Minutes of the Health Commission Meeting

Tuesday, August 15, 2000
3:00 p.m.

101 Grove Street, Room #300
San Francisco, CA 94102

1) CALL TO ORDER

The regular meeting of the Health Commission was called to order by President Roma P. Guy, MSW, at 3:06 p.m.

Present:

  • Commissioner Edward A. Chow, M.D.
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Lee Ann Monfredini
  • Commissioner David J. Sanchez, Jr., Ph.D.
  • Commissioner John I. Umekubo, M.D.

Absent:

  • Commissioner Ron Hill
  • Commissioner Harrison Parker, Sr., D.D.S.

2) APPROVAL OF THE REGULAR MEETING OF JULY 18, 2000

Action Taken: The Commission adopted the minutes of July 18, 2000.

3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Lee Ann Monfredini)

Note: Commissioner Monfredini chaired the Budget Committee.

(3.1) CHN-Primary Care – Submittal of six-month report on the status of the California Endowment-funded Partner Support Program II at Balboa Teen Clinic.

(3.2) DPH-Central Administration – Submittal of six-month report on the status of the contract with Haight Ashbury Free Medical Clinics, Inc.

(3.3) PHP-HIV Prevention – Submittal of six-month report on the status of the contract with Aguilas Inc.

(3.4) CHN-Medical Records/Radiology – Request for approval of a contract modification with Mediscript to increase the contract by $150,000 to provide additional medical transcription services for the Community Health Network, for a new contract total of $225,000, for the period of December 1, 1999 through June 30, 2001. (DPH contracted with Mediscript for services totaling $75,000 during FY 1998-99).

(3.5) CHN-Office of Managed Care – Request for approval for a fee for service performance agreement with the California State Department of Corrections, San Quentin Prison, to provide medical services to inmates and work furlough prisoners for the period of July 1, 2000 through June 30, 2003.

(3.6) CHN-Office of Managed Care – Request for approval of a contract renewal with the Regents of the University of California, San Francisco (UCSF), in the amount if $1,700,000, to provide tertiary care services targeting medically indigent adults and In-Home Supportive Service workers, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with UCSF for services totaling $11,235,592 during FY 1998-99).

Commissioner Sanchez abstained on this item due to conflict of interest.

(3.7) PH&P-AB75 Project – Request for approval to apply for, accept and expend, retroactively, a grant allocation in the amount of up to $4,846,670 from the State Department of Health Services, through its California Healthcare for Indigents Program (CHIP), to provide reimbursement for health services delivered to indigent persons for the term FY 2000-2001.

(3.8) PHP-CMHS – Request for approval of a sole source contract renewal with Ramsell Corporation dba Professional Management Development Corporation, in the amount of $707,010, to provide fiscal intermediary services under the San Francisco Mental Health Plan, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with Ramsell for services totaling $3,320,590 during FY1998-99).

(3.9) PHP-HIV Prevention – Request for approval of contract renewal with Larkin Street Youth Center (LSYC), in the amount of $110,436 per year for two years, for a total of $220,872, to provide HIV prevention services targeting adolescents and young adults ages 13-23, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with LSYS for services totaling $579,869 during FY 1998-99).

(3.10) PHP-HIV Prevention – Request for approval of contract renewal with Urban Indian Health Board (UIHB), in the amount of $138,023 per year for two years, for a total of $276,046, to provide HIV prevention services targeting Native Americans, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with UIHB for services totaling $465,477 during FY 1998-99).

(3.11) CHPP-Promotion Section – Request for approval of contract modification with O’Rorke Public Relations and Advertising in the amount of $246,700, for a total contract amount of $746,726, to provide media services to the Tobacco Free Project, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with O’Rorke for services totaling $222,328 during FY 1998-99).

(3.12) CHPP-Promotion Section – Request for approval of contract modification with Polaris Research and Development, in the amount of $40,000 for a total contract amount of $110,000, to provide evaluation services for the Tobacco Free Project, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with Polaris for services totaling $853,779 during FY 1998-99).

(3.13) CHPP-Promotion Section – Request for approval of contract modification with San Francisco Study Center (SFSC), in the amount of $444,257 for a total contract amount of $801,332, to provide fiscal sponsor services for the Community Capacity Building Training Center for the Tobacco Free Project, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with SFSC for services totaling $1,620,515 during FY 1998-99).

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.6.

President Guy thanked Vice President Umekubo for chairing the July Commission meetings while she was on vacation.

President Guy announced that in Commission meetings, individual public speakers are limited to three minutes. She will not allow disruptive behavior. Those disruptive individuals will be asked to leave and/or be escorted out by institutional police officers. Disruptive behavior includes heckling and hissing.

