welcome to the richmond. [music] francisco health commission recognizes that we're on the homeland of the ramaytush ohlone, they have never seeded lost nor forgotten their responsibility as care takers of this place as well as for all people 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 relatives and ancestors of the ramaytush ohlone and the rights of their people. and we have announcement because of concerns and we'll explain why we're going to. >> it's possible that we may lose quorum during the maoelting, so we're going to move the action items together so that the commission can ensure that they do their business. therefore items 9 and 10 will be moved directly after item 5, so all the action will take place. if they lose quorum, they will continue to have a information session, and continue to discuss, it will just be as information session not official meeting. we'll maintain the video and i'll take notes. i also like to acknowledge a

clerical error on my part, there is usually a jcc update on the agenda and i erroneously deleted it it by accident. so the november 12, 2023, laguna honda meeting will take place and will be on the december 19th full commission meeting. and again i apologize for that. >> thank you very much. the next item on the agenda is approval of the health commission of november 7, 2023, you have before you the minutes. are there any amendments, additions or corrections? >> if i may, commissioner chow asked me to make crepesings and there are several, it relates to the consent calendar which is on page 7, the finance and planning committee update. i added the sentences. she added that the committee

requested that the body diagnostics be removed from the contract report since there was several issues with the contract document nation. the contract will be considered at the december 5th, 2023 meeting and then for the consent calendar which is on page 8, the next to, the november 2023, contracts report, i've included the claws excluding the party diagnostics incorporated contract. >> thank you, so given the corrections, there a motion to approve the minutes. >> so moved. >> second. >> clerk: and i'll check for public comment, is there public comment in the room for the minutes? folks, if you're online, you can press star-3 to let us know that you would like to make comments. great, there is no public comment on this issue. >> all right, then, all in favor of approving the minutes please say aye. >> aye >> and commissioner chow, would you like to vote on this item. >> aye. >> clerk: thank you.

>> wonderful. the next item on the agenda is general public comment, and i believe secretary has a statement regarding general public comment. >> yes, at this time, members of the public may address the commission on items of interest to the public that are within the subject matter but not on this meet ing agenda. each may address the commission for up to 2 minutes. the brown act prevents any items not appearing on the posted agenda including those raised during public comment. please note that each individual is allowed a minute to speak on each agenda. written public comment may be sent, at the emailing address, the word health, the word commission, if you wish to spell for the minutes you may do so during robo comments without taking allotted time.

will not be tolerated. we will first take public comment from individuals attending the meeting in-person in the room. sxl we will then take comment from these with a disability, i've given these individuals a code. i have not given any code so today we will have anybody requesting special accommodations. there will be a time limit of 20 minutes on total amount that can be heard from each item for individuals who have not received any accommodation for disability. is there anyone in the room. all right, every one has three minutes. when the buzzard goes off, please wrap up the meeting. >> speaker: good afternoon, thank you for allowing me to a tebd the meeting. i'm going to talk about technology. the first thing is, first the person that was purchased by

san francisco june 2020, at&t is the company behind it. they would not use any equipment obtained by the contractor. and is in vie laborsing of any applicable law. yesterday i got my freedom of information request back and says i'm completely healthy and that's troubling, because the city and county of san francisco gave me multiple false diagnoses, and i'm not alone. this is happening because people are using first net and other technology to assimilate political greed and it needs to be addressed and it needs to stop immediately. i have the documentation and i forwarded it to you grant, and i'm not sure why it's taking so long to fix it. i have the documents, i have

the evidence. thank you. >> okay, thank you. is there anyone else in the room that would like to make public comment. all right, folks on the line, as i mentioned before, there is no folks who received accommodation. great. so we have no hands for this item. we can go to the next. >> all right, thank you for your comments. the next item is the recommendation to authorize the dph to accept and expend depths of 115,000, 37,000 and 10,027.96, and 15,400.24 from ethics systems corporation. >> mr. wong mr. l present. >> wonderful. >> wonderful. >> please speak up.

>> we are seeking for your positive approval to accept a number of donations in the amount of 115,3500, from the ethics systems corporation. these gifts are from the safety net program and also to support the community resource directory and behavioral health. they representative philanthropy giving and under sub community. the donation will hetch the improve ourselves to these communities and my colleagues and i will endeavor to answer any questions. >> thank you. is there any public comment on this item? >> is there any public comment in this item? folks only the line, if you would like to make public comment, please press star-3. no hands.

>> all right, any commissioner questions or comments? all right, then we'll entertain a moment to approve the resolution. >> so moved. >> is there a second. >> second. >> all right. commissioner chow how do you vote on this item. >> yes. >> and every one else in the room. >> aye. >> aye. >> aye. >> thank you so much the resolution passes and we can move on to the next resolution. >> mr. wong, if you enlighten us, it is the resolution to recommend to the board of supervisors to authorize the dph to accept and expend a gift, from the san francisco public health foundation. >> thank you very much, the public health foundation is donating 38 2000. through the department 6 public health. it's a contribution and improving the health and well being of mothers, children in our city.

we're now seeking your approval for this donation which will be used for several services including prenatal care, planning of family options and adult health services. over arching goal of this funding is to ensure that our committees most vulnerable receive the care and support for this start in life, on going well being. >> thank you, is there a motion to approve this resolution? >> so moved. >> second. >> and what about public comment on the item? >> any public comment in the room on this item. all right, don't see any. thank you. how about remotely, any public comment, press star-3, please. no one. >> any commissioner questions or comments. all right, hearing none, we'll start with commissioner chow, do you vote to approve? >> yes. >> all right, and the rest of us, aye. >> aye. >> aye.

