Committee Hearing, October 27, 2010

COUNCIL OF THE CITY OF PHILADELPHIA2 COMMITTEE ON PUBLIC HEALTH AND3 HUMAN SERVICES4 5 6 Room 400, City Hall7 Philadelphia, Pennsylvania Wednesday, October 27, 20108 10:20 a.m. 9 10 PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR11 COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN W. WILSON GOODE, JR.12 COUNCILMAN CURTIS JONES, JR. COUNCILWOMAN DONNA REED MILLER13 COUNCILWOMAN BLONDELL REYNOLDS BROWN 14 RESOLUTION 100565 - Resolution authorizing the15 Council Committee on Public Health and Human Services to hold hearings regarding the16 HIV/AIDS infection epidemic in Philadelphia. 17 - - -18 19 20 21 22 23 24 25 2 1

Good2 morning. Thank you all for coming this3 morning to this hearing with the4 Committee of Public Health and Human5 Services regarding our Resolution 100565,6 HIV/AIDS infection epidemic.7 We will ask the Clerk to read8 the resolution, and we'll begin with our9 testimony.10

Resolution 100565,11 resolution authorizing the Council12 Committee on Public Health and Human13 Services to hold hearings regarding the14 HIV/AIDS infection epidemic in15 Philadelphia.16

This is a17 resolution and not a bill, which does not18 require -- a resolution does not require19 a vote. Therefore, we do not need a20 quorum at the beginning, but we will --21 Councilmembers will be coming in during22 the course of the hearing.23 Let me recognize Councilman24 Wilson Goode, Jr., who is a member of25 3 10/27/10 - PUBLIC HEALTH - RES. 1005651 this Committee. And as other Committee2 members come, we will introduce them to3 you.4 My name is Marian Tasco and I5 am the Chair of the Committee on Public6 Health and Human Services for City7 Council.8 November 7, 1991, for many this9 date changed the public face of HIV. On10 November 7, 1991, NBA legend Earvin11 "Magic" Johnson announced that he was HIV12 positive. This announcement and various13 subsequent announcements moved our nation14 into a broader public discussion15 regarding the nature of this infection16 and AIDS. In response, HIV/AIDS17 research, prevention and treatment moved18 to the forefront of our collective19 conscience as an issue that must be20 addressed.21 In just 11 days, we will reach22 the 19th anniversary of this23 announcement. Although much has been24 accomplished, it feels as though we as a25 4 10/27/10 - PUBLIC HEALTH - RES. 1005651 city, state and nation have moved on to2 confront other public health issues.3 However, the impact of HIV/AIDS is just4 as important now as it was 19 years ago,5 especially in Philadelphia.6 In our city, we have HIV7 incident rates five times higher than the8 national average, even higher than New9 York City. In fact, our infection rates10 rival those of some third-world nations.11 As a result, these higher HIV incident12 rates have had a devastating effect on13 our city, particularly in the African14 American and the Latino communities.15 This effect has reached epidemic16 proportion, and it motivates us as a city17 to develop new ideas, policies and18 strategies to address this public health19 crisis. From this perspective, it is my20 goal that these hearings will be a21 catalyst for this change.22 So today we welcome you to this23 Chamber. As you present your testimony,24 hopefully we will come up with some25 5 10/27/10 - PUBLIC HEALTH - RES. 1005651 recommendations that we can present as a2 way to further address and join in all3 the groups who have really spent a lot of4 time in educating and trying to treat5 those individuals in our city who are6 HIV/AIDS infected. So I welcome you this7 morning.8 Our first testimony will be --9 let me recognize Councilwoman Donna Reed10 Miller, who has joined us. She's also a11 member of the Committee.12 Our first witness is Jamira13 Burley, a member of the Youth Commission.14 (Witness approached witness15 table.)16

Good17 morning.18

Good morning.19

Would you20 state your name for the record.21

Good morning,22 Councilwoman Tasco and members of City23 Council. My name is Jamira Burley and I24 am a member of the Philadelphia Youth25 6 10/27/10 - PUBLIC HEALTH - RES. 1005651 Commission. As a member of the2 Philadelphia Youth Commission, it is my3 responsibility, as well as the4 responsibility of the Commissioners, to5 advocate on behalf of young people across6 the City. I am here today to help stress7 the importance of City Council's hearing8 in regards to the issues of HIV and AIDS.9 The HIV and AIDS pandemic is a10 health crisis that is affecting not only11 individuals in the United States but also12 people in countries around the world. On13 a local level, a recent 2009 report from14 the Philadelphia Department of Public15 Health claims that currently 28,27416 Philadelphians are currently living with17 the HIV or AIDS virus. According to the18 same report, in 2009, there were 911 new19 HIV infections in Philadelphia. Of these20 new HIV infections, over 38 percent of21 them occur among age groups of 13 to 29.22 These young people are now living with a23 new illness that will significantly24 impact their quality of life for the25 7 10/27/10 - PUBLIC HEALTH - RES. 1005651 years to come.2 Clearly, there is a great need3 for City Council hearings in regards to4 these issues. Hopefully these hearings5 can help devise strategies to prevent new6 cases of HIV infection and to help7 improve the quality of life for the8 people currently infected. To help get a9 firsthand view of what it is like for a10 young Philadelphian living with the11 virus, I would like to introduce Kim, a12 17-year-old young lady involved with the13 Haven Youth Center, an organization that14 helped to support services for young15 people infected with HIV.16

Thank you.17 And Kim is going to testify via telephone18 this morning.19 Is she ready.20 MR. McNALLY: Yeah, she's21 ready.22 KIM: Hello. Good morning.23

Good24 morning, Kim.25 8 10/27/10 - PUBLIC HEALTH - RES. 1005651 KIM: My name is Kim.2

Good3 morning.4 KIM: Good morning.5

And thank6 you for taking the time to testify and to7 share with us.8 KIM: Thank you for allowing me9 to be here today. I'm very grateful.10

You may11 proceed with your testimony.12 KIM: I am a 17-year-old young13 lady. I am currently an 11th grader at14 Science Leadership Academy. I am an A/B15 student. I have a GPA of 3.65. I have16 loving, caring family members, friends,17 and they care for me so much, and I am18 very grateful for them. But I was19 infected with HIV at birth due to my20 mother's unwise decisions, which led to21 her dying of full-blown AIDS.22 My mother is now not living,23 which has a very huge impact on my life.24 I now live with a foster family that25 9 10/27/10 - PUBLIC HEALTH - RES. 1005651 loves and cares for me very, very much,2 and I don't know what I would do without3 them.4 My foster mother helps me on a5 daily basis when it comes to my HIV. My6 sisters and my brothers also.7 How HIV has affected my8 childhood has affected me in positive9 ways, also negative ways. Some of the10 positives are that I have loving, caring11 friends that I can come to on a daily12 basis. I have centers that I can go to.13 I have negatives also that come14 along with being HIV positive. Some of15 the negatives are that there is a lot of16 stigma out here. The stigma comes when17 it comes to my friends. Sometimes I18 don't know how to talk about being HIV19 positive to them, so I just don't talk20 about it at all, and sometimes they can21 have a huge impact on me.22 But what people need to23 understand is that we're all human, and24 we mainly have different shades of skin,25 10 10/27/10 - PUBLIC HEALTH - RES. 1005651 but we all bleed the same color. And so2 that me being HIV positive, I've done so3 many grateful things with it, and that4 I'm also grateful to be here. Some of5 the more positive things that I have are6 camps. I go to a camp called Camp Dream7 Catcher, which allows me to enter it with8 other kids that are infected with9 HIV/AIDS and affected by HIV/AIDS.10 I go to a center, as you guys11 have heard, called Haven Youth Center.12 The faculty that are there are wonderful.13 I can't express how wonderful they are.14 When it comes to taking medication, when15 it comes to relationship issues, when it16 comes to problems at home and especially17 school work, they are a big, big part of18 my life, and I don't know what I would do19 if it was not for them. And so I think20 that having them in my life is really a21 good impact on me.22 Having to take medication, the23 medications that I take on a daily basis24 is really hard for me, and I think that25 11 10/27/10 - PUBLIC HEALTH - RES. 1005651 because being HIV positive and the2 medications that we have today, I'm3 grateful for them, but at the same time,4 I struggle with my pills. Sometimes I5 take them and sometimes I don't, and6 sometimes I feel like I'm not normal7 because of what's in my blood, not8 because of what -- because of me, but9 because what's in my blood, and it hurts10 at times. It really does. And I think11 that I shouldn't be judged by what's in12 my blood, but me.13 HIV awareness is very, very,14 very important, and I think that if we15 had more centers and more places like16 Saint Christopher's Hospital and Haven17 Youth Center and different organizations18 that are around but that are very small,19 if we had more of those, more people20 would be aware of the issue of HIV and21 AIDS. They will be more willing to get22 tested, more willing to know how they can23 catch the virus and not be so scared of24 the virus.25 12 10/27/10 - PUBLIC HEALTH - RES. 1005651 I think that being positive has2 affected me in more positive ways than3 negative, but I still have the negative4 ways. I think that I have loving, caring5 friends and family that help me on a6 daily basis, principal-wise,7 friends-wise, family-wise, school-wise.8

Well, we9 certainly thank you for calling in to10 share your testimony regarding your11 experience of having HIV/AIDS. It seems12 that you have a good support system. We13 certainly understand the emotional, you14 know, roller coaster that you experience,15 but you sound very positive and certainly16 understand your situation. And I agree17 with you, education is very key, and some18 day you will use your voice to help19 educate our citizens in Philadelphia20 about the whole issue of HIV/AIDS.21 We've come a long way. I mean,22 this room, when I first came into Council23 back in 1988, we were dealing with the24 whole issue of HIV/AIDS and what to do.25 13 10/27/10 - PUBLIC HEALTH - RES. 1005651 Certainly the medications that have2 been -- that are used now to help people3 deal with HIV/AIDS has somewhat -- people4 think it's a cure, but it really isn't.5 But the urgency doesn't seem to be there6 anymore.7 But, Kim, we certainly thank8 you and we appreciate your testifying,9 and we're there for you. There are10 members of this Committee here. We will11 ask them if they have some questions or12 they want to make some comments.13 Let me recognize Councilwoman14 Blondell Reynolds Brown, who has joined15 us. She's a member of this Committee.16 Would anyone like to make any17 comments?18 (No response.)19

Thank you20 very much, Kim.21 KIM: Thank you so much. It22 was lovely. Thank you.23

Thank you,24 sweetheart.25 14 10/27/10 - PUBLIC HEALTH - RES. 1005651 Very powerful.2 Our next witness will be3 Mr. Henry Bennett and Waheedah4 Shabazz-El.5 (Witnesses approached witness6 table.)7

Good morning,8 Councilmembers. Good morning,9 Councilwoman Tasco.10

Are you11 going to sit down?12

Yes.13

I14 certainly want to say to the young lady15 from the Youth Commission, the City of16 Philadelphia -- I believe it was led by17 Councilwoman Brown -- urged the City to18 set up a city Youth Commission, and I'm19 proud that they have taken time. They20 are really involved, because we want to21 hear from young people what they are22 experiencing, what they hear, how we can23 be helpful to them as they navigate their24 early life.25 15 10/27/10 - PUBLIC HEALTH - RES. 1005651 Let me recognize Jordan Harris,2 who is here, who is Executive Director,3 does a great job. I'm constantly getting4 e-mails from him about what he's doing.5 And I must say that my granddaughter has6 found a place to work with them, and I'm7 very proud of her, too. Thank you very8 much.9 Good morning.10

Good morning.11 I think I'll begin. My name is Waheedah12 Shabazz-El.13

Proceed14 with your testimony.15

16 I'm a Native American -- a Native17 Philadelphian, I should say. I'm a18 homeowner here. I'm a retired postal19 worker. I'm employed by Philadelphia20 FIGHT as an HIV tester and counselor. I21 am Chair for the CAB, for the Community22 Advisory Board at the University of23 Pennsylvania Center for AIDS Research, a24 founding member of the United States25 16 10/27/10 - PUBLIC HEALTH - RES. 1005651 Positive Women's Network and a long-term2 member of the AIDS Coalition to Unleash3 Power. 6 As a person living with HIV,7 this is one of the most important days of8 my life, because it carries the potential9 to guarantee a closer examination of the10 enormity of the cause and effects of the11 rates of HIV infections escalating12 amongst African Americans, Latinos, women13 and young people in the City of14 Philadelphia. 21 I would like to personally22 thank Dr. Amy Nunn for her background23 research on the HIV epidemic that is24 brewing in the City of Philadelphia and25 17 10/27/10 - PUBLIC HEALTH - RES. 3 I would like to thank both4 Councilwoman Tasco and Councilwoman5 Blackwell for their spirit, their6 leadership in introducing this7 resolution. Because HIV has been8 wreaking havoc in our communities and our9 families for nearly 30 years. So this is10 long overdue. 12 Recently, July 13th, 2010, I13 had the honor to meet President Barack14 Obama. Myself, along with many other15 AIDS activists, were invited to the White16 House to a reception where he announced17 the first time in history that the United18 States had developed its own National HIV19 Strategy to reduce the number of HIV20 infections in this country and increase21 access to care to those who need it. So22 adopting this resolution here today is23 certainly in proper alignment with the24 President's national plan to stop the25 18 10/27/10 - PUBLIC HEALTH - RES. 2 In order to be present here3 today in front of this City Council, I4 had to make a most difficult decision,5 because today, October 27th, I was6 invited back to the White House by the7 Office of National AIDS Policy to take8 part in a discussion around HIV and9 aging. But as a person living with HIV10 who lives in Philadelphia, I felt a great11 responsibility to appear here and be a12 part of this meeting today, where local13 government will move to address the HIV14 crisis, and to put a face on AIDS. 18 So I stand here today in19 support of this resolution, and I stand20 for African Americans and I stand for21 communities of color. I stand for women,22 and not just black women. I stand here23 for all women, including transgendered24 women. I stand here for Latino women and25 19 10/27/10 - PUBLIC HEALTH - RES. 1005651 Muslim women and other women of faith. I2 stand as a parent of adult men and women3 who are at risk for HIV and as a4 grandparent of young teens who are at5 risk for HIV. I stand here for people6 over 50, who are rapidly being infected7 with HIV. I stand here for the8 heterosexual man, who seems to have been9 forgotten in this epidemic. I stand here10 for the gay community, who without their11 advocacy in the early years, there would12 be no services for HIV and who supported13 me when I found out that I had AIDS. And14 I stand here for the homeless, who are at15 risk for HIV, and the mentally16 challenged, the substance user and for17 those men and women behind bars who can't18 be here to represent themselves. 21 In closing, I want to point out22 that as you read the statistics that are23 revealed in the resolution, please24 understand that they are the same people,25 20 10/27/10 - PUBLIC HEALTH - RES. 3 These people's lives have4 value. )23

