Organizing work to do we dont want any of the programs to not sign on and support arrest im sure youre aware of we spend Million Dollars and Million Dollars on hiv care throughout the city thats the real getting to zero group and those dollars are to help align and get a focus on the key areas. We at bridge hiv are working with nativeamerican organizations on cultural humility training for those who are providing the care some of the groups listed on this graph i showed you on retention and care are people that are newly diagnosed were trying to prevent people from becoming enacted and this sub group needs to move into contingency that are less aware for the Prep Services and may not have the Prep Services delivered to the places they receive care weve asked the committees to say look around the table who are we missing in representation here but who are we missing in delivery of services. I was going to share i think you mentioned in our presentation a Small Task Force look at how to eliminate privilege and bias for many of us are people involved in the pathway so to speak its a double hit people may have aids and latino or documented or undocumented or nativeamerican or whatever so looking at this go you presented selflooks like you have a view and going to address those issues so thats good thank you. Commissioner karshmer. Thank you it is an amazing progress chart two things that strike me one weve learned a lot this collective impact is exactly what goes go to make a difference we at consortium had a presentation an stds how were getting to zero there and we started the issue of treatment and the outreach to the users and the ends user im hoping that given were all in the same public sharing the best practices from what youve done successfully and the std unit is a critical part of getting to zero Stephanie Cohen and others are involved were sharing best practices and theres a Council Town Hall meeting for Community Members will the sexually tramentdz infections and i would mention that the increase in sexually infections began they were high they come down with the hiv epididymis and the late 90s when people were receiving adequate treatment for hiv the rates started to go up again we have a huge road ahead of us to try to address hiv we consider addressing stds diseases hiv is one of them the stigma is one of that. And the other thoughts the Rapid Response i mean this should be the standard for any chronic disease if we took the same analogy with the Health Issues and for the moment the person is diagnosed getting the treatment auto r out. We hope the same thing that the hiv treatment has lead the charge for other diagnoses related we hope that serves as a road map for all the huntington park. It seems we get a little bit commandment listed so if you have suggestions for places or ways to share it well welcome that. Commissioner pating. I think i wanted to ask a few more questions the strategy trying to get hiv drugs and floating this into our immediate population our daily initiatives seems to me but your strategies to get to the populations but populations that are not theyre the homelessness or other ingenuity are we geptd ism linked or assess. The Retention Committee is focused on people that are marginally homeless or delusionally diagnosed thats a group we often do lose and need to find ways to engage them theres been a lot of discussion not to deal with that in isolation we have a big focus on use as i said thats the group that is at least likely to come back in but their for example in preexposure to blacks young people may not have Health Insurance or be on their parents Health Insurance and not want to come out as being on preparing were trying to figure out how to work with the o that are focused on youth. My secondquestion is the Africanamerican Community. Weve got a lot of people that are linked in both and both coming from the housing, land use, environment, and Transportation Committee it in one of the intersection the Africanamerican Community is impacted and the outcomes this is one of them were trying to center jiujitsu the best we teris the best we can. And going 1y506 weve not decreased the rate of infection by more than 50 percent if you did that every year for the next 5 years youll end up with a high transition and not reach our goal presumably the more smaller population the exchange gets so score that we operate in an environment that are many Interest Groups have passionate feelings about the way to deploy those resources if you boil it down to the 3 initiatives two questions how do you think about interim goals and serving at end points and the second and probably more important question how do you think about how to allocate the resources you have unequally among the initiatives so that we do the most good given what we know works and the resources we have. I would say if i had the answer to the last question i could i know rule the world or eliminate all heartache disparities everywhere this is such a challenging question id like idle a say first of all, the interims have goals and metrics part of what we did with the city c grant to ramp up the measure citywide we need to measure some of the sewer gets are we getting the right people on preparing when somebody new bottoms enacted do they know about prep have access to prepare prep when someone is diagnosed late in infection where did we go wrong were goinging doing those individuals levels to see where the system failed those individuals not reaching as you point out it gets harder and harder as we get to smaller and smaller numbers to understand how and why i think the issue of how we distribute resources is a huge issue like i said a very very challenging one what were trying to do to get alignment within the various committees about priorities and then make sure that we all work towards that common goal and realign the resources it didnt mean taking resources away from groups but we may if not successful the commitment of groups to common agenda we have to be sure we are heading in the right direction thats how to get to be sure were all on the same page we wont if everybody is doing theyre on thing or what they think is the most successful we started with those 3 initiatives by the way wes we needed to know things we have a measurable impact and set tasks to get to those ends points and measure the end points to see how well, were doing. It seems to me the one of the key to success is the allocate resources completely unequally because the initiatives have unequal benefits and so i still want to go a level deeper how well, do we do that as a department. I can take a stab at that one of the things we can do we fund a majority of those funding it is not the 1. 