>> thank you very much, thank you for the presentation. now we're going to go to what has been item 9, right? yes. >> which is the "fast food nation" and planning committee update. >> yes. and commissioner chow chaired today. >> wonderful. >> thank you, madam president. the finance committee heard the contract before which consisted of four different items. one was the barty contract which was discussed within our minutes. this was an issue of clarifying the amounts of money. a barty is a successor organization to welch from which the general hospital has been contracting for these am blah tory ecg monitoring

devices. and so this is merely a continuation. it is a, a five-year contract at this point under a barty now, the amount of cost for each of the items remains the same. and there is an annual difference of a negative 141,000 per year because this is now based on usage and so, we will be reviewing that for recommendations. the next item was for maximum, max minimum is another additional year of contract, is a travel, i think this is the one that is, let's see. yes. for these temps that are needed as personnel to fill-in for the

hospitals and network facilities and particularly, including laguna hondas needs. and it's a 47 percent annual cost related to the actual usage. as you know, we have a nursing shortage overall and we have a ratio that have to be met within our hospitals. so the maximum contract is being extended by one year with an annual difference of approximately 900,000. based upon needs. obviously, we don't need it, we will not be using that. the third contract reviewed for more renewal was the san francisco public health foundation. this was a renewal from three years to an 8 year contract and this is for the food security program.

it's not listed on the report but over 14,000 are served by this program which is actually funded by a multitude of different projects. which is these are supplements to the programs that the state has and is used very much by use as i said, about 14,000 people. so we would also be recommending that for you. and lastly, positive resource center contract which is being extended for three years, we have to full ten-year contract. the proposed amount is the

1,736,000 or increase of about $700,000 over the original contract was. approximately, 1035 people use the program for financial assistance grantsds wiz are helping people not be homeless. the problem that we had with the positive resource center and discussion was of course their fiscal financial situation which over last several years had run a major deficit of reports from the business office monitoring most recently in october, in september. indicated that with the help that they've been receiving from the city and the department they have turned around their major assets and

are now almost even in terms ever a balances budget. they still have some deliverables that were requested by the blcc office and we are recommending that the program be continued. it could be and the contract on extension of three years but as you know, a contract are really yearly in terms of if we don't have adequate funds or if the organization is not performing well, the contract can be terminated. so the recommendation that we will be making is that, we would recommend approving this contract continuing their monitoring, and the finance committee would receive or report back regarding the deliverables that b o.c. c has recommended and they will also be wrapping up their audit for

the past year. so we will continue maintaining a vigilance over their financial status. the reason for going ahead and approving this, is because their program their program evaluation has been excellent in terms of the work that they've been doing. so we certainly want you to make a good time is important to be sure that they continue a good path for fiscal health. so about 6 new contracts that were before you. the first of those contracts are, regarding the, let me get the agenda and the program here. the first contract that we're proposing to you is from, data

innovation llc. and this is to really connect about the laboratory data information systems to epic. it's a proposed contract amount of 762,616 dollars. over 2 million specimens are performed as general every year and this will allow for this data to be transferred directly over to epic. it will be a five-year contract. the first two years that the contract to october 2025 will be putting into place. and then, our current contract with the current vendors will be ending in the company will then take over for the next three years in terms of having the maintenance for this

information system transfer into, what they call the he pick which is i guess, you can look at the hrc or the labs that has been through this audit. so that's the first new contract. with risk and consulting which will be public media campaign. thts for 540,000, 596 dollars for one year. this is to do public health education in regards to the ability of treatment for opioid, addiction and also the how to use the milloxzone and

we'll be a one-year contract. they have done many media campaigns in different areas. the next four contracts are needed contract which will be the supporting the phase 3 of the erh implementation. it is a total proposed contract for each of these forces. so you can take them as need vepders sort of like our nursing situation where as you need nurses and you pull them from various contractors. as you need to have expertise in the epic electronic health module, this then allows that they have the support different

companies in order to have an expert help with something with the chart or any others that they list on your agenda an entire array of modules that they have. so this provides the back up force. they're proposing that u.s. t financial health to un, given a contract a max of 3 million dollars, the second one will be a similar contract with 3, 14 corporation. these contracts are for five years so you have this bank of four companies for five years, able to then, service us. the fourth is impact advisor llc and the fourth contract is for telljens incorporated.

so those four contracts are for the management of these module that's will allow our ehr people to select the expertise that are needed for a public problem. we then heard two presentations from solicitations our rfps to give, we actually heard one because the second one had a technical problem. so we will hear solicitation at our next meet ing, which had to do with the black african-american maternal health program. so we did hear however, 77 a 1 and a-2, those are mental health that are school base and wellness initiative. as contractors were attached to

each of these which are the contracts that will be coming before the finance committee and the commission. and those are the rfp solicitation that will give us the overall regions for example, one of the contracts has four different vendors, well-known initiative has the, the has one vendor. and this way we will know how they fit into the picture of the behavioral child prescription. it was informational piece that we're lookering forward to hearing. again, as i said the solicitation for the black maternal screening. that ends my report and perhaps

commissioner guillermo who was kind enough to join us to form quorum, may join us. >> thank you. >> that ends our report. >> well not only thank you, commissioner chow but i want to acknowledge. i think this report is emblematic on the work and detail that is involved in the part of the contracting division as well as all the vendors that we work with. and as you see, they do great diligent work and ensure that we're being fiscally responsibility. i think that report was pretty characteristic and 5-minute report but there is a lot going on behind the scenes. i think we're all very grateful to every one for the efforts that are being made. so everything that commissioner chow reviewed is on the consent calendar. sol is there any public comment on this item? >> we're still on, folks are on

item 9, if you would like to make public comment anybody in the room? what dr. chow just noted? online, anyone press star-3. no public comment. >> are there any commissioner comments? all right, we should go to the laguna hospital policy. >> we'll go to item 10 which is the consent calendar, and commissioner chow just reviewed. >> okay, we'll do the finance separate. you have before you, all the contracts that reviewed by commissioner chow. >> i'm sorry, it's vote for everything on the consent calendar. >> should we present the laguna honda policy that is on the consent handle now as well. >> yes, please. >> so then, let's go ahead and have commissioner guillermo present the items that belong to

laguna honda. >> thank you, commissioner green. we have been reviewing and asking for approval for laguna honda as needed for a number of reasons, not just limited to the recertification process. we did approve, recommend for approval to the full commission the set of policies that are before you. there were some questions that the members of the jcc had of the policies and we ask that, that the ed its and corrections and additions in the questions that we had were answered prior to us us making a full recommendation to be placed on the consent calendar. we have received those and are, and per the members of the jcc, are approved, the inclusion of

this set of policies on the consent calendar for today. >> so now should we move to approve the consent calendar. >> yes. >> all right, is there a motion. >> so moved. >> second. >> and i see public comment, is there anyone that would like to make public comment on consent calendar? anyone remotely. anyone online, press star-3. no public comment, commissioners. >> okay, we'll go to vote. >> commissioner chow. >> yes. >> sxl other commissioners in the room. >> aye. >> aye. >> consent calendar is approved and i believe we go back to our regular scheduled programming? >> item 6. >> item 6. is proposed program revaou, city wide program to be relocated at 1263 mission street second floor san francisco california, 91413, welcome.