Thank you.24 Thank you so much for that informative25 21 10/27/10 - PUBLIC HEALTH - RES. 1005651 and caring testimony, and I'm glad you2 chose to stay with us today. We would3 not have had the benefit of your4 testimony and the wonderful words that5 you have shared with us this morning.6 Stay at the table. When we7 finish with Mr. Bennett, then we'll open8 up the floor for questions.9 Mr. Bennett.10

Thank you and11 good morning --12

Good13 morning.14

-- the Honorable15 Anna C. Verna.16

Tasco.17

Tasco. Council18 President and esteemed members of City19 Council.20 Fellow colleagues, residents of21 Philadelphia, we are gathered this22 morning here in Philadelphia because we23 are all concerned and interested in the24 welfare and well-being of our fair city.25 22 10/27/10 - PUBLIC HEALTH - RES. 1005651 The adoption of Resolution No. 100565 on2 the 16th of September 2010 makes things3 quite evident, that first and foremost4 that the City Council of Philadelphia is5 aware of the raging epidemic that is6 taking place in our city with African and7 black people.8 Based on the data collected9 from the epidemic profile, the numbers10 continue to rise and at an alarming rate.11 Why? Why when there are already in12 existence programs and institutions13 designed to stem the rising tide of this14 epidemic? With few exceptions, the15 majority of the programs and institutions16 were not designed for these specifically17 targeted populations. They were not18 designed for women. They were not19 designed for teens and young adults.20 They were not designed for African21 American and heterosexual communities.22 And this gravely affects me to watch my23 African American neighbors, friends and24 community being ravaged by this disease.25 23 10/27/10 - PUBLIC HEALTH - RES. 1005651 I thank you and commend you,2 City Council, for this resolution to3 investigate and examine effective4 strategies on how to combat this crisis.5 And here again, I'd like to put in my two6 cents.7 Whatever is done, be sure it is8 culturally appropriate. Be sure it is a9 collaborative partnership that includes,10 but is not limited to, the schools, the11 churches, the mosque, the clinics, mental12 health and behavioral health13 organizations, community centers,14 recreation centers, and businesses and15 business organizations.16 This is something that not one17 individual or one institution or one city18 government can do on its own. And I19 thought that if each of us put our own20 two cents in, the organizations,21 environments, people in activities, we22 will find that with this united front, we23 have the funds and capacity to win this24 battle.25 24 10/27/10 - PUBLIC HEALTH - RES. 1005651 I thank you for allowing me2 this opportunity to express myself.3

Thank you4 very much. We really appreciate you5 coming in to testify.6 Comments from the members of7 the Committee, questions?8 (No response.)9

Thank you10 very much. I think we don't have a lot11 of questions. We want to hear how people12 feel, what recommendations they have.13 Because this Council has been down this14 road many, many times. And so what we're15 looking for are recommendations to see16 what the City can do to address this17 issue further.18 It seems that when patients19 stopped dying and the headlines went20 away, there was a feeling that there was21 no more issue with HIV/AIDS. But it is a22 very quiet killer, a quiet disease that23 impacts families and certainly, as we24 heard from Kim, throughout their lives.25 25 10/27/10 - PUBLIC HEALTH - RES. 1005651 So we're going to hear some2 more testimony. So don't feel like we're3 not interested. We're here listening.4 So thank you. We don't have the answers,5 and we're getting the answers and the6 comments from you.7 Our next panel will be our8 Health Commissioner, Dr. Donald Schwarz,9 and Jane Baker, Director of AIDS10 Activities Coordinating Office.11 (Witnesses approached witness12 table.)13

And I see14 our friend Kevin Vaughan is joining them,15 Deputy Commissioner.16

Good morning.17

Good18 morning. How are you? Would you19 identify yourself for the record, please,20 Commissioner, and begin your testimony.21

Chairwoman Taco,22 Councilwoman, members of the Committee on23 Public Health and Human Services, I'm24 Donald Schwarz. I'm the Health25 26 10/27/10 - PUBLIC HEALTH - RES. 1005651 Commissioner for the City of2 Philadelphia. 19 As of December the 31st, 2009,20 there were 19,237 people living with HIV21 or AIDS in Philadelphia. This number22 differs from the number that was23 presented earlier, and I want to point24 this out, because many people who at some25 27 10/27/10 - PUBLIC HEALTH - RES. 3 percent of the7 population in Philadelphia. 17 Estimates from the Philadelphia18 Department of Public Health put the rate19 of new HIV infection of Philadelphia20 residents at 114 infections per every21 hundred-thousand population 13 years of22 age and older in 2006. And I use 200623 principally because we can compare that24 to data from other places in the country,25 28 10/27/10 - PUBLIC HEALTH - RES. 1005651 which haven't been able to be updated2 since 2006. 3 That rate was five times the4 national rate, which was 23 infections5 per hundred thousand. 10 Individuals between 13 and 2411 years made up 15 percent of newly12 infected; 25 to 44 years old, 51 percent;13 of those 45 and older, 34 percent. 6 percent of the City's25 29 10/27/10 - PUBLIC HEALTH - RES. 4 percent of new cases of HIV in3 2009. The estimated rate of new HIV4 infection among African Americans is 1765 infections per hundred-thousand adults,6 13 and older. 38 in Latinos or Hispanics. 13 Turning to prevalence, and I14 want to highlight the difference. So15 I've been talking about new cases most16 recently. I want to talk about total17 people infected. I started with that,18 talked about new cases. We'll go back19 and talk about all those who are infected20 that we estimate in Philadelphia. 23 It is estimated that about24 12,800 African Americans are living with25 30 10/27/10 - PUBLIC HEALTH - RES. 1005651 HIV or AIDS in Philadelphia. This means2 about 2 percent of all African Americans3 are HIV infected, or one in 50. S. 12 As you know, race and poverty13 are highly correlated, and Philadelphia's14 poverty rates are the highest of the15 largest ten cities in the nation. 25 31 10/27/10 - PUBLIC HEALTH - RES. 1005651 The socioeconomic issues2 associated with poverty, including3 limited access to quality healthcare,4 housing and HIV prevention education,5 directly and indirectly increase the risk6 for HIV infection and affect the health7 of people living with HIV. 11 Men who have sex with men, or12 MSM, are acquiring HIV at an alarming13 rate in Philadelphia. Again, these new14 cases tend to disproportionately affect15 those of color. Based on local estimates16 of the size of the MSM population, almost17 21 percent of men who have sex with men18 in Philadelphia are living with HIV or19 AIDS. 20 Between 2007 and 2009, there21 was a 25 percent increase in newly22 diagnosed HIV cases among men who have23 sex with men. 25 32 10/27/10 - PUBLIC HEALTH - RES. 1005651 We're also aware that men who2 have sex with men may also have sex with3 women. 9 Persons unaware of their HIV10 status drive this epidemic. Persons11 underestimate risk and worry about12 stigma, especially in heterosexual13 populations where a woman may be unaware14 of her partner's exposure and her partner15 may be afraid to speak about having had16 many sexual contacts potentially,17 including those with another man. 23 Based on national estimates, 2124 percent of people infected with HIV or25 33 10/27/10 - PUBLIC HEALTH - RES. 8 The AIDS Activities9 Coordinating Office administers federal,10 state and city-funded HIV/AIDS programs11 in Philadelphia through collaborative12 service contracts with community-based13 organizations.

In addition, AACO14 coordinates HIV/AIDS planning and policy15 activities through the Philadelphia16 Department of Health; more broadly,17 conducts AIDS surveillance activities in18 accordance with federal, state and county19 laws and requirements; oversees the20 Department's epidemiologic activities21 related to HIV and AIDS, including22 publication of quarterly reports, which23 are available on our website; and24 conducts HIV/AIDS education and training25 34 10/27/10 - PUBLIC HEALTH - RES. 1005651 for professional, civic and community2 groups. 6 AACO approaches HIV prevention7 by focusing on HIV testing to identify8 people unaware of their HIV status and9 works with HIV positive persons to help10 stop transmission; to connect newly11 diagnosed persons and persons lost to12 care to HIV medical treatment; and to13 connect newly diagnosed persons to14 partner services to notify partners of15 possible exposure to HIV and provide HIV16 testing to them. 20 AACO has developed a strategy21 for early identification of individuals22 with HIV and AIDS. It is a multi-faceted23 strategy to implement routine HIV24 screening in clinical settings and to25 35 10/27/10 - PUBLIC HEALTH - RES. 1005651 reach high-risk populations through2 targeted programming in clinical and3 community-based settings so that4 individuals in high-risk groups routinely5 come into contact with HIV screening6 programs. A total of 42 organizations7 receive funding for HIV prevention8 services, in addition to those services9 that are provided by the Department10 directly. Overall, 42 percent of AACO11 providers are considered minority12 providers. 18 The key to HIV prevention is to19 encourage everyone to get tested20 regularly. 25 36 10/27/10 - PUBLIC HEALTH - RES. 1005651 Providers are instructed to offer the2 test to everyone. 12 Philadelphia still supports13 anonymous testing sites, but works with14 clients with a preliminary positive15 result to change the confirmatory test to16 confidential. 19 In the past, a significant20 problem with testing was that individuals21 had to wait days to weeks to get test22 results. During this period, many never23 came back to get their results. Today,24 rapid testing, where the person being25 37 10/27/10 - PUBLIC HEALTH - RES. 17 Extra efforts are made to18 ensure good contact information is19 obtained for all those who need a20 confirmatory test and intensive follow-up21 is done to ensure that those with initial22 positive test results return for23 confirmatory results and, if truly24 positive, get referred and linked to25 38 10/27/10 - PUBLIC HEALTH - RES. 2 AACO concentrates HIV testing3 efforts on targeting populations that are4 particularly high risk. These include5 incarcerated individuals; youth with many6 sexual partners, particularly those who7 are older; adult men who have sex with8 men; heterosexuals with many sexual9 partners; and injection drug users. 18 In 2009, AACO provided over19 73,000 HIV tests. 5 million is allocated to HIV21 testing programs. Of the testing done22 last year, almost 40 percent of tests23 were among youth 24 years of age and24 older; 58 percent of tests were among25 39 10/27/10 - PUBLIC HEALTH - RES. 8 Still we have a lot of work to9 do to reach those who are not aware of10 their HIV infection. For younger folks,11 we have created an innovative text12 messaging media campaign, which we're13 happy to talk more about. 17 Our newest campaign will begin18 during the week of November 7th through19 the 13th of this year, in collaboration20 with the Mayor's Office of Faith-Based21 Initiatives. AACO is collaborating with22 local African American and faith-based23 organizations to offer HIV prevention and24 AIDS specific education and testing on25 40 10/27/10 - PUBLIC HEALTH - RES. 2 Five prominent African American3 ministers, I'm proud to say, have come4 together to reach many churches and5 mosques in the City, and they have all6 been HIV tested as part of this7 collaboration.

15 In addition, we will unveil new16 billboards to be strategically posted in17 high-traffic inner-city locations to18 promote HIV testing, with endorsements of19 the five local faith leaders. With one20 exception, the billboards should be21 installed by next week. The Billboard22 Initiative will be complemented by a host23 of congregationally based programs that24 faith leaders can offer on location at25 41 10/27/10 - PUBLIC HEALTH - RES. 1005651 ministry or congregational sites2 throughout the City. 7

Would you8 for the record state that.9

10 I'd be delighted. 19139, 19146, 19121,11 19132 and 19144. But we're encouraging12 ministries throughout the City. 17 On a regular basis, there's a18 network of 76 HIV care sites in19 Philadelphia, 38 HIV medical sites, 5520 medical case management sites. Some are21 co-located, including both22 community-based organizations and23 hospital-based HIV specialty clinics, the24 Philadelphia Department of Health's25 42 10/27/10 - PUBLIC HEALTH - RES. 1005651 health centers -- where I have to tell2 you we serve more HIV infected people3 than in any other center in the City --4 other community health centers and AIDS5 service organizations. 21 In 2009, only 216 persons -- and I know22 that's too many, but it's better than23 we've been in the past -- were diagnosed24 with AIDS in Philadelphia, which is a25 43 10/27/10 - PUBLIC HEALTH - RES. 2 Intravenous drug abuse as a3 mode of transmission of HIV has4 consistently declined as a proportion of5 new HIV cases each year following the6 introduction of syringe exchange programs7 in Philadelphia more than 15 years ago,8 and we really appreciate Council's9 support on those programs. 13 The continued services provided14 by AACO and its providers and partners15 have had an impact on the HIV epidemic in16 Philadelphia. We have reached many17 Philadelphians with HIV testing and other18 prevention services and provide19 high-quality care to those who are20 infected with the virus, but more needs21 to be done. We need HIV brought to the22 forefront, as in these hearings, to get23 the message across that HIV remains a24 grave threat to the health of25 44 10/27/10 - PUBLIC HEALTH - RES. 3 We need new strategies and4 better targeting of services to impact5 the epidemic. With the implementation of6 a series of new grants, we plan to be7 even more successful in implementing8 strategies to reduce the incidence of HIV9 and AIDS in Philadelphia. As was10 mentioned, many of the programs that11 we've had we've had for a long time, and12 the federal response to the epidemic13 began a long time ago. 23 The planning phase for this24 grant is just beginning, but we're25 45 10/27/10 - PUBLIC HEALTH - RES. 6 There are many barriers to our7 success. As I've mentioned, poverty,8 stigma and fear are substantial. At risk9 heterosexuals are a large and diverse10 population and are hard to reach with11 prevention services. Men who have sex12 with many partners, men who have sex with13 many partners, may be both ashamed of14 their own behavior and afraid to have15 that behavior disclosed. They often will16 not agree to testing. 21 At the same time, I want to22 highlight, we have lost key funding from23 the state within the last year due to24 budget reductions. More than $2 million25 46 10/27/10 - PUBLIC HEALTH - RES. 1005651 that had been used for outreach to youth2 were cut from Philadelphia, cut from3 Philadelphia specifically. 8 The Department of Public Health is aware9 of our many challenges. 19 Thank you for allowing me to20 present testimony on this important21 issue. I'll be happy to answer22 questions, if you have any. I am here23 with Jane Baker, who is the Director of24 the AIDS Activities Coordinating Office,25 47 10/27/10 - PUBLIC HEALTH - RES. 2