4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)

At the last Health Commission meeting I reported to you in the Director’s Report an alarming increase in HIV incidence among men who have sex with men (MSM) in San Francisco. The increase in incidence was seen in a study done of MSM and who were tested at one of the alternative test sites in San Francisco. The data had been reported in both the San Francisco Chronicle and the New York Times. In that same newspaper coverage journalist reported estimates of the number of new HIV infections in San Francisco based on a meeting of experts in May of 2000. That information was leaked to the newspaper. We did not intend for the data to be released at that time because we had not yet finished our work.

During the latter two weeks of July and the first week of August the Department of Public Health (DPH) in collaboration with the AIDS Research Institute (ARI) of the University of California, San Francisco (UCSF) worked to complete the report. In addition to reporting the actual data that those estimates were based on it was very important to me that the report include a plan on how we as a city would deal with the increases in new HIV infections.

On August 8th, 2000, we met with a number of community leaders to detail the findings of the report and our proposed plan to revitalize HIV prevention for MSM in San Francisco. At that meeting were members of the Ryan White CARE Planning Council, the HIV Prevention Planning Council, staff from a number of HIV prevention agencies, and community activists. Both the data and the guidelines for the 11 point plan were well received by the group. Several suggestions were made and incorporated into the document based on that meeting. That same day I had a teleconference with CDC officials, to whom I had previously sent all of our data. They reviewed our data and agreed that we had done a thorough job of characterizing the HIV epidemic in San Francisco. On August 9th, 2000 we had a hearing in front of the Finance Committee of the Board of Supervisors. The hearing was called by President Tom Ammiano. In addition to President Ammiano, Chair of the Finance Committee, Supervisor Leland Yee, Supervisor Sue Bierman, and Supervisor Mark Leno joined the Committee hearing. At the hearing we presented the data and our 11 point plan and heard testimony in support of the plan from President Roma Guy, as well as from Dr. Tom Coates, Director of the UCSF ARI and several community members. I have attached to today’s Director’s Report the report in its entirety. It includes our full presentation to the Board of Supervisors as well as all of the data used to support our estimates of HIV incidence and prevalence in San Francisco. The report is to my knowledge, the most extensive compilation of data on a particular population in a local area. Because any one study can be criticized for inherit biases the estimates by the group of experts was made based on ten indicators. I have listed them below.

San Francisco HIV Prevention Indicators

up

Incidence of HIV among a cohort study of Young MSM

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Incidence of HIV among MSM seeking anonymous HIV testing

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Incidence of HIV among MSM-IDU seeking HIV testing

Stable, high HIV incidence in MSM seeking STD treatment

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Reports of rectal gonorrhea among MSM

up

Frequency of STDs among MSM living with AIDS

up

Number of MSM living with AIDS

Consistent condom use among MSM

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Multiple partners and unprotected anal sex among MSM

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MSM engaging in unprotected anal sex with serodiscordant partners and/or with partners of unknown HIV status

The experts who reviewed these indicators in May of 2000 were epidemiologists, current and former HIV Care Council and HIV Prevention Planning Council members, the Department of Public Health staff, staff from San Francisco General Hospital, the Office of the Mayor, UCSF Researchers and Clinicians, and community members. Based on all of these prevention indicators the group of experts concluded that the incidence of HIV among MSM has increased from 1.1% to 1.7%. The incidence of new infections among MSM and use injection drugs has increased from 2.0% to 4.6%. The incidence for injection drug users and for heterosexuals has decreased. The result of these changes in incidence and improved estimates of the size of the populations in San Francisco shows that the number of new infections among MSM is estimated to have increased from 283 to 573 and for MSM who use injection drugs it has increased from 53 to 143. The number of new infections has decreased for injection drug users and for heterosexuals. Based on this report the Health Department in collaboration with the ARI put together an 11 point plan for HIV prevention in San Francisco. The action plan is listed below.

11 Point Action Plan for HIV Prevention in San Francisco

1.

Ownership Take ownership of the epidemic, implementing culturally-specific, community-driven responses. Prevention is not done to a community, but by and with a community.

2.

Condoms for HIV positive Tops with HIV negative Bottoms.

 

Assume responsibility.

3.

Condoms for HIV negative bottoms with HIV positive tops.

 

Assume responsibility.

4.

Know your current HIV status. Get HIV tested every six months if you’ve had risky sex or needle use. Seek care if you are HIV positive.

5.

Prevention for positives. Develop and expand HIV prevention programs that are designed by and for HIV positive individuals.

6.

Eradicate bacterial STDs in Gay Men. Rectal GC, syphilis, chlamydia.

7.

Recovery. Expand drug treatment. Mature our substance abuse services to address real life issues facing gay men such as the relationship between speed use, Viagra, and unprotected sex.

8.

Counsel. Rebuild the network and services for mental health and wellness.

9.

Positive care. Get more HIV positive people into care, onto appropriate anti-viral treatments, on better treatment regimens, improve adherence and provide individually tailored counseling and care.

10.

Reality check. It remains a fundamental truth that it is better to remain HIV negative.

11.

Gay men’s health matters. It is important that HIV prevention be nested within a broader health agenda for the community.