>> and this is a discussion item there is no action on this. >> yes. thanks. can you hear me. i'm michelle rug lz i'm the director of dph units. the business units of contract d o.c. c and one of the things that b o.c. c does is make sure that we're in compliance with the city's administrative code which is the, the citizens right to know act of 19 98 which we adopted as a dph good neighbor policy. you'll also hear it often referred to as prop i, because that wased or the nans letter. but, chapter 79. but anyway, so our chapter 79 and therefore our policy requires that for certain city funded projects to meet the

criteria that citizens and neighbors are given their right to share their concerns about the city project. for dph, the project may be something that comes here or the action may be something that goes to another body to approve, like it's, the building is purchased for dph real estate takes it to the board and that satisfies the action. so one of the common places or times that we bring, to you here, is a relocation of a city contracted vendor. so this can apply to city contracted vendors or dph that, so a project or a relocation if it's changing the use of relocation of wla the site was used before, funding, and that can trigger this. so it was triggered today and that's why we're here specific for city wide case management

which is a set of program for under uc, that dph contracts with and they are relocating all of their contracts that are currently at 82 mission street to trial 63 mission street. so like, this is a hearing, there is no action today that is subject to health commission approval. i'm joined today by dr. who has the director of the city case management program as well as jenna reyez who is director of the business office compliance. so nothing, this is been a not controversial items. and so, but they're here if you have any other questions besides me going over how we can comply with the process. the essentially the biggest piece of this requirement is that we post signage, 30 days before the hearing and this is the hearing.

so and then also, our dph policy add at the second meeting has already happened at the community meeting. reposted our signage on november 3. and on your package there are copies of the signage and then attachment five is a photo crew proof that we posted the signage. if you post signage on the building and the 30 days, you're not required to mail flyers to the neighboring, to the neighbors businesses. and so, we didn't do that mailing. if you, the site, there is not a ton right around there. but the city wide walked around the neighborhood and where there was four open businesses that they spoke toxer the flier. one of the flyers, we had the signage which has to be a certain size, 30 by 30 but then

we also posted another attachment, how to contract the health commission. sol that was part of, that's a day they distributed. they did not get any comments or concerns raised. and then the community meeting was held on november 15th by the city light staff and the b o.c. c staff leading that and nobody showed up. and nobody provided comments to city wide case management or to jenna reyez, the director of docc whose name is on the poster. i realize as i was preparing that you have attachment one which is a summary, i don't think i put down the updated spertion. so there is two empty boxes in there. the square footage of the new

building is 28,571 rentable square feet. and then the hours of operation, 8:30 to 4:30 monday through friday. and discussing the move with the staff, it seems like they're actually going to improve the area with lighting and what not. but, you have questions about the program or if you want to wait if there is, public comment, however you want to do it. so see if there is public comment. like i said, doctor. ms. sushi is here, if you want her to have her come up and talk about the program or any. >> thank you ,z there any public comment on this item? >> is there anyone here to make any public comment? i don't see anyone, how about we motelly. would you like to make public comment. there are no hands for public comment. >> and are there any

commissioner comments or questions on this item? >> are the, just curious to hear from the doctor what the moves will accomplish for the organization? >> good afternoon, commissioners. the program necessitated to move because we were losing our lease on existing building. so really it was an operation al necessity. so this is square footage is increased which is necessity, provides services are in high demands from the city. so we are, i think this is a great opportunity for to us have an expanded capacity. >> i had the privilege to work with city wide and the staff and what an amazing work city wide does. and i've been to the current or former building. and i'm glad to know that more

square footage will be available for the amazing work that they do for the community and that the staff will be a little more comfortable than, they might have been before, you had a wonderful space. you created a wonderful space before. but i'm hopeful that it's going to be better. >> i look forward to seeing you at our new space. >> look forward to being there. >> thank you. >> any other commissioners comments? well what a wonderful way to close out that item. i'm delighted that you have great experience. >> it's a great organization. >> thank you very much. wonderful. so the next item is dph update and i was thinking how incredible it is that you're presenting o close to the 25th anniversary of world aids day. it's hard to believe that 25

years have gone by. it's really a testament of how far we've come. so the presentations i'll just read your names, stephanie cohen, director of prevention and control. tran who is an pi modologist and iesha, we've been looking forward to this presentation. so please again. >> before you begin, commissioners, the presentation i've worked with them to try to get it down to about 30 minutes and please note that it's longer because of questions. if every one is okay with that. >> thank you. thank you so much for the warm introduction. i'm stephanie cohen director of

hiv prevention section and disease prevention branch. and i'll be presenting an updated h.i.v. update. next slide. a lon with my colleagues. we will share two data presentations today to show sdi trends and two program presentation to see describe how we're addressing disparity during a patient centered approach. alongside of overdose and by those interactions, increase the adverse affects on the communities. response requires a multi sect tore al and holistic approach that we apply for our work in sdi and h.i.v. prevention and care. next slide.

all the presenters work under the leader ship 6 our division director dr. suess an philip. next slide. and as a reminder this is our current structure. you'll be hearing from staff and the branches outline in the red boxes from arches, the prevention and control and health equity. and i will also share briefly update to get into zero consortium. on that, i'll turn it over to sharon who is joining remotely and we'll start with our h.i.v. updates. >> good afternoon, commissioners and staff. is volume okay. >> you sound great. >> i'm sharon and epidemiologist. next slide.

for h.i.v. we begin with trends. looking at the red line representing you new diagnosis, we see that the decline and new infections have stalled. declined 28% and only 12%. in terms of prevalence at the end of 2022, represented by the last--we have an aging population in persons with h.i.v. also informs the mortality trends that we're observing shown by the yellow line.

you see that, that's gradually increased since 2016. increase from 10 percent to 18 percent in 2018 to 2021. next slide. while we look at diagnosis rates which take into account, biracial group, continue to be disparity for the new h.i.v. infections. 2022 for the first time, there were higher rates of new h.i.v. diagnosis in latino men shown by the solid green line than black men and race in both of these groups were substantial higher than in white and asian pacific islander men. although latino men, black

women shown by the dashed purple line were higher than white and api men and also women of other racial groups. i would like to note that race are too small and may be unstable. population, denominaters are not available for trans women and trans men. next slide. as i mentioned earlier, overall there is been a 12% decline in new diagnosis from 2019 to 2022. if i select populations at the same time period, new diagnosis for white, down by 22%, black 17%. all persons addicted to drugs, 9%. homelessness, 13%.