Are they3 going to make statements?4

They are not.5

They are6 not going to make statements, okay.7

Not unless you8 ask them.9

Well,10 we'll probably get some questions that11 they may want to answer.12 Thank you so much for your13 testimony. And, as you said, it's been a14 long time that Council has been involved15 in this issue, and certainly hopefully16 that we'll be able to work with the17 organizations who are out in the street18 trying to bring about awareness to be19 more successful in reaching our community20 about the importance of prevention.21 The Chair recognizes Councilman22 Goode. I believe you had your light on23 first.24 Councilwoman Brown.25 48 10/27/10 - PUBLIC HEALTH - RES. 1005651

Go ahead.2 Thank you.3

Good4 morning. As with many public health5 issues and other issues, there's a6 recurring theme with regard to poverty7 and race, and we keep statistics with8 regard to those demographics because we9 should, but quite often as we cite10 statistics for both poverty and race, we11 may sometimes confuse the issue.12 So the first question is, to13 what extent is the issue of race really a14 poverty issue? When we talk -- to what15 extent is the higher incidence among16 African Americans a result of their17 impoverished condition? So what extent18 are we really talking about poverty19 rather than race or to what extent are we20 talking about race?21

It's a great22 issue, and as you know, across pretty23 much every health issue there's a24 balance. So is poverty important here?25 49 10/27/10 - PUBLIC HEALTH - RES. 1005651 It is. It's important in terms of access2 to care. It's important in terms of3 people's linkage to any place that they4 get information, because we know people5 who are poor tend to be less connected.6 However, we also know this is a7 sexually transmitted infection in largest8 part, and we know that people tend to9 have sex within their racial or ethnic10 group. Not all the time, but more likely11 so.12 So, yes, this is an issue13 related to poverty, particularly in terms14 of progression of disease and people who15 have died and die from this.16 Transmission is affected by17 people's knowledge about the disease and18 who they have sex with and who they share19 needles with, although needle-sharing20 fortunately because of great work has21 become a smaller part of the issue, but22 we can't move away from it. However, who23 you have sex with is a critical issue.24

So as we25 50 10/27/10 - PUBLIC HEALTH - RES. 1005651 approach new solutions for this problem,2 do we approach them both from a racial3 perspective and a poverty perspective, or4 how do we distinguish?5

We need to6 approach them from both, but we have to7 be careful, as you're pointing out, so8 that we try to target high-risk9 communities. And I've tried to highlight10 those who we know are most likely to be11 infected, and you'll notice that they12 don't say poor people, they say people13 particularly related to who they have sex14 with, because it's principally a sexually15 transmitted disease.16 But in terms of programming, we17 have to be very much aware that there are18 communities where we could identify19 infection, we could present prevention20 information, but those communities may21 not have access to the tools that they22 need either to prevent the disease or23 prevent progression. So poverty is an24 issue that we have to be aware of as25 51 10/27/10 - PUBLIC HEALTH - RES. 1005651 well.2

Is there any3 data related to moderate- to4 middle-income African Americans versus5 lower-income African Americans?6

Not to my7 knowledge.8

I don't know -- I9 don't know that we have specific data on10 it.11

Okay. Next12 question is -- and I'm not challenging13 the data, first just look for some14 clarification of data. Your testimony15 says that African Americans accounted for16 66.4 percent of new HIV cases in 2009.17 Where does that data come from?18

It's coming --19

Would you20 identify yourself, please, and speak into21 the microphone.22

I'm Jane Baker.23 I'm the Director of the AIDS Activities24 Coordinating Office, and I thank you for25 52 10/27/10 - PUBLIC HEALTH - RES. 1005651 the opportunity to come here, Marian2 Tasco and members of the Council3 Committee.4 That comes from our5 surveillance unit, who goes out and does6 surveillance activities for HIV/AIDS7 cases and identifying that.8

So it's9 local data generated locally. And what's10 the methodology?11

Excuse me?12

What's the13 methodology?14

Through counseling15 and testing, looking at data and16 information from the CDC, because we17 report directly to them.18

The reason I19 ask and that's why I want to distinguish20 between whether it's local data, whether21 it's CDC data, particularly because I was22 paying attention, I did read the23 testimony, and it says that 66.4 percent24 of new cases are African Americans, but25 53 10/27/10 - PUBLIC HEALTH - RES. 1005651 also says that 60.5 percent of those2 tested were African Americans.3

It is both from --4

So if5 two-thirds of the people that you test6 are African Americans and two-thirds of7 new cases are African Americans, there8 might be a correlation there. If there9 is not, then please explain why there is10 not.11

So remember that12 only a fraction of those who are tested13 are positive. That's the first thing.14 So that 66 percent and 66 percent --15

It still16 doesn't mean there's not a correlation17 between the two.18

It doesn't mean19 there's not.20 How best to do it? So if we21 had tested -- if of the people tested22 only a third were African American, the23 rate of positivity, so the number of24 people positive compared to the entire25 54 10/27/10 - PUBLIC HEALTH - RES. 1005651 population, not just the tested2 population, should be relatively3 constant. But if we were testing only a4 third of the people we tested who are5 African American, we would worry that we6 weren't giving information and finding7 people. So what we try very hard to do8 is to make testing available,9 particularly in communities that we10 believe and the CDC believes are at11 higher risk.12 Your initial question was13 methodology. So the national methodology14 for estimation comes from the Centers for15 Disease Control and its estimation.16

I'm actually17 just dealing specifically with the data18 within this testimony.19

So the20 proportionate data comes from two things.21 One, who is tested in Philadelphia,22 what's the rate of positivity, who are23 those populations, are they incarcerated24 populations, are they women, are they25 55 10/27/10 - PUBLIC HEALTH - RES. 1005651 men, are they young, are they old. Those2 are then interpreted or estimated based3 on national --4

So there is5 still a possible correlation between the6 two, between the fact that two-thirds of7 people tested are African American and8 two-thirds of new cases are African9 American. Because you're relying upon10 information from the testing.11 I'm not saying it's wrong. I12 mean, it actually could be two-thirds.13 I'm just saying, is there a possible14 correlation? And from everything you15 said so far, there still is.16

So the methods17 that are used would not make it make18 sense that there was an actual19 correlation there.20

Why not?21

So that the22 estimates are based on the rate of23 positivity in those people who are being24 tested, and the rate of positivity in25 56 10/27/10 - PUBLIC HEALTH - RES. 1005651 people who are being tested varies across2 all the different groups who are tested.3 I could give you a mathematical4 explanation, which might be the easier5 way to do it. I just don't know how to6 do it easily in words in this situation,7 other than to say the two shouldn't be8 directly related to each other, and I'm9 happy to send you or show you10 mathematically why.11

Well, I'm12 not trying to make this point or push13 this point too far. I'm actually just14 trying to find out.15

And I'm trying to16 say no.17

So the next18 place I'll go is simply asking, you don't19 test the entire City. You choose where20 you go to test, and you choose who you're21 reaching out to. So by that, you are22 actually creating a correlation.23

If we gave you --24

Between who25 57 10/27/10 - PUBLIC HEALTH - RES. 1005651 you decide to test and do outreach to.2

If we gave you3 the number of tests, you would be right,4 but the issue with the proportion here is5 based on who does get tested and how they6 demographically relate to a larger7 population. It's the same for sampling.8 So if there's an opinion poll, people try9 to figure out who is going to vote in10 Philadelphia. There are certain11 populations that --12

But in an13 opinion poll, there's a controlled14 sample.15

So the national16 sample from CDC in that same way, if I17 understand what you mean by control, is18 the controlled sample. So we use19 their --20

So what does21 the CDC data say about new cases?22

The numbers that23 you have are Philadelphia numbers24 interpreted in light of CDC's25 58 10/27/10 - PUBLIC HEALTH - RES. 1005651 methodology.2

So it's3 still local data.4

Yes.5

It's not CDC6 data.7

No.8

Thank you,9 Madam Chair.10

The Chair11 recognizes Councilwoman Brown.12

Thank you,13 Madam Chair.14 Good morning.15

Good morning.16

Good morning.17

Let me18 first seize the moment to say on the19 record, Dr. Schwarz -- and I'm sure Chair20 Lady and members of this Committee21 agree -- on how much we deeply appreciate22 your continued work there at the Health23 Department. It's appreciated, and we24 need to say that every chance we get.25 59 10/27/10 - PUBLIC HEALTH - RES. 1005651 And the resonance of this issue is just2 further affirmation of the work that your3 team is doing.4 I have a number of questions,5 and I'm going to start with, my6 inspiration for submitting a bill for the7 Youth Commission and the ultimate law8 creating it was that young people ought9 to have a voice in a number of public10 policy issues. So I want to thank the11 leadership of the Youth Commission for12 being here, as the Chair has already13 recognized.14 To young people, in the breadth15 of places where you do all of your work,16 unless I missed it, there's no mention of17 high schools. And it gets back to18 Councilman Goode's point. I put here19 education; others might call it20 awareness. I put here access; Councilman21 Goode says availability.22 What work is done in our high23 schools, even if it's nothing more than24 awareness education across the board for25 60 10/27/10 - PUBLIC HEALTH - RES. 1005651 young people, given when you state in2 your testimony that individuals between3 13 and 24 years old make up 15 percent of4 the newly infected?5 So what are we doing to touch6 them and capture their attention early7 and all that comes with that?8

Good morning. We9 have health resource centers in eight of10 our high schools across Philadelphia. We11 also fund providers who do work with12 youth in Philadelphia. I too have had13 the opportunity of meeting with the Youth14 Commission and really applaud that being15 introduced and them coming to AACO and16 telling me how they want to be a part of17 this here and help us with planning.18 We're getting them connected to our local19 Ryan White HIV Planning Council so that20 they could be involved at that level as21 well.22 But right now, like I said, we23 do health resource counseling, education.24 We're not testing in the schools, but25 61 10/27/10 - PUBLIC HEALTH - RES. 1005651 testing is available through mobile2 testing venues that we have that do3 target youth.4

Of the5 eight high schools, did that happen6 because the leadership of that school;7 namely, the principal, was okay with it8 or did that happen because young people9 in that school said we want it? Why is10 it not universal?11

It happened because12 we had worked with the School Board to13 try to get this here into the schools.14 It wasn't the schools saying that we15 wanted it. We knew that it needed to be16 there, there was a need for that, because17 we are doing some STD testing in high18 schools and we noticed rates of chlamydia19 and STDs and they thought that this was20 only a natural progression, that if we21 didn't get involved for HIV and AIDS,22 that this would really be problematic.23 So we did work with the School Board --24 at the time, Louis Bonia and Judith25 62 10/27/10 - PUBLIC HEALTH - RES. 1005651 Peters -- to try to bring services2 through the school. There were a lot3 of --4

Was that5 during the leadership of Mr. Paul Vallas6 or under the current leadership of7 Dr. Ackerman?8

Under the current9 leadership.10

And the11 reason why it's limited to eight schools12 is because of lack of resources, or what?13

Lack of resources.14

Okay.15

I want to add one16 thing.17

Please.18

So this goes back19 to Dr. Hare when we had a Board of20 Education, Dr. Ruth Hare, who was the21 President of the Board of Education. And22 early in the HIV epidemic, people23 throughout the City came together to say24 we need to be able to do counseling in25 63 10/27/10 - PUBLIC HEALTH - RES. 1005651 schools and we need to be able to make2 condoms available. And so the School3 District passed a resolution in, I4 believe, '89 allowing condoms to be made5 available in high schools.6 The Family Planning Council of7 Southeastern Pennsylvania and the Health8 Department have a long partnership, but9 the Council has taken -- and you'll be10 hearing from people later from the Family11 Planning Council -- tremendous leadership12 in creating these centers in high13 schools. So we are related to about14 eight of them. There are about 14, I15 think, total in high schools in16 Philadelphia, not every high school, and17 that is not related to high school wants18 it or not. It is that the resolution19 from the School District says that the20 District won't provide the service with21 its own personnel. It must be provided22 by outside helpers now. And so willing23 providers have to be identified and then24 funding is needed.25 64 10/27/10 - PUBLIC HEALTH - RES. 1005651

I see.2

And there are3 funding limitations and there are4 provider limitations. So before I took5 this job, I ran two of those health6 resource centers in schools in West7 Philadelphia, and we started in the first8 year and it continues to the present.9

Is there a10 correlation between those eight high11 schools and the zip codes where you say12 there's the highest incidence of -- any13 correlation at all?14

Yes.15

So some of16 those high schools sit in some of those17 zip codes?18

They do.19

Yes.20

All right.21 Instead of doing what Chair Lady Tasco22 said, which was listen first, I started23 writing a series of questions. And then24 at the end of your testimony, you spoke25 65 10/27/10 - PUBLIC HEALTH - RES. 1005651 to what I would consider a2 non-traditional audience, and, that is,3 the clergy community. So I'm thrilled to4 hear that that bridge has been connected.5 And what is the expectation, if any, in6 growing the number of churches that are a7 part of the faith-based effort?8

We have been9 working with the Mayor's Office of10 Faith-Based Initiative, Reverend Handy11 and Minister Byrd, and they've been very12 instrumental knowing a lot of the clergy,13 particularly the black clergy throughout14 Philadelphia, and bringing them together15 in groups and helping us to plan testing16 events, as well as them bringing about17 awareness. Again, they've been tested18 themselves, and I think that that reduces19 some of the stigma for people to see them20 out front and taking a stand with it. So21 it's been very positive thus far, but we22 still have a lot more work to do with23 them. And, again, this is just now24 starting with the --25 66 10/27/10 - PUBLIC HEALTH - RES. 1005651

So there's2 a written plan on how the effort will hit3 across -- there are a number of4 denominations within black clergy, and so5 I'm asking, is there -- for me if it's6 not in writing, it doesn't exist. That's7 what works for me.8 So is a written comprehensive9 plan with rollouts on how you're going to10 touch each denomination of the black11 clergy?12

We've selected for13 the week of November 7th through the 14th14 ten different churches strategically15 located throughout the City, in Southwest16 Philadelphia, North Philly, West17 Philadelphia, Germantown, to try and18 start this, and we're going to look at19 what that pans out and then to continue20 this.21 This is not just a one-shot22 thing that we want to do. We want to23 continue this, because we know it's an24 integral part of what we're doing and25 67 10/27/10 - PUBLIC HEALTH - RES. 1005651 reaching their congregations and2 educating them and having them help us in3 this fight.4

Okay.5 I'll pay close attention to that.6 One population that has come to7 my attention that is touched on in your8 testimony -- and this is purely what they9 call anecdotal experience -- are senior10 citizens. Is there any reach into the11 senior citizen community on this with12 regards to this issue as well?13

