was found out in order to be hung by confederate general braxton bragg of the union troops the town . no longer any good she even wrote a book. she was given the honorary rank of major president lincoln and

her inscription reads union spy. >> memorial day is a day of respect and morning for our veterans who have given their all five presidential proclamation it became a national holiday to beobserved on the last monday of the month of may . originally memorial day was called decoration day during the civil war to recognize the veterans whogave their lives . memorial day and veterans day getconfused because it involves veterans .veterans day is on november 11 is a day to honor our veterans who are still alive while at the same time we pay respect to those who have passed but memorial day is a day to show our respect to what was said and honor ourveterans who have passed on . >> lieutenant john david miley was a graduate of the united states military academy atwest

point in 1887 . he was commissioned as a second lieutenant with the fifth artillery regiment with the outbreak of the spanish-american war in 1898 he was assigned an aide-de-camp to major general william shatner, khmer and commander of the expedition to cuba.he was highly trusted and when the general staff fell lieutenant miley was designed to coordinate the attack on san juan hill in his place and would ultimately be the one to give the order that led to the charge of lieutenant colonel theodore roosevelt and the roughriders . a few days later he served as one of the commissioners who negotiated the spanish surrender of santiago july 17. in 1904 miley in san francisco wasnamed in his honor.we know that today as san francisco va medical center .

>> as a young man i grew up in south san francisco right next door to the national cemetery so when i became a cub scout we used to go over there in the 50s and decorate the gravesthat were there. when i got out of the service i stepped right back into it . went out with the boy scouts and put up the flags every year and eventually ended up being a scout at golden gate cemetery for many years. one day a gentleman walked upto me with a uniform of colonel retired . he grabbed me, i wasin uniform and says i need your help . from that day on i worked with cardinal sullivan doing military funerals and formed a group called the volunteers of america who brought in other veterans to perform military service and the closing of all the bases we got military personnel to do all the funerals. to this day i've done over 7000

funeral services and with my group we supplement the military, all branches. i'm honoring a fellow comrade was given his or her life in service to this country. and the way ilook at it , the last thing the family and friends will remember about that individual is the final service we give to them. so we have to do a perfect job. so that they go home with good memories. >> our nation flies the united states flag at half staff by presidentialproclamation as a symbol of mourning . also in va national cemetery flags are flown at half staff on the days we haveburials . is lowered to half staff before the first burial takes place

and ray is back to full staff after the last arial has been completed . on memorial day weekend we have hundreds of scouts veterans and volunteers who come out and placed individual gravesite flags on every grave throughout the cemetery transformation from when they begin to when they conclude and to have that coupled with our memorial day ceremony is very moving and suchappointment reminder of the cost of our freedom . it's a reminderto us not to take that for granted , to be truly grateful for the price is paid not only by those who given their lives but those will have served our country and still pay the price today in one way or another and it's so meaningful to be to work in the national cemetery and see the history around us and to know this is such an integral part of our nation's past and present.

>> [♪♪♪]

>> my family's starts in mexico in a small town. my parents are from a very, very small town. so small, that my dad's brother is married to one of my mom's sisters. it's that small. a lot of folks from that town are here in the city. like most immigrant families, my parents wanted a better life for us. my dad came out here first. i think i was almost two-years-old when he sent for us. my mom and myself came out here. we moved to san francisco early

on. in the mission district and moved out to daily city and bounced back to san francisco. we lived across the street from the ups building. for me, when my earliest memories were the big brown trucks driving up and down the street keeping us awake at night. when i was seven-years-old and i'm in charge of making sure we get on the bus on time to get to school. i have to make sure that we do our homework. it's a lot of responsibility for a kid. the weekends were always for family. we used to get together and whether we used to go watch a movie at the new mission theater and then afterwards going to kentucky fried chicken. that was big for us. we get kentucky fried chicken on sunday. whoa! go crazy! so for me, home is having something where you are all together. whether it's just together for dinner or whether it's together for breakfast or sharing a special moment at the holidays.

whether it's thanksgiving or christmas or birthdays. that is home. being so close to berkley and oakland and san francisco, there's a line. here you don't see a line. even though you see someone that's different from you, they're equal. you've always seen that. a rainbow of colors, a ryan bow of personalities. when you think about it you are supposed to be protecting the kids. they have dreams. they have aspirations. they have goals. and you are take that away from them. right now, the price is a hard fight. they're determined. i mean, these kids, you have to applaud them. their heart is in the right place. there's hope. i mean, out here with the things changing everyday, you just hope the next administration makes a change that makes things right. right now there's a lot of changes on a lot of different

levels. the only thing you hope for is for the future of these young kids and young folks that are getting into politics to make the right move and for the folks who can't speak. >> dy mind motion. >> even though we have a lot of fighters, there's a lot of voice less folks and their voiceless because they're scared. [crowd noise] [music] as a city we do a lot of parades and

celebrations. public work system in the middle of things, doing inspections and cleanings and organizing our crews so we are used to creating something it is something we know how to do. >> this is managed by city workers. they are out here doing the jobs to make sure our city looks good in our city time. >> we are also routing for the warriors whether we work. it was thrilling when they won and we had to get to work to plan for the parade and to make sure that everybody in the city everybody that come to the city is safe and taken care of. >> a lot went everwent in 100 hours of planning with the warrior and mayors office and city partners it took a team to make today possible.

>> important this the department has the presence, seeing the priority and vehicles makes everyone feel safe we value our commute and serve it, it is important. >> the giant crowds we are to bring out our specialized equipment. we have small response united staffed by a paramedic and mt the small golf cart devices have a gender and he get in and out of crowds. >> i'm here to help people get to where they need to go and figure out the bus routes and navigate things temperature is important we take care of safety and make sure everyone gets to where they need to so everyone can celebrate the warrior and be out on parade day. >> how is or ems book >> when we have been able to do is set up mobile command posts. and we partnered with the private sector with verizon to

provide priority communication so we can run our entire emergency response on that network for our first responders. we know they will work even though we are getting thousands of people all competing for the same network to send photos and e maild and texts and video our first responders are able to do the same amongst the large crowd. >> get out here at 5:30 a.m. and saw employees cleaning the street its takes a team to build a champion. >> i love it and bum when he left i'm glad he is back no matter how much he plays or does not play that man's heart and spirit he carries everyone along and really mentor people and mentoring is so important whether in basketball or the fire service or ems. mentoring is huge and having a presence like that around is

huge. >> my favorite player is jordan i like he is a role player and come out as a starter i feel similar to the city i like a structure and plan when there is an opportunity to lead i like that, also. >> the player i like lisa. he is similar to me all there and game is in the pretty but gets the job done. every time he scores all right. my man is back. >> happy with seth curry's wife strong. she is a leader and she just really puts on a great face for females and being strong and in the face of challenge and negativity. [music] [crowd noise] >> they were tons and tons and tons of blue and yellow

confetti. every wrchl the end we picked up 38 tons of trash. mostly confetti. >> in terms of for our crews we were ready. after we had been data break and done carnival in may. our team was prepped to do the work and they felt tremendous pride in part of the huge celebration and tremendous pride in the coordination we did with the mayor's office, the police department issue public health and the city agencies that got together and put on a party for the bay area. put on the party for the nation. [crowd noise] [music]c]c]c]c]c]]

>> good morning, everyone. it's so good to see you after covid shutdown everything last year. [♪♪♪] >> we're going to have 12 of our department staff who have shown exceptional dedication to their craft who make our park system what? the best in the damn c