persons homelessness were 17% of 2022 diagnosis. and latinx where new diagnoses increases by 10 percent with three quarters of latin diagnosis being latino. another population of interest towards the bottom, trans women annual diagnosis are stable through this time period. next slide. for new diagnosis in the last five years, we further analyze outcomes to just linkage to care, and viral suppression indication. here each represents cases diagnosed that year. looking at the middle of group showing care, in 2022, 90% of persons were linked to care within one month of their diagnosis. and the percentage of viral suppressed persons within six months of diagnosis, has improved to 80% in 2022, just

the highest of the year 2018. next slide. turn to go virus affected persons living with h.i.v., here we show viral suppression rates in the last three years, starting with the year 2020 shown in the blue bars and 2022 in the yellow bars. we focus primarily on demographic that have lower viral suppression than the overall rate for 2022 which was 73%. now these groups were women, blacks, people age 25 to 49 years old. persons who injected drugs, who acquired h.i.v. through heterosexual contracts born outside of the u.s. and persons experiencing homelessness. although, these groups with lower suppressed, improvement

to note among persons experiencing homelessness, viral suppression increased from 20% in 2020 to 52% in 2022. and this improvement maybe attributable in part to persons experiencing homelessness, getting reengaged to medical care after the covid-19 pandemic. engaging in care from 33% in 2020, to 70% in 2022. next slide. in summary, the rate of decline has evolved and protections are on going. high levels of linkage to care and viral suppression are occurring but despair its remain. and the concerning trend in h.i.v. that are highlighted

include an increase on latinx people, and trans werjs the continued high proportion of new diagnosis in persons experiencing homelessness and the increase in accidental drug deaths. and the next section, you'll see what is reflected currently in trends and epidemiology. >> commissioners my maim is tran and i lead the sti evaluation in arches. next slide please. overall, in san francisco, annual incidents rates for kla mid-ia morning, in gonorrhea in red and syphilis in green. the steep decline in 2020 is due to reduced testing.

rates have decreased between 2020 and 2022 but still lower compared to 2019 while rates of syphilis have continue to decline. given the limited time, we will not be presenting data cross all sti but we do want to address president green's trend for race and ethnicity. for chlamydia and early syphilis, by race and ethnicity and among males, the trends in rate by race ethnicity is similar to what is shown here. next slide please. compared to other jurisdictions, san francisco experiences relative high rates. the graph on the upper left shows san francisco in the orange doted line, with the higher gonorrhea rate in five years compared to california and u.s. as well as compared to los angeles and new york city. this trend is also true for

chlamydia and syphilis. for primary and secondary syphilis rates in the left set of bars and early syphilis rates in the right set of bars, san francisco has the ryest rates compared to l.a., new york see and u.s. next slide. increased syphilis among females con general till remain an area of concern. national increases among pregnant women and congenital syphilis since 2015 . the light on the right since 2013. next slide. we've seen increases in san francisco and reported female syphilis since 2014. given the goal of preventing congenital syphilis, we monitor persons who can become pregnant.

gender who's were female or trans male. data for 2023 are through the third quarter. in 202 2, there were 186 syphilis cases 18 whom were pregnant. of the 18 pregnant cases six experienced homelessness, one reported meth use and one reported heroin use. the left, represent syphilis cases. bit end of 2023 there were congenital cases, but we know there is a fourth case so far in the fourth quarter. and supplemental slides that we provided page 7 shows by rating and he is nisity. latinx were lower cases of all for all stages in 2022, at 211% than they have been in resent years.

next slide please. while the response originated w9 graourntion we learned through investigations in 2022 the primary mode of transmission in u.s. and san francisco is close contract with sexual partners. therefore the m pox prevention control positions to the relevant groups with ash muches and control branch and the community health and equity branch this. transition was completed in november of this year. next slide. after the first wave ended in late 202 2, there were support add i can. but in increase since july 11, result inside 50 cases reported through october 31 of this year. vas majority of male who report sex with other men. last mobsinger additional 12 reported cases. san francisco has the highest m pox in california. next slide.

we have seen the des pater for race and ethnicity. the graph shows that san francisco population by race ethnicity the proportion of race and ethnicity in the blue bars. the red aeuro points to the two blue bars where the m pox is higher. 28% has been hispanic latino compared to 17% who are hispanic latino. and 45 are white compared to san francisco 39% residents who are white. vaccinated cases have experiences less severe systems and less likely to go to the emergency room or be hospitalized. next slide. by october of 31 of this year, san francisco residents

received one dose of m pox vaccine. of those 59% also received their second dose which completes the volcano seen series. next slide. another population given their rates is adolescent in young adults, ages 15 through 24. next slide please. while race have declined, disparity exist both by race ethnicity and gender. here we rate between 2018 and 2022. those identified as black a frick man american or hispanic experience higher rate compared to white, asian or multi racial youth. next slide please. disparity additional seen by age. we focus on chlamydia.

we present the data by race ethnicity by age and the age group. you can see reflected in longer blue bars that the groups experience lower rates within each race ethnicity. and that a black african females, experience the higher rates, highest rates. the same pattern is true for gonorrhea that is not shown here. next slide. finally we're always monitoring trends and rates and epi modology. next slide please. the known and perceived impacts on covid on health service sxz sexual behavior or network has muddled how to interrupt resent declines. hao*er you see on the aeuro in

the left, in quarter of two of 2020. immediately following the first cases of covid in san francisco in march 2020. cases slow slaoe increases as screening services opened back up and people got in close contact again. next slide. the identified our first m pox in may of 2022, at the second arrow and then at the third arrow, we the san francisco department of health, released guidelines for recommending post exposure referred as doxiy for sdi prevention in 2022. next slide please. after the introduction of m pox and dox' pab, we have outlined by the box, study totally decreases in chlamydia cases. next slide please. that same pattern is not seen

among females p very few m pox cases. next slide. but among men who have sex with men both experiences the highest rate of m pox. the quarterly decline are seen and more notable in qeii and q3, the last two orange bars on the graph. next slide. for gonorrhea there were decline soon after covid and m pox were introduced. but there was an up tick in quarter 3. this is seen on men who have sex with men among and among females not shown. next slide. for total syphilis, we highlight the data where there is men who have sex with men, quarter cases since m pox were introduced. next slide please.

in some rate, elimination of congenital remains our objective. on going promotion and are warranted and continue to continue disparity needed to promote pok use. and then finally sti the patterns will be evaluate. thank you. >> good afternoon, i'm nye eastbounder a under wood coacting director and i'll be discussing community efforts to address and ultimate use the curve on the disparity discussed during the presentation.