Our Education Unit14 at the AIDS Activities Coordinating15 Office goes out to senior centers and is16 working with the senior centers to have17 education and presentations. We go to18 health fairs and bring the same19 information to them, offer testing as20 well.21

Okay. So22 you do offer testing to them as well?23

Yes.24

All right.25 68 10/27/10 - PUBLIC HEALTH - RES. 1005651 Might there exist, in terms of best2 practices, condom machines? It's a weird3 idea, but clearly it's non-traditional4 approaches that are going to ultimately5 make the difference in reducing all of6 these numbers, which means we have to7 think out of the box in every way, and8 just like everything else is available9 via vending machines and since10 accessibility is an issue, has that --11 across the country is anyone doing12 anything like that?13

I've heard it14 discussed. I mean --15

Really?16

Yes. It was very17 controversial, as you can imagine, where18 they might be located and --19

I told20 her, she can start that business. Get21 some vending machines. There's no law22 against it. So we'll talk about that.23

We must.24

No, we haven't --25 69 10/27/10 - PUBLIC HEALTH - RES. 1005651

But you2 said it was discussed. Was it discussed3 locally or was it discussed with a task4 force someplace in the country, what?5

I think6 anecdotally, like you said, we heard7 about it. It's not something that we've8 actively pursued here in my office, but,9 you know, it's an idea.10

Doctor.11

The one thing I12 will say on the record that I want to13 make sure everyone knows is that Medical14 Assistance pays for condoms. So that15 anyone who is on Medical Assistance can,16 for free with their medical card, get17 condoms. In addition, there are sites18 throughout the City that for free give19 out condoms.20

Yes.21

So all of the22 family planning sites in the City and23 other sites that are funded by AACO give24 out condoms for free.25 70 10/27/10 - PUBLIC HEALTH - RES. 1005651 Now, your question is an2 interesting one, which is will people at3 the time of being interested in having4 sex either want to go to a pharmacy to5 get condoms or go to a health site to get6 condoms. If it's Saturday night at 107 o'clock --8

Not.9

Not. So your10 point of we have a system where people11 need to plan ahead is an important one.12 And there are other countries in the13 world that have tried this, and it's been14 long talked about within HIV prevention.15 So it's an interesting idea.16 COUNCILWOMAN BROWN:17 Interesting. So is it safe to assume18 that persons with Medical Assistance are19 fully aware?20

No.21

So that22 suggests that there's a gap there in23 awareness and education. Like we get24 these little pull-outs in our PECO bill25 71 10/27/10 - PUBLIC HEALTH - RES. 1005651 and PGW bills, do they get with their2 Medical Assistance check or do they get3 with their Medical Assistance card a list4 of services available to them, like the5 availability of condoms?6

So there are a7 whole series of issues like this.8 Obesity education services are available9 under Medical Assistance for children.10 Smoking cessation benefits are available11 under Medical Assistance, if you're on12 the right pharmacy plan. But, yes. And,13 as you know, the Department of Public14 Health is working with Medicaid and the15 Medicaid Managed Care companies in the16 country to talk about how do we publicize17 the benefits that are available to the18 communities that are particularly high19 risk.20

You gave a21 lot of discussion to funding. Where are22 we in terms of trends and funding from23 the CDC and others? Is there an uptick?24 We know clearly what's happening with the25 72 10/27/10 - PUBLIC HEALTH - RES. 1005651 state or not happening with the state,2 but with regards to CDC and the other3 funding source that you talked about,4 where are we? Has there been a decrease?5 Is there a trend of increased dollars6 from the CDC, or what?7

We just recently8 received a new planning grant from the9 CDC as a result of the National AIDS10 Strategy. We have a planning grant, and11 as a result of this resolution, we are12 enlisting the support of Dr. Amy Nunn to13 help us with this planning grant to look14 at our system and see what's working and15 what's not working. But we did get a16 slight increase in our CDC prevention17 funding for this year.18

So the19 planning grant allows you only to plan,20 not to do any service delivery?21

We can plan and22 then implement.23

Okay.24 I'll push the pause button for there and25 73 10/27/10 - PUBLIC HEALTH - RES. 1005651 allow other members to ask questions.2

Thank you.3 Councilwoman Miller.4

Thank5 you. Thank you, Madam Chair.6 Good morning, everyone.7

Good morning.8 COUNCILWOMAN MILLER:9 Dr. Schwarz, you brought back memories.10 I worked for many, many years with family11 planning agencies, and we were a part of12 that whole getting the permission for the13 schools, not just on condoms but on14 family planning classes. So you just15 brought back some memories. I was like,16 I forgot all about that.17 I'm really interested in18 finding out what's happening specifically19 in zip code 19144, which is Germantown.20 It's an area I live and represent. With21 the schools, with other youth service22 agencies, what's happening there? What23 programs do you have that's based in that24 zip code, and what exactly are they doing25 74 10/27/10 - PUBLIC HEALTH - RES. 1005651 around education, prevention, testing? I2 would assume that testing is at the3 public health center, but also at like4 Covenant House and some of the other5 community-based health centers.6

Thank you,7 Councilwoman. That is an area that is8 underserved, and we recognize that and --9

Could you10 speak a little louder.11

Pull the12 mike up closer to you.13

We have14 old ears.15

We do16 have old ears.17

We recognize that18 the Germantown area is an area that's19 underserved and we're cognizant of that,20 and when we do our planning, we will be21 looking to putting services in that area,22 because, as you said, currently it is23 just our health center. We did have an24 agency there, Positive Effect, years ago.25 75 10/27/10 - PUBLIC HEALTH - RES. 1005651

Oh, yeah.2 On Germantown Avenue.3

Yes, but it's no4 longer -- I mean, they're currently5 funded, but they're not providing6 services in that area at the time.7 They've since relocated.8

Well, we9 need to look at that, because certainly10 zip code 19144 is one of the zip codes11 that you identified as being a targeted12 area.13

Could I14 follow up on that? Because it's been on15 my mind for a minute.16 My area, it's not 44, but my17 constituents live in that area. But do18 you reach out to find organizations to19 provide -- to fund, to provide the20 service, or do you wait until someone21 comes to you to seek funding? Because if22 you identified these zip codes, how do23 you plan to reach out to the community to24 provide the services there?25 76 10/27/10 - PUBLIC HEALTH - RES. 1005651

We widely publicize2 our procurement process. We don't sole3 source to providers, but through our4 procurement process, we tell them which5 services we're looking to fund and in the6 areas that we're funding.7 Currently, if we have an RFP,8 we would tell providers that this area is9 underserved and we would prefer to fund10 someone from that area as opposed to11 having a provider in Center City go to12 Germantown. We would prefer to have13 someone who is already in Germantown.14 But these aren't folks that have applied15 with us through our procurement process.16 COUNCILWOMAN TASCO:17 Dr. Schwarz, when you talked about -- and18 I don't mean to take -- I just want to19 follow up on this whole thing.20 You talked about 42 agencies21 receiving funding for HIV prevention.22 Are these organizations tied into these23 zip codes somewhat?24

Many of them.25 77 10/27/10 - PUBLIC HEALTH - RES. 1005651

Many of2 them?3

The majority.4

Are they5 broad based? How many of the groups are6 in Center City or how many are in7 neighborhoods?8

I would need to get9 that information to you. I wouldn't want10 to venture and give you misinformation,11 but I can forward that to you. I will12 send you a list.13

Okay. I14 have other questions around that, but15 I'll let Councilwoman Miller.16

You said17 that Positive Impact is still -- Positive18 Effect is still in business?19

Yes.20

Are they21 still at the same location?22

No, they're not.23 They've moved out of Germantown.24

Right.25 78 10/27/10 - PUBLIC HEALTH - RES. 1005651 So what's happening in Germantown, other2 than the public health center? What is3 going on at Germantown High School, for4 example? Do you have one of the resource5 health centers there?6

Yes.7

Okay.8 Good. And I'm particularly interested in9 education prevention and, of course,10 testing services. And what would be the11 indicator that would have a doctor test a12 13-year-old for AIDS, for HIV? I mean,13 that's not a normal -- I just raised a14 daughter. I mean, she's an adult now, of15 course. When I took her to the16 pediatrician, they did not check her for17 HIV. So I want to know what makes a18 doctor check a young child that age for19 HIV. What's going on in that child's20 life or what's happened, and how much21 of -- how many 13-year-olds do you know22 locally, nationally, how big of a problem23 is this? Because if that's the case,24 then we need to be in middle schools.25 79 10/27/10 - PUBLIC HEALTH - RES. 1005651

I don't think it's2 necessarily commonplace that a doctor3 would just do that when a child presents,4 unless they're there for other reasons5 and they are seen as high risk for some6 other disorder or reason for their visit.7 I don't think that they're just asking8 them to be tested for it.9

No. I10 didn't say they were. I was just11 wondering why, how would a 13-year-old12 end up being tested for HIV.13 See, my assumption is, when you14 recommend that HIV testing be a routine15 part of my yearly physical or anybody's16 yearly physical, I don't think about17 13-year-olds. I think about adults. So18 the recommendation, though, would be19 what?20

I would think --21

Pre-teens22 and teens and adults? What?23

Yes.24

Okay.25 80 10/27/10 - PUBLIC HEALTH - RES. 1005651 Does health insurance pay for HIV2 testing?3

Yes.4

Does the5 City's health insurance? We don't pay6 for a lot anymore, but anyway, do we pay?7

(Dr. Schwarz nods8 head in the affirmative.)9

So10 nothing else is going on in Germantown, I11 assume, other than the health center and12 the center at Germantown High School?13

Correct.14

That's15 it?16

That's it. We have17 mobile testing units that go to18 Germantown for different venues, but not19 just there all the time.20

So that's21 an underserved. What other areas of the22 City are underserved?23

Southwest24 Philadelphia. But we now currently have25 81 10/27/10 - PUBLIC HEALTH - RES. 1005651 three providers in Southwest2 Philadelphia, which we're pleased. We3 have Haven Youth Center that has4 relocated to Southwest Philadelphia. We5 have Neighborhoods United Against Drugs,6 and we also have the Family Annex that7 does clinical care and case management8 services.9

Before I10 became a City Council person, I worked11 for Representative Richardson, David12 Richardson, who was Chair of the13 Pennsylvania State's Health and Welfare14 Committee, and every month we received15 statistics from actually the Philadelphia16 Health Department telling us what was17 going on with the incidence of HIV/AIDS,18 and I used to read them every month, so I19 really used to keep up with this. But20 it's interesting that -- and it came from21 the City government. Now that I work for22 the City, I never get them.23

We could make that24 available to you. We do have -- and it's25 82 10/27/10 - PUBLIC HEALTH - RES. 1005651 on our website.2

Well, I3 don't have time to go on websites.4 Everybody talks about websites. Child,5 please. Sometimes my computer doesn't6 get turned on for weeks, because that's7 not -- I mean, I don't have time for8 that. Send it to us. I can just read it9 real quick.10 But anyway, I think it's11 important that we know, particularly the12 underserved areas know, that you're13 looking for someone, because we're14 meeting and talking and going out to15 events and going out to meetings all the16 time, and if we know that this is17 something -- this is one of your goals,18 then we can help you with that.19

Okay.20

I had no21 idea until this hearing, until this22 testimony that 19144 was a very high-risk23 category and that it's underserved. So24 keep us informed. We can work with you.25 83 10/27/10 - PUBLIC HEALTH - RES. 1005651

Thank you. I2 certainly will.3

Thank4 you.5 Thank you.6

I have a7 number of questions, but what I'd like to8 do, we have another panel that's going to9 be working with you, Dr. Nunn and --10 Ms. Nunn. Is it doctor?11

Yes.12

Dr. Nunn.13 So I know, Dr. Schwarz, you may not be14 able to stay, but if Ms. Baker could15 stay --16

I will.17

-- come18 back and answer questions we may have,19 but we'd like to bring the next panel on.20 And then if you could stay, we'd21 appreciate that.22

Yes.23

Thank you24 very much.25 84 10/27/10 - PUBLIC HEALTH - RES. 1005651 The next panel will be Dr. Amy2 Nunn, Associate Professor of Brown3 University Medical School; Lisa Bowleg,4 Professor of Drexel University; and Lee5 Carson, Research Associate, Philadelphia6 Health Management Corporation.7 Would the three please come8 forward.9 (Witnesses approached witness10 table.)11

Good12 afternoon. We didn't want you to wane.13 And the other people are here too, so we14 had two more panels, and we want to make15 sure that we get everybody in on the16 testimony.17 Good afternoon, Dr. Nunn. You18 want to begin your testimony? Identify19 yourself and proceed with your testimony.20 Because you've been doing some wonderful21 work in the City, and I participated on22 one of your panels relative to this whole23 issue of HIV/AIDS, and this hearing came24 as a result of the work that you're doing25 85 10/27/10 - PUBLIC HEALTH - RES. 1005651 in the City.2

Thank you so much3 for your kind words and particularly for4 your leadership on this critical social5 justice issue. I also want to thank6 Tyrone Smith, long-term AIDS activist,7 who has made everything that I've done8 possible.9 (Applause.)10

And has been11 whispering in my ear about strategy on12 how to make all this come together. I'd13 be remiss not to thank him.14

He's been15 around a long time and has been very16 helpful in working in this area.17