1 over thirty something Million Dollars so one of the things well be looking at rfping out according to need and rereflecting what the new need is as we really out new rfps well have to look at go where the targeted pongsz and how do we get money back to them and this is what the federal government did they look at the country and thats why we dont get as much money we may have to do the same as we move into this direction we control the dollars and have to figure out how to do this without new people at the table i dont continue to win the game so to speak i think we have the ability to shift the dollars where it is needed it will take time this is the first step were looking at how to have those communications in the community about reorganizing the way we do our rfps it is not just the hiv dollars were talking about Mental Health and dollars to make sure we are aligned not only in this but you brought up the africanamerican Health Initiatives right there that community is being impacted and put more resources the fact that this is one of the smallest is community in the community we should be able to have an impact and share the resources it will be a rae alignment of the dollars youre right on the mark. And im asking the question i think that is really imtalking about this in various things that is so important that we have the courage to be disciplined about this so that we get the most health for the resources we have to deploy or the most preservation or whatever thats kind of not easy for a Public Service local Government Organization to do so is is it is unequal but educate people so we get what we all want. I will say the department has been doing that for a number of years there were a realignment uaw from the large counseling preambles and counting the number of people you service h serve to what we do to link people to care and get them on meds and virtually suppressed find a way to increase the the president but not the size but repurposing the ways people not providing services need to provide the services around the care. Prep is so important in reducing the risk of hiv infections at highrisk individuals that you reduce our costs so even though there is an initial expense to the system and the individuals it is so not reduce to zero but thats where we say synergy he know the treatment is much more than that highly effective without side effects so if we work at hiv positive and incline with that the people negative and at risks we think we can get synergy. For the first time were not growing like india but actually turning the curve and going downward with the next innovation in 3 to 5 years well need more wind to get to the zero but the innovation is moving in that direction. I want to acknowledge the doctor shes the researcher in hiv group and she brings in Million Dollars from the federal government to and theres a beautiful clinic she brought in go 11 million at 25 van ness and utilizes the 6 floor thats the trial clinic shes brought in volunteers towards the future of new innovations i want to acknowledge her for her work. Were the only hunt this supports this kind of forever we have a Public Health approach wetlands. One last approach people coming into San Francisco four for our wonderful sunshine and weather people not born here is that part of the statistic. We have susan it is a challenging thing a lot of the numbers that i show you are the people that are newly diagnosed in San Francisco numbers for retention and the number of new diagnose i didnt see the way that the susan i dont know if you want to come up or not the way to measure this in the past once we have a case we follow that case and get other information on other People Living in San Francisco who are in care but that information is less complete. So most of the information that she presented are residents of San Francisco but we do have a lot of people that receive care that have been dgdz elsewhere and tracking that. Are dgdz elsewhere and show up here like new york and others places come in. Thats what makes it challenging to get to zero thats why weve reached out to oakland and having a Similar Initiative we cannot do this as to be routine by the planning commission, and may be acted upon by a single roll call vote island but it is true we get people coming in that have goggles enacted who get diagnosed here and included in those numbers. And glad you clarified that this is getting confusing clearly this is an initiative do you have an idea when our roles are to try to reach zero i mean that is obviously it is a continue goal but some sort of finite thought. Our goal to get to 90 percent in 2020 like 2013 it is going to be daunting lets see where is the hiring we we want to take those 2013 numbers and bring them down to 2020 and weve got as youve pointed out we have to turn those kifshz carton drift darned we so to downward and use did resources to get there our focus on the whatnot the whom weve got to focus on. So clearly deaths are something you can measure but