so ending the epidemic, community informed to address the sin dem i can of h.i.v., sti and overdose, following the principles on the slide and there is a living document called the san francisco eta plan that will guide all of our prevention care work over the next ten years. before by grants through our federal partners which is center for disease control, our california of public health and the city and county general fund as well as parsa, next slide please. sorry about that. so part of ending the epidemic effort is the health access model. so we have previously shared our hat vision. the hats provide low barrier and community services and welcome spaces free from stigma. the goal of the health access

point is to ensure that all san franciscans have equitable access to all, sti prevention care and treatment services as well as harm reduction and overdose prevention services. next slide. so the community health equity and promotion grant from 7 health access points focusing on the following communities on the slide. all thoet health access points are population, focus nobody turned away from health services. also wanted to note that disparity were a factor in determining the amount of funding for each of the points. so the lat i can x received about half of the total funding for the health access point. we have launched in july of 2023, the planning phase before

tha. we are currently collecting data from the hat of services delivery. the initial data submission happened this past friday and we'll have more outcome to share in the coming year. next slide, please. so some of our efforts, focus in latinx community to address disparity seen in the data. we are advising community programs which for the latinx communities. check is also focusing on strengthening collaboration with our funded programs and other community partners such as the latino task force and collaboration to support the work needed in a number of new

h.i.v. against latino and gay men. so we're work with health center as part of our health access point efforts. h.i.v. testing. additionally we're supporting our ucsf pacific in their efforts to offer h.i.v. testing. in the heart of the mission district. next slide, please. like wise we have our efforts in the black community. because our ipoc in the black african-american youth.

we have partnered with our street youth clinic where we fund a full-time health educators. we have created an access point for youth to order self sti tests and i'll talk about that a little bit in upcoming slide. some of the other efforts in the black african-american community are the mobile contingency service. this is a street base out reach and brief intervention for people experiencing homelessness and focused on ipoc who smoke fentanyl. on going counseling and drug testing services. we are also funding three

community advisory program focused on the african community, they provide expanded community engagement and continuous and meaningful dialogue to address h.i.v. in the black african-american community. and then lastly, we have a, a black african health access point lead by rafiki coalition and they also have some partners in that. so our youth we support using young support through a variety of activities. our think no home testing program which i spoke about briefly in the previous slide provides low barrier access to free and confidential chlamydia and syphilis screening.

providing sti h.i.v. screening and array of other services. and providing youth access at the clinics. where a black initiative sti committee pulls together partners to think how to bring youth back to the clinics and promote and empowerment overall. lead a story project with focus on empowerment and youth development. they develop videos about sexual health and identity to share with other youth. the youth videos they live on the city clinic youth page.

next slide please. we also have focus on people who use drugs. so we fund, which is lead by 186 in collaboration with dlied and alliance health project their population of focus, also excuse me, also includes people who engage in sex work. check has a team, we call them wishes, it's the wellness initiative for social health and equity. so they support and capacity building and training for services for people who use drugs and experiencing homelessness across all of our access points.

we also partner with behavioral health services. the next slide please. lastly i'll talk about our community base m pox prevention efforts. has been informed about m pox and how to access low barrier vaccination. for the past year and a half, we created video and various languages to feature community members and prioritize lgbtq communities that provide health information on symptoms, and how m pox spread and does not spread. we contracted with a social media to increase message as cross social media plat forms. and then we've also developed a survey that offered the state inside on people's vaccine adherence during the street fair. and i'll turn it over to

stephanie cohen. thank you. >> okay, next slide. hi again. i will start with updates from our getting zero consortium. getting to zero was a coalition that was started in 2019. in getting severe include a press committee, retention, committee foc pused on people experiencing homelessness and one on h.i.v. and aging. over the past decade getting so zero has been responsive on issues and population. where we are seeing despair its. some key current areas of focus are overdose prevention as well as tacking new products such as the education and post purple access. our get to go zero meeting

tomorrow in honor of world aids day, we'll focus on discussion and h.i.v. next slide. now i'll turn to the work section. i'll just describe our problematic efforts to describe a dress disparity in sexual health. this slide focuses on the work of our linked team which is central to the work of get to go zero ending epidemic. navigaters who work to link individuals with h.i.v. and sti to prevention treatment and care. thed learning pair mid-on the left shows the vas of skills to do this complex work. in 2021, the team provided navigation services living with h.i.v., almost 60% of whom are

xaoerntion homelessness and thoz. this work is helping contribute to those improvement among people experiencing homelessness. the team also works with many experiencing h.i.v. and as dr. win shared, they have taken over m pox and served as of october 58, individual with m pox. a major focus of our program is prevention of congenital syphilis. this is an area of national concern and local concern and biden administration has created a task force. luckily, we have had task force for several years which includes partners from city

clinics and maternal adolescent health and emergency department and urgent care and other key partners. in 2022 through this work, we averted 50% of potential syphilis cases. task force focused on many programmatic initiative to see identify missed opportunities, developing work flow making optimization, maintaining a weekly pregnancy loss and increasing provider knowledge, around sexual health and syphilis screening. that now recommended syphilis screening three times in

pregnancy including in delivery. many of our congenital syphilis and patients who are diagnosed with syphilis at delivery because they have not received any prenatal care. our training and technical assistance extend beyond congenital syphilis. we work with providers around the city who star disproportionately, to increase to provide evidence base affirming case. we developed and did i sim nature guidelines and protocol and work with important clinical sites including m community sites like navigation center, our msx clinic and newly formed access points. we also provide clinical observation management and stis. next slide.

san francisco city clinic is a nationally center of excellence and remains a integral part of our city wide get to go zero efforts. we, highlighting some of the work in 2022. several years ago, the clinic was awarded four-year competitive grants, one of 19 jurisdiction to receive the award to optimize h.i.v. prevention in sexual health clinics. and with that funding, we have been able to implement a number of things to op miez prevention services. so it's at the clinic and throughout the san francisco network, we built a press registry to support retention and prep care. we scaled up our capacity improve patient experience and visit times. we have implemented long acting injectable prep and innovative new tool in h.i.v. prevention.

we initiated medical and engagement through a prevention which resulted in the beautiful mural that was painted on the building last year. next slide. through our rta and training program we work to optimize the delivery of prep throughout san francisco. next slide. and with these efforts, we have seen year after year increases with men who have sex with men who report that they are taking prep and we've seen these increases across ethnic groups, although some disparities do remain. these far surpass national data, only 11% of black african

americans patient wise. next slide. by i am mrimgt new technology, injectable we're a dressing disparity. this slide shows the proportion of prep by gender on the left and race ethnicity on the right with the orange bars showing patients who are receiving all of our patients on prep and the blue bar represent those who are receiving injectables. and you can see that through our l.a. program we're reaching populations including trans women and sis women as well as latin patients. the last intervention is psych lin propsighssis, this is a new sti prevent ition that reduces sti by nearly 70% and trans women.