Thank you. My name18 is Amy Nunn. I'm an Assistant Professor19 at Brown University Medical School. I20 hold Masters and Doctoral degrees from21 the Harvard School of Public Health, and22 I receive funding from the NIH to conduct23 research on racial disparities in HIV24 infection in Philadelphia and also in25 86 10/27/10 - PUBLIC HEALTH - RES. 2 I've been doing HIV prevention3 research in the City of Philadelphia for4 several years. First, I've been doing5 population research on the risk behaviors6 and HIV outcomes of people undergoing7 rapid testing in Philadelphia's public8 clinics. 12 I've also been engaged in and leading the13 project, in partnership with Reverend14 Dr. Marguerite Handy at the Mayor's15 Office of Faith-Based Initiatives, and I16 do have some written materials about17 that. It's just a one-pager, but I'm18 going to distribute that information to19 you all when I finish testifying. 23 I'm a researcher, and I have now grown24 accustomed to spending a lot of my time25 87 10/27/10 - PUBLIC HEALTH - RES. 3 The fourth project I've been4 engaged in is community-based research5 here in the City of Philadelphia. I6 recently had focus groups among 607 African American community leaders, many8 of whom have expertise in the field of9 HIV/AIDS. In the focus groups we10 solicited their comments about the11 HIV/AIDS epidemic, and we also asked them12 to provide proactive solutions and13 suggestions for what we can do to address14 the epidemic that we've heard so much15 about. 23 I also just want to begin by24 talking about health disparities more25 88 10/27/10 - PUBLIC HEALTH - RES. 1005651 broadly. We are 30 years into the AIDS2 epidemic, and African Americans face3 seven times the risk of HIV infection4 nationwide as people of other races. We5 cannot tell you scientifically what is6 driving those disparities. That is7 nothing short of a scientific and social8 justice crisis. If you look at the data,9 you will see that African Americans have10 similar numbers of sexual partners,11 similar rates of drug use and similar12 rates of condom use as people of other13 races. 21 What researchers tend to do22 oftentimes is recruit people for studies,23 enroll them, publish papers and present24 those findings at conferences, write25 89 10/27/10 - PUBLIC HEALTH - RES. 1005651 grants, et cetera. Well, that's all well2 and good, and it's very, very important3 to do that, but it does nothing to4 address the alarming rates of health5 disparities in our communities. So when6 I started reading about what was going on7 in Philadelphia, I thought to myself, I8 have got to change the way that I do9 business. I have got to get out into10 communities. I've got to talk to people11 who are affected and infected with HIV12 and start engaging policymakers. 17 So today I want to focus on18 some of the most important critical19 recommendations that came out of my20 action-oriented research with community21 leaders. 25 90 10/27/10 - PUBLIC HEALTH - RES. 4 Simply distributing condoms does nothing5 to address the issues that are driving6 this epidemic; for example, poverty. 19 And she expressed to me this morning that20 she didn't appreciate that researchers21 never come out and talk to people that22 are living with HIV. 25 91 10/27/10 - PUBLIC HEALTH - RES. 1005651 I also want to talk about2 incarceration. Philadelphia has the3 fourth highest rates of incarceration in4 the country, and incarceration5 systematically interrupts long-term6 partnerships. Now, there's an urban myth7 out there that people think, well, you go8 to jail, you get HIV and you bring it9 back to your partner. 13 It often goes something like this: A man14 is incarcerated, and his partner, because15 of economic circumstances or simply for16 the need of human companionship, starts17 another relationship. Sometimes those18 people end up resuming their19 relationships when the partners are20 released from jail. 25 92 10/27/10 - PUBLIC HEALTH - RES.

1005651 These are just a few of the2 complex social factors that we absolutely3 have to address when we're thinking about4 HIV prevention. 6 I also think we need to focus a7 lot more on geography and this phenomena8 called social networks. Social networks9 are people who are linked directly or10 indirectly through sexual contact. If11 you look at how HIV infections in the12 City of Philadelphia are clustered, the13 new infections are mostly clustered in14 Germantown, North Philadelphia and15 Southwest Philadelphia, but that's not16 where most of the resources go. Why is17 that? 20 So we really need to rethink21 our HIV prevention strategy in terms of22 social factors, geography and sexual23 networks, and stop focusing so much on,24 quote, risk behaviors and distributing25 93 10/27/10 - PUBLIC HEALTH - RES. 1005651 condoms. 4 My second point is about5 resources. As I mentioned, most of the6 new infections in Philadelphia are7 concentrated in a select few areas, but I8 encourage the City Council to take a good9 hard look at how resources are10 distributed in this city. Most of the11 resources go to contractors and NGOs who12 are largely based in Center City. Most13 of those contractors do extraordinary14 work, and a lot of them have been doing15 it for decades. However, that's not16 where people who are becoming infected17 live. And passively waiting for those18 people to come into Center City is not19 going to solve the AIDS epidemic. )22

We need to get out23 into the communities that are affected,24 and that might mean that the contractors25 94 10/27/10 - PUBLIC HEALTH - RES. 1005651 who receive support from the City today2 are encouraged to go out into those3 communities with mobile vans, to4 establish new offices or to do something5 much more proactive than what we6 currently see today. 22 Because as you all know, Philadelphia is23 a city of neighborhoods, and having a24 long history in the neighborhood where25 95 10/27/10 - PUBLIC HEALTH - RES. 4 If you go to other cities with high HIV5 prevalence, you will see -- you can't --6 if you walk through Harlem, if you walk7 through Chicago or Washington, DC, you8 cannot throw a stone without hitting an9 ad about HIV from the city, from an NGO10 encouraging people to get tested. 13 Now, we've got these billboards going up14 that the AIDS Activities Coordinating15 Office has generously funded with the16 pastors encouraging people to get tested,17 but short of that, there is very little18 HIV messaging in billboards across the19 City. I think we need a massive media20 campaign. 24 We need to be creative with the25 96 10/27/10 - PUBLIC HEALTH - RES. 1005651 way that we use the media. It needs to2 be on buses, television, radio, and we3 have to use new media like Facebook and4 Twitter. 14 My research suggests that a lot15 of people in Philadelphia engage in very16 high-risk behaviors, but when you ask17 them to comment on their HIV risk, they18 think that they're not at risk for HIV,19 and this is including people who are20 testing positive. A lot of these people21 are the core transmitters of HIV22 infection, but don't understand their23 risks. If we have a media campaign, it24 will help people understand their risks25 97 10/27/10 - PUBLIC HEALTH - RES. 2 We need nuanced messaging. Not3 just one message. 7 That's right, elderly women over the age8 of 50 are increasingly infected in this9 city. Children, our children are being10 infected with HIV. Fifteen percent of11 new infections are among children. We12 also have to have nuanced messaging for13 men who have sex with men and14 heterosexual men. 19 The last point I want to make20 is about education. Currently, the21 Philadelphia public schools only have22 one -- students are only required to take23 one semester of health coursework, and24 that might be PE. There is very little25 98 10/27/10 - PUBLIC HEALTH - RES. 1005651 information and almost no comprehensive2 sexual education offered in the3 Philadelphia public school system. I4 think we need comprehensive sexual5 education programs for students, teachers6 and administrators. And, you know,7 Philadelphia has a program to test people8 for chlamydia and gonorrhea that is9 renowned nationwide, and that is in the10 Philadelphia public school system. )13

-- to that program.14 Why aren't we doing it? We could be15 blazing trails.16 The reason that we have that17 program is because we know from the CDC18 youth survey -- I've forgotten the exact19 name of it -- that students in20 Philadelphia have some of the highest21 risk behaviors and STD rates in the22 country. Well, the exact same -- you23 contract HIV the exact same way that you24 contract chlamydia and gonorrhea.25 99 10/27/10 - PUBLIC HEALTH - RES. 1005651 There's a real opportunity to just add an2 HIV test to a very successful program,3 and it probably wouldn't cost very much.4 You could do rapid testing.5 So I just want to summarize the6 four actionable items that I've presented7 today. One, we need to focus on the8 geography of HIV infection in9 Philadelphia and in social networks and10 the social and economic factors that are11 putting Philadelphians at risk for HIV.12 Simply handing out condoms and waiting13 for people to come to Center City for14 services is not going to solve this15 crisis. We have to get out into the16 communities and especially into the high17 prevalence communities and meet people18 where they are.19 We also need to allocate more20 resources to communities in need and get21 out into the communities. We need to22 give more resources to NGOs that service23 African Americans as a core function of24 their mission. If you look, I did some25 100 10/27/10 - PUBLIC HEALTH - RES. 1005651 back-of-the-envelope calculations. Very2 few resources are allocated to NGOs and3 contractors that serve African Americans4 as a core function of their mission, and5 I think this needs to change.6 We need to implement a media7 campaign and we need to implement robust,8 comprehensive sexual education programs9 in schools that are compulsory, and we10 should at least be offering, if not11 requiring, HIV testing.12 I want to thank you for the13 opportunity to testify here today, and I14 want to thank you for your leadership on15 this issue and encourage all of you16 Councilmembers to start speaking out17 publicly about HIV/AIDS, because you are18 in privileged positions of power and can19 do so much to help de-stigmatize this20 disease that is so prevalent in21 Philadelphia and that has been so22 neglected.23 Thank you so much.24 (Applause.)25 101 10/27/10 - PUBLIC HEALTH - RES. 1005651

Thank you2 very much. We will come back with some3 questions. Don't leave.4 Yes. Would you identify5 yourself, please.6

Good morning. I'm7 Lisa Bowleg. I'm an Associate Professor8 at the School of Public Health at Drexel9 University in the Department of Community10 Health and Prevention. 20 For the last three years,21 funded by a National Institutes of Health22 grant, I have conducted HIV prevention23 research here, and as was made mention24 earlier, when we talk about heterosexual25 102 10/27/10 - PUBLIC HEALTH - RES. 6 The aim of my testimony is to7 highlight what I perceive to be some8 critical initiatives and innovations9 needed to prevent HIV/AIDS in10 Philadelphia. 13 First, I'm going to give you14 just some background information about15 heterosexually transmitted HIV in16 Philadelphia, some of which you've heard17 already, but I'm just going to add a bit18 more. 25 103 10/27/10 - PUBLIC HEALTH - RES. 1005651 So let's start with the2 epidemiological data. The incidence of3 HIV/AIDS among black men in Philadelphia4 is staggering. Data from AACO5 demonstrate that black men account for6 the majority of the City's newly7 diagnosed HIV cases, about 44 percent,8 and AIDS cases, 46 percent. And9 heterosexual exposure is the leading HIV10 transmission category in Philadelphia, in11 all of Philadelphia, accounting for 5412 percent of newly diagnosed HIV cases in13 2008 overall. And although the majority14 of the City's male cases are still among15 men who have sex with men, between 200416 and 2008 heterosexual exposure accounted17 for a larger proportion of cases among18 men. This is sort of one of these sort19 of untold stories. Yet, black20 heterosexual men remain the missing link21 in HIV prevention initiatives, despite22 their role in heterosexually transmitted23 HIV. And as I like to point out, I think24 it's important to remember the CDC's sort25 104 10/27/10 - PUBLIC HEALTH - RES. 5 So what I want to do now is6 just turn attention to some key findings7 from my research. For all of the reasons8 already highlighted, my co-investigators9 and I designed a three-year study just10 focused on black heterosexual men here,11 and in 2008, what we did is, we conducted12 interviews and focus groups with 71 men13 between the ages 18 and 51 who identified14 as heterosexual and reported having sex15 with a woman in the last two months. 18 One, the majority of the men19 who participated of this phase of the20 study described their lives, as one of21 the men noted, as an uphill battle every22 day, filled with daily and unrelenting23 stressors. Unemployment was chief among24 them. Thirty-nine percent of the sample25 105 10/27/10 - PUBLIC HEALTH - RES. 1005651 was unemployed and 42 percent reported2 annual incomes less than $10,000. 8 Two, many men appeared to be9 distressed by the context of their lives,10 particularly by unemployment. Our11 analyses about what they said showed that12 most desperately want to be able to13 provide financially for their families14 and for themselves. And, of course, this15 is part of the sort of idealized gender16 norm about what it means to be a man in17 our society, and black men certainly are18 no different. And so one of the things19 that we're looking at is, we're20 hypothesizing, as others have done, is21 that the strain of not being able to22 fulfill these expectations may be linked23 to sexual risk, because men facing24 constant financial hardships may find25 106 10/27/10 - PUBLIC HEALTH - RES. 1005651 themselves doing things like having sex2 with multiple women to compensate for not3 being able to measure up to society's4 norms that men should be financially5 successful. 10 Three, many men in our research11 linked having sex with multiple women as12 a core component of what it means to be a13 black man, and most reported having14 unprotected sex with multiple women,15 often with little concerns about16 contracting or transmitting HIV.

It was17 fascinatingly disturbing to listen to18 men's narratives about how the presumed19 promiscuity of what they often called20 "down low brothers" was responsible for21 the high rates of HIV in black22 communities, with no apparent recognition23 of how their own sexually risky behaviors24 with multiple women might be fueling25 107 10/27/10 - PUBLIC HEALTH - RES. 2 So that was the first3 qualitative phase of the study. The4 second phase of the study was5 quantitative. We recruited men from6 various venues throughout Philadelphia to7 complete a computer survey about a8 variety of concepts. We asked them about9 masculinity idealogy. We asked them10 about housing, employment, a whole bunch11 of measures. And we completed data12 collection at the end of July of this13 year with 581 men in Philadelphia, and14 we're just now beginning to analyze this15 data. 20 One, 65 percent were21 unemployed. So of the 581, 65 percent22 were unemployed. Fifty-six percent had23 been incarcerated. And Dr. Nunn has24 already spoken about the link between25 108 10/27/10 - PUBLIC HEALTH - RES. 9 So what do things like10 unemployment and poverty and11 incarceration and housing have to do with12 risk? Increasingly, national public13 health officials, like the CDC, and14 locally, Deputy Mayor and Health15 Commissioner Dr. 18 So not just on people's perceptions or19 whether they like using condoms, things20 like that. Instead, these public health21 officials and an increasing chorus of HIV22 prevention researchers, ourselves among23 them, and activists are directing24 attention to the need for focus on25 109 10/27/10 - PUBLIC HEALTH - RES. 5 Addressing the structural context of6 people's lives, their unstable housing,7 their poverty, their unemployment, black8 men's disproportionate rates of9 incarceration and so forth, are critical10 steps in preventing HIV/AIDS,11 particularly in black and other ethnic,12 minority and low-income communities. 17 One, employment. Jobs, jobs,18 jobs. The literature linking poverty and19 HIV/AIDS, particularly in black20 communities, is unequivocal. A 2010 CDC21 study found that the HIV prevalence rate22 among those who lived in urban poverty23 areas was more than 20 times greater than24 the rate among all heterosexuals in the25 110 10/27/10 - PUBLIC HEALTH - RES. 6 Two, housing. The literature7 on housing and HIV risk is also pretty8 clear. People who are unstably housed9 are at increased risk for HIV because10 they must often exchange sex for drugs,11 money or a place to sleep. 16 They are right. Housing is HIV17 prevention. 21 Three, HIV prevention to22 heterosexual men. The lack of HIV23 prevention outreach to black heterosexual24 men and heterosexual men in general25 111 10/27/10 - PUBLIC HEALTH - RES. 1005651 remains a grievous oversight. 9 Public health officials often10 tell people that they ought to adopt11 certain behaviors, but fail to tell12 people why. 18 Four, development of linkages19 between existing structural services and20 public health. Gravely needed are21 linkages between health services, such as22 HIV testing and counseling and treatment,23 with social services, things like24 referrals for employment and housing and25 112 10/27/10 - PUBLIC HEALTH - RES. 1005651 legal services. 9 In summary, my take-home10 message is that the secret to preventing11 HIV in Philadelphia's communities lies in12 taking bold and innovative steps to13 improve the structural context of14 Philadelphia's communities, particularly15 low-income, ethnic, minority and16 historically underserved ones. Rather17 than focusing on individual level aspects18 of HIV risk solely, our public health19 policies need to be grounded in empirical20 evidence and good old-fashioned common21 sense. The evidence and common sense22 attest that our best shot at being able23 to substantially reduce HIV/AIDS in24 Philadelphia lies in first addressing25 113 10/27/10 - PUBLIC HEALTH - RES. 6 Thank you. 9