in terms of the the hiv diagnose that is dependent on the number of people being tested how do you reach it determination i can get to 90 by stopping. multiple voices . Im curious how you will keep up how do we keep up the awareness; right . Of the need to test and the need for testing so we dont miss the opportunity because with an of the reasons were testing to find a case. Right. Exactly. And. Theres been a tremendous testing since 2009, 2010 . Reflecting despite more testing were undercover people that were diagnosed long ago were driving down numbers we also track a calculated number of infections we dont know how many infections are happening but dr. Sheer can explain we vw have a session on focusing on the testing but there is a greater lag time and pretty wide confidence when we go back and said there were 3 hundred and 71 new diagnose i didnt see 365 what did estimated number that probably isnt right but were very close in what we estimate as the incident. So very good let me pick a new tag on the question of retention and aside from the fact youve identified the areas which have been identified also in the std world that whole challenge of a new population too that may feel less vulnerable anymore and have less risky habits what im curious about is not only the group has perhaps less retention but 3 we also have a thirty percent average loss of cases that were there so are we also working on that it seems to me once weve been able to capture somebody this seems like a lost opportunity for thirty out of 70 people. Yes. So we have theres a big part of the cdc initiative to get this thing called data to care were using the data and a on who were losing weve been doing that linkage before but we need a broader effort were starting with the city that the 3 city clinics that have the highest burden and the most vulnerable populations with hiv but the goal is also weve got a lot of communitybased organizations that serve Vulnerable People and were working with the archer group to have this mechanism to find the people hopefully, we can predict bra they are really out of care anybody that is missing an appointment and go after people aggressively were trying to work across the programs as a member of the storm mentioned at kaiser it is if a person misses an appointment they assume hell contact them before the Affordable Health care act there themselves a turn of where the peoples medical homes are and making sure that people get to their medical homes and kept in the medical homes and if their get whatever support of services are needed and data to find those people. Very good thank you i think clearly this is enormously important issue we should see an annual report that would be useful and looked at it as a Community Health so we continue to track and for those areas in which you feel we can be of support and have an opportunity to let us know. And appreciate the questions they stimulate the kind of work. Thank you for your we have work. Ill note no Public Comment and dr. Bucking finder comments to present hiv ass on worlds aids day ill make sure it is calendared. We look forward to the presentations that you bring to us after you present it to the world. Thank you. So moving on to item 8 the update on the dpw budget for 2014 through 2017. It turns out you do present it here and slightly different. Try the finance committee was asked and spent time and commissioners well have the update as mr. Wagner has for the commission and the commission has the background details okay. And to clarify this is on the development of fiscal year 20152016. Oh our new budget autopsy you covered the Financial Statement so, yeah it is a brief update only the process on where we are are on the project for the coming two fiscal years that is in process im sure youre aware of every year the mayor 134i789s balances budget to the board of supervisors the budget that was submitted we discussed it at this commission at the last hearing board of supervisors during the most month of june reviewed the mayors budget and makes amendments the way that process works their bucket and budget analyst comics through the departments budget and finds proposals for where we can trim the savings and makes those savings available to the board of supervisors to reallocate for the priorities in the bunt process so at the end of june we went through that process with the board of supervisors and Board Committee passed out of Committee Budget that includes should reductions to our budget and then some additions back into it so we wanted to quickly cover what those changes were that happened in the board so ill talk through a little bit about the reductions. Mr. Wagner im not sure youre talking into the microphone. And director Barbara Garcia b will talk 0 through the add back as every year we work with the boards budget analyst to identify places they can trim and look at it things such as positions that have not been filled for an extend period of time or pots of money not stepped up to the plate on a prior fiscal year and put those reductions and we negotiate with them based on what we can accept so we did to agreement with them on the list of items that is in front of you, we dont each year any of those are going to have a intunlt Service Impact for us theyre reasonable there are are about 1. 2 million worth of one time reduction but the board may put that into the top section those are the recommendation of a position to a later start data or some are close out of oneonone one time dollars there are 1. 5 million on the ongoing reductions and as you can see from the table here the bulk of those is in positions that have been recommended for elimination those are all vacant positions theyre all positions that we think we can manage through again without a significant disruption so the total reductions to the budget by the board of superviso