nons traited the ethicacy, and became the first jurisdiction in u.s. to release guidance. it's having an impact on city wide sti and through get to go zero new product initiative we're working to monitor up take to identify and address disparities and assess impact. two important sites of delivery, president green you asked are both h.i.v. clinics. next slide. in summary, social determinants continue to drive the sti and h.i.v. ep deposit i can. we have promising new tools in both h.i.v. and sti prevention but intensive efforts are needed to ensure equitable access. you have heard about

disproportionate on m pox. and this is an area of concern and focus for us. the reason are complex and i think we still have more to learn but we do think that stigma and lack of access prior to arrival in san francisco, lack of insurance, and fear of immigration status all play a factor. lastly, our systems and our newly form task are critical to reaching latinx residents as well as other populations where we're seeing disparity. thanks for your attention, i think all four of us are happy to answer questions. >> thank you so much for that incredible presentation. what an amazing enterprise, we'll go to public comment. >> ye, eduardo, can you turn on

the bottom light switch so we can get more light in here. thank you in advance. is there anyone in the room that would like to make public comment? and no one online either that would like to make public comment. >> all right, we'll go to commissioner comments and questions. >> thank you. >> i don't have any questions, i just want to comment on the overall presentation. it just, one to congratulate you on being able to keep the issues of h.i.v. and sti prominent and very much in the public's you know, sort of mind set. because it's so easy with everything else that we're being confronted with for folks to think and there is not a lost visible you know, i think

that it's really important for us to continue to, to keep the agenda that we have had particularly in san francisco with all the success. across all the demographic, i think that's really key. it's very surprising, well maybe, not as surprising but very concerning relative to the latinx population. and then with the young, with the rates of sti in young women, i think that's something that we really need to be paying attention to. i want to thank you for being able to make this presentation. a lot of date and data, in

order to keep our eyes on the prize. so thank you. i want to thank and thank you and congratulate to present the information on clear manner which is not always the case in any circumstances. but really thank you for and very successful. and look forward to continuing to hear about your work. >> well, i can't say it better than my fellow commissioners. we're in awe of your work and the all that you a accomplished, the way you defined the problem and the way

you're setting out to solve them. we're grateful for your work, you are really really among the many dwitionz of health that make us proud. so we're very grateful. i think colfax wants to say a few words about your amazing work. >> one more point, i think the other thing that i wanted to, the partnership that you have created with the community base providers and others that supplement and augment, the leadership that the department has shown in this area. i think it's a model for the partnerships that we can do across many different health concerns, public health concerns that we have, not just in san francisco but across the nation and so again, i think that and it's been over decades. and that's how long it takes.

this is an exemplar' way to show how important the departments can be. >> i graoe, the partnership that you make is also noteworthy and the leadership within the community that you're supporting and building through the partnership is also quite useful in and of itself. thank you so much. >> if you can get one or two questions. and i'm really pleased that the integration of sti and h.i.v. have really worked out and we're all working together. and very massive reports that you have put together.

i was just wondering why we have such a very proportion of these, this order compared to the entire united states. does everything that we have a different environment. wanted to clarify that syphilis is so much higher than california and the u.s. do we do something different? >> thanks for the challenging question, one thing we know is once you have a high prevalence in the network it short of persist so i think part of it is that we have a stis in our community and that means anytime you're exposed to somebody you're most likely to be exposed to an sti, i think

that we, have also, you know, as you know, we're one of the jurisdiction that's was hit hardest and earliest by h.i.v. and i think the conditions in san francisco, that put us in a situation where we had a, more of the tep dick and the things that put us at-risk for sti rates. but the good news is that we have a strong collaboration throughout the health department and community. you've noted that you believe that the h.i.v. numbers are plateaus. but in previous presentations, we talked about i think both in

the sti that we're still having, that we were having difficulty in trying to influence the younger generation. maybe i missed it the presentation, of which, that we are trying to reach. i was surprised about the latino rates rising. we're finding that this is now under control? >> you can also make some broader comments. >> yes, while we did not

include as much age related information, on new diagnosis today, did you reference the 2022, at the annual report in section 1. you'll see that by age, new diagnoses are in the 30 to 39 followed by the 29 young adults. and young adults 18 to 24, it's ranged from 10 percent to 12-14 percent. and recently in the last year, it's 12 percent of new diagnosis. >> so is there a campaign on that? because you didn't really show.

i think from the stand point of h.i.v. the use focus is that we're working with lyric for use. and i think we all, you know, strongly believe that we have to maintain a focus on youth because they're coming into their sexual debut without having received prevention education. so it's always the population that is entering the network and that we need to have on going efforts to reach. i don't think it's why our new h.i.v. diagnosis are plateauing in rate of decline but it's a very important population focus for us. >> so, so i think on the basis of future presentation, we should be looking at this younger age also in terms of

letting us how successful we are doing with the group. as i think you said, this is where much of the younger and much of the new infection is coming from. and i know that we had talked about trying to really reduce that and that might be, a focus that you would like to hear about. but certainly i join my fellow commissioners on this report, i push forward because it's so rich and data, i want to thank everybody in this combination for the work that they've done. >> thank you. i just wonder, whether some of the reporting is due to the fact that you're so excellent at what you do, you probably track cases better than a lot of organization in this, in the country and also because you have done such a great job of

destigmatizing, that maybe your numbers seem worse because you're doing better, i wonder if that's a component as well. so we'll go to director colfax. >> thank you, hi, everybody. i want to touch on partnerships, this is recognized nationally and i often get text from colleagues that i used to work more closely with, who say, one of your team members is presenting and as usual, san francisco is doing a great job. i think the other part with the presentation, the team was, maybe a little too humble

particularly around doxy pad trial that the city clinic was a major site for. and stephanie was coti, of this trial published in the journal of medicine. i think the other thing that was very that was very, ground breakinging for the department is for their recommendation, we move aggressively. you're seeing some of the data that looks promising, we're not ready to say definitely do the dox' pad. from the month we initiate dox' pa*d from now, it's becoming commonized. and many of them have taking it, it's not considered an unusual thing for people.