Thank you10 very much.11 (Applause.)12

Don't go13 away. Thank you.14 Mr. Carson.15

Yes. Good16 afternoon. I guess we're just right at17 12 o'clock right now. My name is Lee18 Carson. And so I'm going to veer a19 little bit from the testimony you have in20 front of you, because I think that some21 people have talked enough about local22 statistics related to MSM, particularly23 Commissioner Schwarz, so I'm going to24 adjust this a little bit.25 114 10/27/10 - PUBLIC HEALTH - RES. 1005651 So I would like to take the2 time to thank members of City Council,3 the members of City Council who are here,4 to have this testimony and to allow me to5 be a part of this process.6

Let me7 also say that we do have -- our hearings8 can be heard in the offices. So9 sometimes the Councilmembers are not10 here, but they do listen on their -- we11 call it the squawk box. And if they have12 a television, they can see it on13 television.14

Oh, okay. All15 right. Great.16

This is17 broadcast on our local TV station,18 Channel 63 and 64.19

Great. 25 115 10/27/10 - PUBLIC HEALTH - RES. 1005651 So as I mentioned, my name is2 Lee Carson. I'm going to speak from a3 few different hats that I wear in the4 community, which is that of a research5 associate for Public Health Management6 Corporation, as a mental health therapist7 for the Mazzoni Center's Open Door8 Program, counseling program, as the9 President of the Black Gay Men's10 Leadership Council, and I also sit on the11 Advisory Board of LGBT Affairs under12 Gloria Casarez, Mayor Nutter's board13 under Gloria Casarez, and work on the14 Health Subcommittee there. 18 While my overall concern lies19 with stemming the tide of HIV infections20 in the entire human race, today my21 testimony will focus on black men who22 have sex with men, from this point23 forward referred to as black MSM. My24 other colleagues here today have and will25 116 10/27/10 - PUBLIC HEALTH - RES. 4 I want to now turn to the5 research from a study I have had the6 pleasure of working on at Public Health7 Management Corporation under the8 leadership of Drs. Jennifer Lauby and9 Lisa Bond called the Black Men's Health10 Survey. The Black Men's Health Survey11 was conducted from 2005 to 2006 and is12 the largest study ever done to date on13 the lives of black MSM in the City of14 Philadelphia. 18 In this study, 540 men took19 part in a survey asking a multitude of20 questions about their lives and were also21 tested for HIV. I will use data from22 this study to help illustrate some of23 the -- sort of some of the issues that24 we're dealing with here in Philadelphia25 117 10/27/10 - PUBLIC HEALTH - RES. 11 Through our study, we found12 that 27 percent, or 146 of the men,13 already knew they were HIV positive,14 while an additional 49 men, or 9 percent,15 found out for the first time in our study16 that they were HIV positive. 22 At that time, given -- I'm23 sorry. So through this study we24 estimated at the time that 27 and a half25 118 10/27/10 - PUBLIC HEALTH - RES. 1005651 percent of black MSM in Philadelphia were2 HIV positive. 12 The study also assessed13 sociocultural factors surrounding the14 lived experiences of these men. Of these15 540 men, 64 percent reported being16 insulted or verbally abused by a lover or17 boyfriend, and 49 percent reported being18 hit, kicked or slapped by a lover,19 boyfriend or girlfriend. Intimate20 partner violence among MSM is a serious21 issue and one that receives little22 attention. And, in fact, this is23 Domestic Violence Awareness Month, for24 those of you who may not be aware of25 119 10/27/10 - PUBLIC HEALTH - RES. 2 In fact, there are very few3 services in our public institutions that4 provide specific services to male victims5 of any sexual orientation in6 Philadelphia. 10 Twenty-three percent, or 125 of11 these men, reported been raped or forced12 to have sex. 24 Additionally, there were25 120 10/27/10 - PUBLIC HEALTH - RES. 1005651 also -- there are also studies that have2 identified a high prevalence of childhood3 sexual abuse among MSM who are HIV4 positive. While this does not establish5 causation, it is significant to note and6 suggests that identification and7 treatment of childhood sexual abuse at a8 young age could help decrease the growing9 number of HIV infections in adolescents10 and adults. 15 Substance abuse treatment is16 another significant issue that was17 identified in the Black Men's Health18 Survey. The two substances that I will19 mention here are the use of crack and20 cocaine. Forty-one percent and 3921 percent of men reported using crack and22 cocaine, respectively. We have learned23 that over time, that these substances24 also contribute to the spread of the HIV25 121 10/27/10 - PUBLIC HEALTH - RES. 1005651 epidemic. There are a significant amount2 of treatment programs that exist in3 Philadelphia to help people recover from4 the use of these substances.

9 There is only one institution10 that provides some substance abuse11 services specifically for MSM -- to MSM,12 which is Mazzoni Center. 15 Additionally, the City of Philadelphia16 has supported with funding a City meth17 recovery campaign, in which crystal meth18 primarily in this city affects white gay19 men. 24 I will now put on my community25 122 10/27/10 - PUBLIC HEALTH - RES. 1005651 activist hat via my work with the Black2 Gay Men's Leadership Council, and many of3 you may recall in 2006 when October was4 listed as Gay and Lesbian History Month5 on the School District's calendar. 8 It was discouraging to see the amount of9 homophobia that was unleashed at these10 hearings over a simple acknowledgement of11 Gay and Lesbian History Month. 16 There were many young gay and17 lesbian youth present at these hearings18 who walked away hurt and shaken up at the19 amount of anger and negative things said20 by some of those who were against the gay21 and lesbian -- October being listed as22 Gay and Lesbian History Month. I talked23 with several of these young people,24 trying to encourage them to stay strong25 123 10/27/10 - PUBLIC HEALTH - RES. 1005651 and that nothing was wrong with their2 sexual orientation. As a result of the3 controversy, the School District decided4 to do away with Gay and Lesbian History5 Month, and the message sent to LGBT6 students is that you should be silent7 about that aspect of your being. 13 With the recent tide of teens14 committing suicide due to a lack of peer15 acceptance of their actual or perceived16 sexual orientation or gender identity, it17 is further damaging to have minimal18 support from the educational system. 22 Lastly, I want to talk about23 the supportive housing of homeless LGBT24 youth and the need to ensure that those25 124 10/27/10 - PUBLIC HEALTH - RES. 4 There have been a number of5 complaints from young LGBT people who6 have accessed services from Bethel House,7 which is located in the Queen Village8 section of the City. And it was a9 housing unit for LGBT teens who were10 still dependents. 15 Instead, many of these young people16 suffered similar abuse to where they came17 from prior to Bethel. There have been18 reported similar abuses of teens in the19 Youth Study Center, where many teens are20 verbally abused by staff, particularly if21 you are lesbian, gay, bisexual or22 transgender or perceived to be. 25 125 10/27/10 - PUBLIC HEALTH - RES. 1005651 I have purposely included this2 wide range of topics in this testimony,3 which may not all seem to relate to the4 HIV/AIDS epidemic, but they do, and5 Dr. Bowleg and others have alluded to6 this as structural issues. 7 In public health, many of us have been8 looking at the tremendous HIV rates we're9 seeing in urban communities through the10 lens of Syndemics, which are two or more11 diseases in a population that work12 together to exacerbate one or all of13 those diseases in that population; for14 example, the syphilis and HIV15 co-infection rates. I am suggesting that16 in addition to biological issues, there17 are a number of social and/or structural18 factors that are contributing to the19 burden of HIV infection among black MSM20 in Philadelphia and as I have outlined21 some of them to you in my testimony22 today. These include intimate partner23 violence, childhood sexual abuse,24 substance abuse, homophobia and lack of25 126 10/27/10 - PUBLIC HEALTH - RES. 22 Programs need to be established23 where male victims of intimate partner24 violence can access more than just phone25 127 10/27/10 - PUBLIC HEALTH - RES. 1005651 counseling services. 21 And, finally, ensure that all22 programs receiving funding from the City23 of Philadelphia -- and I underscore --24 establish, monitor and enforce -- because25 128 10/27/10 - PUBLIC HEALTH - RES. 8 I thank you all in advance for9 your time and consideration, and avail10 myself at any time to any efforts moving11 forward to move any of these things12 forward. 19

Thank you20 very much.21 All of you have presented some22 compelling testimony and also some23 recommendations that we will like to24 further pursue.25 129 10/27/10 - PUBLIC HEALTH - RES. 1005651 Dr. Nunn, are you still in and2 out of Philadelphia? And I heard, I3 think, Dr. Schwarz mention this morning4 you're going to be part of a planning5 program with the office of -- AACO?6

Yes, ma'am, and I'll7 make myself available for any programs or8 anything that the City Council needs, the9 AACO, the AIDS Activities Coordinating10 Office, needs. I'm happy to provide my11 support.12

Well, what13 I was sitting here thinking while you14 were testifying is that usually when we15 have these hearings, it's to gather16 information, and from that, we try to17 figure out what is the action plan or18 plan of action. So I think that what19 we'll do is a follow-up, so any of you20 who may leave, would be to meet with some21 of you again in a smaller group to22 develop -- first we'll try and develop a23 report from this, but if not, come up24 with an action plan of what we need to do25 130 10/27/10 - PUBLIC HEALTH - RES. 1005651 and how we use the offices of City2 Council to help implement some of the3 ideas and recommendations you've made4 today.5 So I don't want just to have6 this hearing and not have some follow-up.7 So I'm thinking that we will probably8 have an action plan committee or strategy9 committee as a follow-up, and I certainly10 want the three of you to participate.11 And since you're local, it would be very12 helpful, except for Dr. Nunn, but she's13 in and out of the City.14 So you've given some good15 recommendations. You certainly presented16 the statistical information we have. We17 have plenty of that. What we need is how18 do we coordinate the issues, the problems19 surrounding HIV/AIDS, coordinating it20 with housing issues, education and other21 kinds of services. So I appreciate your22 testimony.23 You have questions?24

Just a25 131 10/27/10 - PUBLIC HEALTH - RES. 1005651 couple.2

Madam3 Chairman, may I be recognized, please?4

Oh, I'm5 sorry.6 Let me recognize Councilwoman7 Blackwell, who is the co-sponsor of this8 resolution.9 Thank you for coming,10 Councilwoman.11

Thank12 you.13 We also wanted to -- I just14 left to go back and pull out a newsletter15 we did in September/fall of 1994. On the16 front of it is welcoming Dr. David17 Hornbeck, Superintendent of Schools, and18 Dr. Judith Rodin, President of University19 of Pennsylvania. So it shows you how old20 it is.21 But in our resolutions, I said22 that to say that Resolution No. 53423 calling on the Council Committee on24 Education to hold comprehensive hearings25 132 10/27/10 - PUBLIC HEALTH - RES. 1005651 into the prevention of Acquired Immune2 Deficiency Syndrome (AIDS) and other3 sexually transmitted diseases among4 students within the Philadelphia School5 District.6 So we have some other7 information. I will certainly make that8 available to your staff so we can take9 the benefit of old lessons learned. We10 had so many medical professionals and so11 many other people testify during that12 time. So we'll try to see what's13 relevant to today's time. And,14 unfortunately, the illness still exists,15 so there is something that we may be able16 to use that we've looked at in the past.17 So we wanted to certainly make that18 available to this Committee.19 Thank you all for your20 commitment to this issue, and hope that21 maybe in another ten years we won't be22 sitting here again having to have this23 very discussion.24 Thank you, Madam Chair.25 133 10/27/10 - PUBLIC HEALTH - RES. 1005651

Thank you,2 Councilwoman. And certainly the members3 of the Committee will be the committee to4 work with you on coming up with an action5 plan for the City of Philadelphia to6 address the whole issue of HIV/AIDS in7 the community.8 When I first came here, we were9 dealing with this issue, and here we are10 today. So it's been a long time.11 So thank you very much for your12 testimony, and we certainly will be in13 touch with you relative to this issue.14 We have other panels, and one15 doctor has to leave, so we're going -- we16 have three more panels. So we have to17 move on. Please stay, and if you want to18 come back after we finish with their19 testimony, we can do that, too.20 I'm going to now call on Panel21 4. Oh, I'm sorry. I'm sorry.22

Give me 6023 seconds.24

I'm moving25 134 10/27/10 - PUBLIC HEALTH - RES. 1005651 too fast. Go ahead.2

And I3 clearly understand why.4 So let me put on the record, I5 look forward to the subsequent follow-up.6 There are a number of recommendations7 you've suggested that can happen without8 waiting for funding, in my view, and I9 look forward to being a part of those10 discussions.11 What I'm curious to know right12 now, however -- and I agree 2,00013 percent -- a large-scale media campaign.14 Is there a best practice example,15 someplace in the country where a city or16 a municipality is already doing that?17

I think there's18 several great examples. If you go to19 Washington, DC, they've got a great one.20 Also if you look, there's one that's21 being sponsored by Gay Men's Health22 Crisis in New York City called Love My23 Boo, and it's in --24

Love my?25 135 10/27/10 - PUBLIC HEALTH - RES. 1005651

Love My Boo.2

B-O-O-T?3

No; B-O-O.4

Got it.5

Like your6 sweetheart.7

And I think we can8 take a lot from those.9 I also say that the New York10 Department of Public Health has invested11 massive resources in this, and we can12 probably be in touch with them and learn13 a lot from what they're doing,14 particularly in Harlem and the Bronx.15

Have any16 of you ever applied for -- would the CDC17 fund a media campaign?18

Yes, and I'd like to19 just also allude to the fact that the20 Kaiser Family Foundation has a terrific21 program. I'm working in partnership with22 them on the pastors initiative. It's23 called Greater than AIDS. I'd suggest24 that we partner with them. They have25 136 10/27/10 - PUBLIC HEALTH - RES. 1005651 funding for this, and they are willing to2 help us with radio outreach, with3 financing some of the billboards, and I'm4 working in partnership with them on the5 faith-based initiative. They also have6 materials that they will provide for free7 or at very low cost.8 I think working with these9 groups that already have these materials10 would save us from having to reinvent the11 wheel.12 COUNCILWOMAN BROWN:13 Absolutely.14