it's an example of ground break research going from academic journal to being applied in the community. >> thank you, and how weird that the study ends up operationalized. thank you so much. would you all join me in applauding this group because they have done a great job and they continue to do so. [applause] >> all right, i guess we'll go. this is a hard act to follow, now director colfax, now you have to do the director's report. >> i'm not trying to follow. thank you again, everybody. so i did want to mention one thing, one thing is that at laguna hospital we're engaged

in our second survey. we had surveyors come on monday and again this week. we're ensuring that we do all we can for a successful survey. as always, we expect findings especially for a facility of our size. the goal is to ensure that findings are taken care of as quickly as they are found. and even after the survey that is complete, we anticipate the participation will take more time. so i really want to acknowledge that all laguna honda staff, surveys are stressful and they are, continue to go work very hard to make sure that we're doing everything that we can. so more news to come. but we are in a major, this is the second survey after the

first survey that lead to successful medicaid certification. this is the second survey that is required for medicare recertification. just also, wanted to emphasize that you started, president greensinger i believe you start thed the presentation around acknowledging the world aids day. and we, we recognized world aids day last friday, including making sure that people understand that san francisco is a leader in this work, both nationally and very pleased to see some of the activities going on. i was able to attend the aids memorial grove event which is a nice local event that has a national print. i encourage people to go there.

in the written director's report i'm thrilled to announce that our new chief medical officers, medical director started last monday, december 4th. dr. albert lamb, he has extensive experience examine expertise in skilled nursing, long term care facilities patient care. and you'll see his qualifications there. we're so happy to see him join the team. we're in the holiday season, and we would like everybody to stay as healthy as possible. so we have a lot of detailed

guidelines. but i would point out the key areas, get back against covid-19 flu and rsv, if you're qualified for rsv, stay home, please if you're sick. get treatment if you do get sick. consider weaker a mask particularly people over 65 and these recommendations were issued bye-bye other near by health officers. and then just another, i wanted to also celebrate the department's work, acknowledge the department's work during the apec conference during weeks ago.

again under the population health department under the department. huge amount of work along with our other department division. and it was so ensure minimum disruption to see health and health service sxz to be ready to respond adverse events. this would not have been possible speaking in may. leading up to a pack, between supporting a pack coordination and other resources, and exercises support and community messaging and facilitate planning for departmental and access healthcare facilities.

to community partners and across the department, there were many other cxz including the environmental health branch was working very hard to ensure food safety. we had the clinic open in late hours for people for people to access healthcare. and acknowledge the work at the hospital praum a center was coordinating with many entities. and working with adverse air he's with other governments to make sure that we're prepared for any catastrophic events which thankfully did not happen. i want to emphasize the work

across the department and overall success of from thed public stand point of that conference. and i will stop there. i do have one more covid update. test positivity rate is 62%. we're not seeing a big increase after the thanksgiving, we may see it in a week or two. and right now, there are 28 total hospitalizations in hospitals across the city. i think it's triple the national average. we have more room to go. we're doing better than national numbers by far.

that all, i'll be happy to answer any questions. >> thank you for your question, we appreciate you calling out all the work that went into a pack. so it's a real testament, to pull this off which is quite, quite an undertaking and then we're delighted that we have a medical director at laguna, that's such great news. so is there any public comment on the item? >> would anybody in the room like to make public comment? all right, we have one caller. can you unmute the caller and i'll put three minutes on the timer. caller let us know that you're there. >> caller: hi, i'm dr. palmer. i'm delighted that you recaoutd

dr. laum to be the medical directer. so laguna honda does not run into trouble again. i know you've done extra goals. and you give us any estimates of when, you know our range of when admissions might be reinstituted? we're going into flu season. and people are transferred out of county because they need the beds. i would like the assurance that you will continue to get, get to get those 120 beds back. thank you very much. >> thank you.

that's the only public comment on this item. >> and then commissioner comments or questions? all right, i see none. so thank you so much for our report. and our next item is other business. is there any other business? >> let me check to see, would anybody online like to make a comment online. so the meeting was officially adjourned at 5:35 for not having qualmer but you can just end. >> thank you, thank you for being here. >> yes.

>> # >> >> >> >> you are watching san francisco rising. >> hi, you are watching san francisco rising. reimagining our city. he's with us to talk about how our library's economic recover. mr. lambert, welcome to the show. >> thank you. i'm glad to be here. >> i know it's been difficult to

have books going virtual. have we recovered? >> yes, we are on our way. our staff stepped up big time during the pandemic to respond to the health emergency. since last may, we have been able to steadily increase in person access to library facilities. currently we are at 95% of our precovid hours of operation. in the coming weeks we are going to fully restore all of our hours. we have four branches that we are going to bring back to seven day service. they are currently operating at 5 days a week and we are going to go to every tag line and i know all the foot traffic has not returned to san francisco, but our library is seeing a resurgence coming back. >> can we talk about programs

after covid? >> absolutely, that is part and parcel of our mission. we were doing that work precovid and certainly the library stepped up during the pandemic. we doubled our level of programming for personal finance, small business help, jobs and careers. we have a dedicated small business center here at the library. there is a wide suite of programs that our librarian led. we have a financial planning day coming up in october and we have financial coaches that members of the community can come to the main library and take advantage of their expertise. >> i understand the mission is in the middle of a renovation. how is that going and are there other construction projects in the horizon? >> yes, we have major projects in the pipeline. the historic mission branch library, carnegie

library over 100 years old and we are investing $25 million to restore that facility. we are going to restore the original entrance on 24th street, the staircase from the lower level up to the grand reading room. we are going to push out on the orange alley side of the library and expand space for teens and children, we are going to create a robust community room, a multipurpose space. we are also investing $30 million in the chinatown branch, we are going to upgrade the mechanical systems to the highest level of filtration as we increasingly respond as cooling centers and air respite centers and open access to the roof. it has some unique views of chinatown to create the inspiring space it is. >> i believe you have programs

for families that have free and low cost entries for museum and zoos, is that correct? >> yes. it's a fabulous resource. go to our website. with your library cart, patrons, our residents can go to the public library and get passes to the museums, all of the incredible cultural institutions that we have in san francisco all for free with your library card. >> how are these great free services paid for? how is the library system funded? >> we are so fortunate in san francisco. we are funded for by the library fund and those that taxed themselves just for library services. we also get a dedicated portion of the general

fund. that together allows us to be one of the most well supported libraries in the nation. we have the third most library outlets per square mile of any municipality. all of our branch libraries have professionally trained librarians on-site. service that we are able to provide, the collection, we are a leading library in our country. >> that lead know ask about your biggest annual event in the city. how does the event work and what's happening this year? >> we are excited for this year's one city one book. this is our signature annual literature event. we have everybody in the community reading the same book. this year's title is "this is your