Perhaps we can15 tailor some of the messages for local16 audiences, but there are already people17 out there doing great work on this, and I18 think we can learn a lot from them.19

If I could just20 add, I was going to mention that,21 actually. The Black AIDS Institute, it22 must be funded by the Kaiser Foundation,23 but the Black AIDS Institute, which is24 located in Los Angeles, has done a25 137 10/27/10 - PUBLIC HEALTH - RES. 1005651 national campaign and mostly to cities2 who have large black populations. I've3 not really seen any billboards locally,4 but I thought they said that Philadelphia5 was one of their locations, but I may6 even have in my office some of the7 materials that they have in their8 campaign and can forward those to your9 offices, if I can find them, but10 certainly have a connection to the Black11 AIDS Institute, who can provide any12 information about that campaign. But I13 believe it's funded by the Kaiser Family14 Foundation.15

Two16 remaining follow-up questions. I do17 believe that Senator Vincent Hughes and18 Sheryl Lee Ralph are a part of that19 effort, because that's really the only20 billboard I've seen in the City that21 speaks to this particular issue. So that22 may or may not be a part of the LA23 effort.24 We have Brown University25 138 10/27/10 - PUBLIC HEALTH - RES. 1005651 represented here, Drexel University. I2 know of the good and important work at3 the University of Pennsylvania with4 Dr. John and Loretta Sweet Jemmott. Is5 there any connectedness, speaking to not6 reinventing the wheel, with the work that7 all of you are doing at your various8 universities, any thread that's running9 through the work with what you're doing10 and the Jemmotts at University of11 Pennsylvania?12

I think we all speak13 a lot informally, but this may be our14 first collaborative effort, certainly our15 first attempt to engage policymakers.16

I would17 hope and underscore the importance of18 connecting and having glue with the work19 that you're doing. Operating in silos20 doesn't help us when we know we're21 operating in an environment where there's22 limited funding. So to the extent that23 that's possible, they too should be24 invited to the ultimate follow-up session25 139 10/27/10 - PUBLIC HEALTH - RES. 1005651 that Councilwoman Tasco is going to2 convene.3 Thank you all for your4 important testimony.5

Thank you.6

In7 Dr. Schwarz's testimony, they did say8 that they're going to have new billboards9 going up. So it may be tied in with the10 Kaiser program. But collaboration is11 very important. As we see, there are a12 lot of good ideas out there, a lot of13 recommendations, but we got to pull them14 together and try to figure out how do we15 develop a program where we are all16 working together, because you know the17 City does not have a lot of money, so we18 have to go after grants and have to find19 funding to support the ideas that we20 have. And as we move forward, what would21 be the policy of the Department of Public22 Health in some of the -- implementing23 some of the recommendations that you have24 made relative to funding, where the25 140 10/27/10 - PUBLIC HEALTH - RES. 1005651 funding is appropriated and how do we get2 new organizations to come in and3 participate, particularly in those zip4 codes that Dr. Schwarz has outlined5 and/or those organizations who are6 serving the minority community, how do we7 strengthen their funding base so that8 they have a greater outreach to some of9 these other communities.10 So we thank you all, and we'll11 be in touch. Thank you.12

Yes.13

Let me14 call now Gary Bell --15 (Applause.)16

--17 Executive Director of BEBASHI; Robert18 Burns, Executive Director of COLOURS;19 Jose de Marco and Samuel Morales,20 Proyecto SOL Filadelfia; Carlos Gonzalez21 and Nina Serrano from the same22 organization. And I'm going to add23 Dr. Ellen Tedaldi from the Comprehensive24 HIV Practice Program at Temple25 141 10/27/10 - PUBLIC HEALTH - RES. 1005651 University. Is she still here?2

Yes.3

I'm going4 to let you go first.5 (Witnesses approached witness6 table.)7

I'm sorry8 to keep you waiting, but this gets very9 involved, and we love just having people10 come and testify.11 So why don't you summarize12 your -- because we've heard all the13 statistics. So let us know what you're14 doing and give us a summary of your15 testimony. We're going to include you in16 this follow-up, too.17

Well, thank you18 for your indulgence. And I apologize to19 my panelists, but I do have an office20 full of people who are coming from the21 infected neighborhood -- or impacted22 neighborhoods that have been described in23 North Philadelphia and Germantown. So I24 don't want to disappoint them.25 142 10/27/10 - PUBLIC HEALTH - RES. 1005651 I think a couple of points2 which have not been raised, and, that is,3 one of the barriers on the medical side4 for not being able to detect and treat5 individuals is to get rid of our6 antiquated testing law that requires an7 entire separate written consent and8 procedure before actually asking a9 patient to get an HIV test. This should10 be part of routine -- you've heard this11 discussed this morning -- routine12 healthcare. There should not be the13 barriers of creating these extra consent14 processes, which really can sometimes15 deter both providers and patients from16 getting their HIV status known.17 I just want to emphasize from18 the medical point of view that we talk19 about HIV as a sexually transmitted and20 infectious disease, but the collateral21 damage is pretty extensive in terms of22 the medical complications of23 longstanding, untreated HIV disease in24 terms of kidney failure, cancer. So it's25 143 10/27/10 - PUBLIC HEALTH - RES. 1005651 not just infectious disease that's the2 issue. It's really the multitude of3 medical complications related to AIDS.4 So, therefore, again, very important to5 get your status known early before you6 have the ravages on your immune system.7 And I think reflecting on the8 comments of the last group is, as a9 provider for over 24 years in the area,10 there is very little in the way of11 integrated models of best practices. We12 struggle daily with patients who you've13 heard, very significant social and14 economic disparities, and we are often15 struggling to find ways to integrate16 mental health, social services in a17 patient-accessible model that really is18 functional and understands where HIV19 sometimes falls in an individual's life.20 It's not necessarily at the top.21 And so it really takes, I22 think, an integrated model to provide the23 maximum amount of care and have patients24 reap the benefits of the drugs that are25 144 10/27/10 - PUBLIC HEALTH - RES. 1005651 out there that can add decades back to2 their life.3 Thank you very much.4

Thank you5 very much. We appreciate your testimony.6 We're going to hear from Gary7 Bell, BEBASHI, one of the funding8 organizations in the City who is9 struggling to provide services in the10 City of Philadelphia.11 Proceed. Identify yourself.12

My name is Gary13 Bell. I'm the Executive Directors of14 Blacks Educating Blacks About Sexual15 Health Issues, otherwise known as16 BEBASHI. 21 I wanted to -- one of the22 downsides about coming later on in the23 process is a lot of the good points have24 been made. So I really want, in the25 145 10/27/10 - PUBLIC HEALTH - RES. 5 We've talked about the high rates of6 STIs. We've just touched on teen7 pregnancy, which is also an issue. We8 started a text line. We have a 24-hour9 text line where young people who are10 sexually active can text their questions11 to us 24 hours a day, and we will respond12 within 24 hours. 16 What is a sexually transmitted infection17 and how do you get it? 24 The City of Philadelphia estimates that25 146 10/27/10 - PUBLIC HEALTH - RES. 1005651 roughly about 22 percent of people living2 with HIV at any point in time may not be3 in care. 6 So they are not in care either. 11 We know that people who learn12 their HIV status tend to be safer. They13 tend to disclose to their partners. They14 tend to practice safer sex. We also know15 that people who are taking their16 antiretroviral medication on a regular17 basis may be less infectious, because we18 know that one of the stronger efforts19 that we've seen in reducing the spread of20 HIV is by getting people into care. So21 there really needs to be a focus on that22 perhaps 40 percent or as many as 10,00023 people, 8,000 to 10,000 people, who are24 not in care in Philadelphia at any point25 147 10/27/10 - PUBLIC HEALTH - RES. 7 A Cornell University study looked at the8 cost of per person over the lifetime of9 someone living with HIV, and that cost is10 about $600,000 a person, or about $1111 billion for the 19,000 people we have12 living with HIV in Philadelphia. If we13 average another 1,200 people a year, as14 we've been averaging over the last three15 years, that could add another $6 billion16 to the cost. Now, we won't shoulder that17 entire cost, but we will serve a fair18 share of that cost. And that doesn't --19 that's just for medications. It doesn't20 include hospitalization, doesn't include21 the expense of tests, doesn't include the22 impact on other City agencies like DHS23 and Community Behavioral Health or the24 Office of Housing, and, most importantly,25 148 10/27/10 - PUBLIC HEALTH - RES. 4 I just want to talk about what5 I think we need to do, and I think what6 we need is a strategy. 11 The media campaign should be part of that12 strategy, but there's a lot of low-cost13 things we can do. We can put posters14 around in City offices. We can put15 little things in mailers, little mailers16 in all the correspondence. Can you17 imagine how much correspondence goes from18 the City offices? We could just put19 little mailers encouraging people to get20 tested. " We could have people23 listening when they're waiting on hold,24 as I have often done, on the City25 149 10/27/10 - PUBLIC HEALTH - RES. 1005651 switchboard. 10 Everyone is at risk. They're the people11 picking up our trash, they're the people12 running into burning buildings, they're13 the people fixing our streets. 21 That strategy also needs to22 incorporate every City department. They23 each need to step to the plate and say24 what they're going to do to educate their25 150 10/27/10 - PUBLIC HEALTH - RES. 1005651 own staff people, to encourage their own2 staff people to get tested and to train3 people, because we hear horror stories4 all the time of people living with HIV5 and how they're treated when they go to6 certain City agencies. 9 And there's some -- getting10 people into care, I have two specific11 strategies for that. One is something as12 simple as having the City health center13 social workers get clients to sign a14 consent form so that we can find them15 when they get lost to care. Over half of16 the people being treated for HIV are17 going through City health centers.

22 We also have a waiting list for23 case management services, and the main24 reason for this waiting list -- and I'm25 151 10/27/10 - PUBLIC HEALTH - RES. 1005651 going to be very unpopular for saying2 this -- is because providers won't step3 to the plate and take those people off4 the waiting list. )9

Those people are10 ready for care today. We can't let them11 sit on a waiting list for two to four12 weeks when they're ready for care today.13 And that's not the Health Department's14 responsibility. That's our15 responsibility, because we're not taking16 those clients off that waiting list.17

Could you18 explain that a little more to the novice19 here who does not understand what you're20 talking about?21

The Case Management22 Unit for the City Health Department,23 AACO, has a process where people who want24 medical case management services are25 152 10/27/10 - PUBLIC HEALTH - RES. 1005651 referred to agencies to receive those2 services. The City has worked very hard3 to try to give people a choice, and4 sometimes those folks choose to go to a5 certain agency. They may want to go to6 Mazzoni, they may want to go to Action7 AIDS or whatever. Unfortunately, if that8 agency does not take those clients right9 away, they're left hanging. And one of10 the practices that some agencies do is,11 they keep people on the rolls so it looks12 like they have more cases than they13 really have, because there's a lot of14 attrition with these clients. They drop15 out of site, they leave the shelter, they16 pick up their drug habit, they go back17 into prison.18 So I know specifically, because19 we provide medical case management20 services, that some of those clients drop21 out of sight. So there's attrition in22 every one of our caseloads in every City23 agency that's funded for medical case24 management. There's no reason why we25 153 10/27/10 - PUBLIC HEALTH - RES. 1005651 can't take those cases. There's no2 reason why we can't have a plan where3 perhaps in 72 hours every one of those4 people referred for medical case5 management get medical case management.6 I have not yet to hear one convincing7 argument that we can't eliminate that8 waiting list. But it's the providers9 that are going to have to do it.10 (Applause.)11

So in closing, I12 just want to say that we really have a13 choice here, and the choice is what we14 want to be known for. Do we want to be15 known as an organization that had our16 heads in the sand when the rates soared17 or an organization that stepped to the18 plate and came up with innovative19 programming and stopped this thing from20 spreading the way it is?21 We know how hard it is to get22 rid of a bad reputation. We have a23 reputation for throwing snowballs at24 Santa Claus that we haven't gotten rid of25 154 10/27/10 - PUBLIC HEALTH - RES. 1005651 yet. But I think we have the resources.2 And I don't think we just have to depend3 on the Health Department to do it. If4 the whole City pulls together, I think we5 can make a big difference.6

Thank you7 very much for your testimony. Appreciate8 it.9 (Applause.)10

You want11 to be next? Are these guys going to let12 you be next?13 You have to come to the table.14 Would you all just switch with15 her for a minute, please. Don't leave,16 but just switch.17 Please identify yourself for18 the record.19

I'm Anastasia Gray,20 and I thank City Council, Chairperson21 Tasco, assistant Co-Chair Blackwell and22 the rest of City Council for not only23 this resolution, but having us talk today24 about something that is so close to all25 155 10/27/10 - PUBLIC HEALTH - RES. 1005651 of our hearts.2 I am a registered nurse and I3 have been a registered nurse for 364 years. Twenty-nine years ago I became an5 advanced practice nurse, a nurse6 practitioner. A nurse practitioner is7 someone who provides primary care for a8 group of patients.9 In the City of Philadelphia, a10 lot of the care for our HIV positive11 individuals are being taken care of by12 advanced practice nurses and physician's13 assistants. So this is a very important14 topic for us, and it's very close and15 dear to my heart.16 I've been working at Temple in17 the primary HIV comprehensive practice18 for the last 24 years. Yes, the patient19 population that I take care, I provide20 services for a very diverse group of21 patients - old, young, men, women,22 straight, gay. I take care of those who23 don't -- who no one else wants to take24 care of. I provide services to those25 156 10/27/10 - PUBLIC HEALTH - RES. 1005651 individuals who the stigma is still so2 great, that they can't even talk about3 it. I am the voice for those who can't4 speak for themselves.5 Several weeks ago I lost a6 30-year-old patient. Why? Not because7 there wasn't medication, not because that8 we weren't providing the services. It9 was because of the stigma. She could not10 tell her family. She could not tell her11 loved ones, and she died. When she died,12 her family members didn't know she was13 HIV positive. All they found was a14 closet full of medication that was locked15 up. And this young woman died, who was16 heterosexual, because of the stigma of17 HIV.18 We've talked a lot about the19 statistics here today. People are living20 longer, growing older, and even growing21 older, they're living with a22 life-threatening illness that our23 community still won't talk about. This24 is 2010. I didn't think I would have25 157 10/27/10 - PUBLIC HEALTH - RES. 1005651 this conversation today. I thought when2 I got involved in HIV taking care of my3 first patient, who was gay but had gone4 straight, got saved and was in a new5 world, wife was pregnant with their6 first-born child, and I had to practice7 in the mirror to tell him that he was8 going to die, because we had nothing at9 that time. Well, he did die. His wife10 did have the baby, and fortunately and a11 blessing, neither she or the baby was HIV12 positive. He is now a college graduate,13 raising his own family.14 We rival the epidemic that is15 occurring in Sub-Sahara Africa in the16 United States, and we've already heard17 many members express that we are seven18 times the national average. People are19 still entering care late, not knowing20 their status. I cannot emphasize enough21 about testing, testing, testing. I22 should not be seeing patients, brand new23 patients, just yesterday, with full-blown24 AIDS, full-blown AIDS. Never tested, got25 158 10/27/10 - PUBLIC HEALTH - RES. 1005651 tested.2 Two days ago, a 25-year-old in3 family planning clinic, I was called to4 help her deal with this.5 Ms. Gray, she's all freaked6 out. I don't know how to handle her.7 Can you come up?8 We talked to her, and she did9 not think she was at risk. Why? She had10 one partner, but, of course, her partner11 had multiple partners. And she is still12 dealing with this. She is on Facebook13 right now telling everybody she wants to14 die because now she doesn't feel she can15 live.16 This is the epidemic that I as17 a healthcare provider deal with every day18 in my practice. Yes, there's a changing19 face in the HIV community. This is not a20 gay man's disease. This is not a gay21 man's disease only.22 (Applause.)23