hustle" named after the pulitzer prize nominated and pod taste. this is about the population. one nice thing about this selection is that they are both local. we are going to have several weeks of programming, kicking off next month. it will culminate here in the auditorium november 3rd. so our library patrons will get to meet the authors, hear from them directly, and one other important aspect about this year's selection, we have our own jail and reentry services department. recently the foundation awarded the san francisco public library $2 million to work with the american library association to shine a light on our best practices here in san francisco, and really help our peers in the industry learn how they can

replicate the service model that we are doing here in san francisco. >> that's great. well, thank you so much. i really appreciate you coming on the show, mr. lambert. thank you very much for your time. >> thank you, chris. that's it for this episode, we will be back shortly. you are watching san francisco rising. thanks for watching. >> roughly five years, i was working as a high school teacher, and i decided to take my students on a surfing field trip. the light bulb went off in my

head, and i realized i could do much more for my students taking them surfing than i could as their classroom teacher, and that is when the idea for the city surf project was born. >> working with kids in the ocean that aren't familiar with this space is really special because you're dealing with a lot of fear and apprehension but at the same time, a lot of excitement. >> when i first did it, i was, like, really scared, but then, i did it again, and i liked it. >> we'll get a group of kids who have just never been to the beach, are terrified of the

idea, who don't like the beach. it's too cold out, and it's those kid that are impossible to get back out of the water at the end of the day. >> over the last few years, i think we've had at least 40 of our students participate in the city surf project. >> surfing helped me with, like, how to swim. >> we've start off with about two to four sessions in the pool before actually going out and surfing. >> swimming at the pool just helps us with, like, being, like, comfortable in the water and being calm and not being all -- not being anxious. >> so when we started the city surf project, one of the things we did was to say hey, this is the way to earn your p.e. credits. just getting kids to go try it was one of our initial challenges for the first year or two.

but now that we've been doing it three or four years, we have a group of kids that's consistent, and the word has spread, that it's super fun, that you learn about the ocean. >> starting in the morning, you know, i get the vehicles ready, and then, i get all the gear together, and then, i drive and go get the kids, and we take them to a local beach. >> we usually go to linda mar, and then occasionally ocean beach. we once did a special trip. we were in capitola last year, and it was really fun. >> we get in a circle and group stretch, and we talk about specific safety for the day, and then, we go down to the water. >> once we go to the beach, i don't want to go home. i can't change my circumstances at home, but i can change the way i approach them. >> our program has definitely been a way for our students to

find community and build friends. >> i don't really talk to friends, so i guess when i started doing city surf, i started to, like, get to know people more than i did before, and people that i didn't think i'd like, like, ended up being my best friends. >> it's a group sport the way we do it, and with, like, close camaraderie, but everybody's doing it for themselves. >> it's great, surfing around, finding new people and making new friendships with people throughout surfing. >> it can be highly developmental for students to have this time where they can learn a lot about themselves while negotiating the waves. >> i feel significantly, like, calmer. it definitely helps if i'm, like, feeling really stressed or, like, feeling really anxious about surfing, and i go surfing, and then, i just feel,

like, i'm going to be okay. >> it gives them resiliency skills and helps them build self-confidence. and with that, they can use that in other parts of their lives. >> i went to bring my family to the beach and tell them what i did. >> i saw kids open up in the ocean, and i got to see them connect with other students, and i got to see them fail, you know, and get up and get back on the board and experience success, and really enjoy themselves and make a connection to nature at the same time. >> for some kids that are, like, resistant to, like, being in a mentorship program like this, it's they want to surf, and then later, they'll find out that they've, like, made this community connection. >> i think they provided level

playing fields for kids to be themselves in an open environment. >> for kids to feel like i can go for it and take a chance that i might not have been willing to do on my own is really special. >> we go on 150 surf outings a year. that's year-round programming. we've seen a tremendous amount of youth face their fears through surfing, and that has translated to growth in other facets of their lives. >> i just think the biggest thing is, like, that they feel like that they have something that is really cool, that they're engaged in, and that we, like, care about them and how they're doing, like, in general. >> what i like best is they really care about me, like, i'm not alone, and i have a group of people that i can go to, and, also, surfing is fun. >> we're creating surfers, and

we're changing the face of surfing. >> the feeling is definitely akin to being on a roller coaster. it's definitely faster than i think you expect it to be, but it's definitely fun. >> it leaves you feeling really, really positive about what that kid's going to go out and do. >> i think it's really magical almost. at least it was for me. >> it was really exciting when i caught my first wave. >> i felt like i was, like -- it was, like, magical, really. >> when they catch that first wave, and their first lights up, you know -- their face lights up, you know you have them hooked. >> i was on top of the world. it's amazing. i felt like i was on top of the world even though i was probably going two miles an hour. it was, like, the scariest thing i'd ever done, and i

think it was when i got hooked on surfing after ♪♪ >> san francisco! ♪♪ >> this is an exhibition across departments highlighting different artworks from our collection. gender is an important part of the dialogue. in many ways, this exhibition is contemporary. all of this artwork is from the

9th century and spans all the way to the 21st century. the exhibition is organized into seven different groupings or themes such as activities, symbolism, transformation and others. it's not by culture or time period, but different affinities between the artwork. activities, for example, looks at the role of gender and how certain activities are placed as feminine or masculine. we have a print by uharo that looks at different activities that derisionly performed by men. it's looking at the theme of music. we have three women playing traditional japanese instruments that would otherwise be played by men at that time. we have pairings so that is looking within the context of

gender in relationships. also with how people are questioning the whole idea of pairing in the first place. we have three from three different cultures, tibet, china and japan. this is sell vanity stot relevar has been fluid in different time periods in cultures. sometimes being female in china but often male and evoking features associated with gender binaries and sometimes in between. it's a lovely way of tying all the themes together in this collection. gender and sexuality, speaking from my culture specifically, is something at that hasn't been recently widely discussed. this exhibition shows that it's

gender and sexuality are actually have been considered and complicated by dialogue through the work of artists and thinking specifically, a sculpture we have of the hindu deities because it's half pee male and half male. it turns into a different theme in a way and is a beautiful representation of how gender hasn't been seen as one thing or a binary. we see that it isn't a modest concept. in a way, i feel we have a lot of historical references and touch points throughout all the ages and in asian cultures. i believe san francisco has close to 40% asian. it's a huge representation here in the bay area. it's important that we awk abouk

about this and open up the discussion around gender. what we've learned from organizing this exhibition at the museum is that gender has been something that has come up in all of these cultures through all the time periods as something that is important and relevant. especially here in the san francisco bay area we feel that it's relevant to the conversations that people are having today. we hope that people can carry that outside of the museum into their daily lives.

please welcometh