Only. Only. Most24 of the women are -- most of the new cases25 159 10/27/10 - PUBLIC HEALTH - RES. 1005651 are heterosexually transmitted, and our2 community continues not to have this3 recognition.4 I have been working in HIV, as5 I said, for at least 30 years. My6 mother, who knows me very well, she's 797 years old, and she knows I talk about8 this all the time. And you know what she9 said to me just two days ago? She said,10 I didn't think AIDS was still a problem.11 Nobody is talking about it. You're the12 only one I hear talking about it.13 We have to change that14 paradigm.15 We've already talked about the16 statistics. Dr. Kimberly Smith, who is17 an infectious disease doctor from Rush18 University, spoke at a national19 conference on -- conference for20 retrovirus and opportunistic infection in21 February in California, and she pointed22 out that communities of color are23 marginalized, homophobic and continue to24 keep our secrets behind closed doors.25 160 10/27/10 - PUBLIC HEALTH - RES. 1005651 This is straight, gay and transgender.2 Our churches have failed us,3 with only a few who speak out in support4 for those who are infected and affected.5 We have a hidden community, a hidden6 epidemic of life-threatening causes here,7 and, that is, the heterosexual African8 American man. I have been talking about9 this for 15 years. I have talked to10 pharmaceutical companies. I have talked11 to people who implement programs. Where12 are the programs for heterosexual men?13 This is what's fueling this epidemic.14 (Applause.)15

If we get to the16 men, we will get to the women. Many17 women are in power. There's domestic18 violence. They depend on their loved19 ones for financial and housing resources.20 They're not going to tell, I'm positive21 and I need you to use a condom. Some22 women will.23 I run a heterosexual -- I run a24 women's support group, as well as a25 161 10/27/10 - PUBLIC HEALTH - RES. 1005651 heterosexual men support group. How many2 in the City of Philadelphia do we have?3 None that I know of. Men come and talk4 to me, and I'll tell you, I have learned5 a lot. I have a Master's in Nursing, but6 I got my Ph.D. from my patient7 population.8 (Applause.)9

The men I talk to10 are empowered. They are strong. They11 feel bad about what they have done in12 terms of infecting themselves and some13 have infected their partners, and they14 want everybody to know that we are here15 to help and we don't want this infection16 to spread, but there's no one addressing17 them. There should be programs across18 the City for the masons, for the19 fraternity brothers, for public housing.20 Programs should be in public housing all21 across. These are a lot of the catchment22 areas where this is being impacted.23 There should be programs at the24 basketball courts. And I just don't mean25 162 10/27/10 - PUBLIC HEALTH - RES. 1005651 testing, because nobody is going to admit2 that they could be HIV positive. So to3 have an isolated test of just testing4 individuals in terms of just come in here5 today and we'll test you, that may not6 happen. We need to offer other kinds of7 resources to have them tested.8 I don't know if you're aware,9 but in the City of Philadelphia, there10 are 18 federally funded health centers.11 There are 18, and many of these health12 centers are within the communities. You13 can walk in if you are uninsured. Now,14 we've talked about people who have15 insurance, we talk about people who have16 Medicaid, but there is a large population17 who don't have any insurance.18 Every federally funded clinic19 in the City of Philadelphia, outside of20 the nine health districts, you can walk21 in and be tested for free. This should22 be advertised across the board. We23 should know those numbers. We should24 know where they at, so that we can inform25 163 10/27/10 - PUBLIC HEALTH - RES. 1005651 not only our consumers but our patients.2 And no one is advertising.3 The mental health and housing4 issue is of such paramount in the City of5 Philadelphia. I don't know if you're6 aware of it, but there is a two-year7 waiting list for people who are HIV8 positive and needs housing, and all the9 studies state if they have housing,10 they'll be adherent. If they have11 housing, they may decrease their drug12 issues. If they have housing, they're13 more likely to take better care of14 themselves. That list needs to become15 extinct. There should not be a list.16 (Applause.)17

No way.18 The incarceration rate, the19 homicide rate has continued to fuel this20 epidemic. You mentioned earlier about21 poverty and what's the difference between22 poverty and African Americans contracting23 HIV, as Councilman Goode -- that was a24 very important question that he raised.25 164 10/27/10 - PUBLIC HEALTH - RES. 1005651 Yes, a lot of this is poverty, but a lot2 of it is also that people of color are3 very colloquial. We stay within our4 communities. We don't travel outside our5 communities.6 If I was professional woman, as7 I am, and I lived in Mt. Airy, but I8 still go to church in North Philadelphia,9 I still hang out with those individuals10 in North Philadelphia, and if zip codes11 19139, 19146 and 19121 is where I hang12 out, guess what? I consider myself low13 risk, but the gentleman that I may go14 out, because he just got out of jail, may15 have two or three partners, because16 that's how he lives. So that makes me at17 high risk. That is what we call the18 sexual network. There is a network that19 makes an environment high-risk20 environment with high-risk behavior with21 someone who is low risk and that person22 does not think that they're at risk for23 HIV.24 We have to educate. The more25 165 10/27/10 - PUBLIC HEALTH - RES. 1005651 people we test in our communities, the2 more likely that people who are positive3 will find out, the more likely they will4 get into care, and the more likelihood5 that those numbers of HIV in that6 particular community will drop7 dramatically.8 (Applause.)9

Early treatment,10 early treatment, care is extremely11 important.12 I want to emphasize one more13 thing, because I have learned so much14 from my patients. And I'm not going to15 get emotional, but I'm going to read16 something to you, and I want you to think17 about this, because this applies to18 everyone who is in this room.19

Let me20 just, before you begin, recognize that we21 do have Councilman Jones, because he's22 very interested in this issue, too. So23 he's here to hear your message, too.24

Thank you.25 166 10/27/10 - PUBLIC HEALTH - RES. 1005651 Do you really know who I am? I2 am your neighbor next door who you borrow3 a cup of sugar from. I am the sweet old4 lady that watches your kids. I'm the5 person who sings on the choir with you or6 sits next to you on the pew. We shout7 and praise the Lord together on Sunday8 morning.9 Do you really understand who I10 am? I am your best friend who you11 confide in. Yes, I am the one you tell12 your deep, dark secrets to. I am your13 husband, your boyfriend, your girlfriend14 or your lover. I am your sister, your15 brother and even your mother who brought16 you into this world.17 Do you really know who I am? I18 walk your children to school each day. I19 even drive the school bus. You shop in20 my store and purchase food and other21 items from me. I am the homeless one,22 the street walker, the lady of the night23 and the runaway child. I am the uncle or24 father with crack and heroin in my veins25 167 10/27/10 - PUBLIC HEALTH - RES. 1005651 to ease my pain, which you really don't2 want to know about.3 Do you really understand who I4 am? I am your teenage son or daughter or5 the young people who hang on the corner6 with your children. I am the baby, the7 grand-baby who is always sick and you8 don't know why. I am your grandmother,9 your grandfather, the elderly man or10 woman who sits on the porch and always11 has a smile for you. I am the person12 whose life-style is different from you13 that you make fun of because he or she is14 sweet, trans, gay or lesbian.15 Do you really want to know who16 I am? I am you.17 Thank you very much.18 (Standing ovation.)19

Thank you.20 Thank you very, very much. Thank you.21 Okay, gentlemen. We will now22 proceed with Mr. Burns from COLOURS.23

Good afternoon,24 Chairwoman Tasco, members of the25 168 10/27/10 - PUBLIC HEALTH - RES. 1005651 Committee on Public Health and Human2 Services. I am Robert K. Burns, the3 Executive Director of the COLOURS4 Organization. 22 Through my experience as a23 provider, I've watched the escalation of24 HIV disease impact African American men25 169 10/27/10 - PUBLIC HEALTH - RES. 6 Specifically at COLOURS, our7 HIV testing positivity rate is 7 percent8 for African American men who have sex9 with men. That's nearly four times that10 of the City of Philadelphia's AIDS11 Activities Coordinating Office average of12 less than 2 percent. Nationally, more13 than an astounding one in 16 black men14 will be diagnosed with HIV at some time,15 at some point in their life, as will one16 in 30 black women. 23 COLOURS provides direct24 services to over 3,500 African American25 170 10/27/10 - PUBLIC HEALTH - RES. 9 As a 19-year-old institution10 that was born out of the need to empower11 a disenfranchised sexual minority12 community of color here in Philadelphia,13 we are still met at an impasse with14 increased rates of violence; trauma that15 is both mental, emotional and sexual;16 discrimination; stigma; depression and,17 now made more visibly through our media,18 suicide. The lack of resources in the19 form of comprehensive culturally and20 linguistically responsible services and21 monetarily in our organizations force22 organizations such as COLOURS, an agency23 that is deeply rooted and connected and24 committed to LGBT communities of color,25 171 10/27/10 - PUBLIC HEALTH - RES. 3 Yesterday, in preparation for4 my testimony, I spent half of my day5 providing support for a 23-year-old young6 black gay male who was contemplating7 suicide. For him, it was not getting8 better. 10 Unfortunately, I was not able to provide11 this same level of support for another12 black young male who committed suicide on13 Saturday. 15 More than two weeks ago, a16 young transgender woman of color was17 murdered. A month and a half ago,18 senseless violence took the life of19 another person at a popular LGBT20 community of color club in North21 Philadelphia. 25 172 10/27/10 - PUBLIC HEALTH - RES. 6 Finally, I would like to7 highlight the systemic failures that8 continuously happen and contribute to the9 increased risk of10 acquisition/transmission in our11 community. Collectively, we must begin12 to examine the mechanisms to sustain our13 institutions that have been the key14 stakeholders and the cultural fabric of15 our community. 22 Changing the paradigm that will allow for23 increased capacity building, development24 and succession planning is necessary in25 173 10/27/10 - PUBLIC HEALTH - RES. 14 I ask City Council to examine15 the lack of infrastructure, effective and16 meaningful technical assistance and17 capacity building for our African18 American institutions. 20 I further ask City Council to21 assist in pushing the policy agenda as it22 relates to ensuring cross-collaborations23 of partnerships with our non-traditional24 institutions that are often the25 174 10/27/10 - PUBLIC HEALTH - RES. 8

Thank you9 very much. We appreciate your testimony.10 (Applause.)11

We are12 really seriously concerned about the13 issues raised around funding, and14 certainly we will follow up on that.15 This Committee will follow up on that.16 That will be one of the top agenda items17 for me and my colleagues in looking at18 this whole issue of funding. And it has19 been raised before. It's not something20 that's new. So we will follow up on21 that.22 Thank you very much for your23 testimony.24 Next, who is going to be next?25 175 10/27/10 - PUBLIC HEALTH - RES. 1005651

2 My name is Carlos Gonzalez. I do HIV3 testing and counseling and I'm a member4 of Proyecto SOL Filadelfia. It's a5 non-profit organization that helps the6 Hispanic community, empower the Latino7 community to advocate for themselves and8 to stay healthy. And I'm here because9 I'm a person affected by the disease of10 HIV. 19 I can tell you statistics, but20 I'm not here to tell you statistics. 22 I was diagnosed with AIDS in23 2003. 24 I've been through drug addiction. And25 176 10/27/10 - PUBLIC HEALTH - RES. 1005651 when I was diagnosed, my CD4 was three2 and my viral low was 987,000. I was 1143 pounds, and I was dying with every4 opportunistic disease that you can5 imagine. I was diagnosed by Dr. Ellen6 Tedaldi that just testified as well. And7 if it wouldn't have been for the services8 that the City provides, I wouldn't be9 here sitting here right now testifying in10 front of you. By the grace of God, and11 thanks for the services that have been12 provided by AACO and by other agencies in13 the City, I have been able to accomplish14 all the things that I have accomplished15 until today. Today I speak about the16 disease. 19 I'm a heterosexual Latino man20 who live with the disease today. And21 it's empowering to know that I can rely22 on people in the City, and those funders23 are getting cut. Two million dollars24 have been just cut from federal money25 177 10/27/10 - PUBLIC HEALTH - RES. 1005651 that we used to get that used to provide2 housing, that used for information to3 people. And it's very important,4 housing. 17 I know what it has been in a shelter and18 I know what it has been incarcerated, and19 today I live a totally different life,20 and it's because of the services that21 were provided -- that are provided by the22 City. 25 178 10/27/10 - PUBLIC HEALTH - RES. 11 I know the City is not putting any money12 towards -- understandable, yet it's13 short. But there's other cities that14 match the federal money that they get,15 the city match or at least put some input16 into the funding that then the agencies17 will have. Agencies are closing right18 now. Siloam just closed. 22 Just to tell you a little23 example, yesterday I was at the Mazzoni24 Center and I was talking to the person in25 179 10/27/10 - PUBLIC HEALTH - RES. 1005651 charge of the Food Bank, and she was2 mentioned to me that they getting low on3 food, because they get food for 4394 people. Last year, they were getting5 food for 439. Today they serve over 8606 people. 15 I thank you for listening to16 me, and I encourage you to please do your17 best in order to be able to address these18 issues. )23

I'm sorry,24 I had to leave, but before you go, what25 180 10/27/10 - PUBLIC HEALTH - RES. 1005651 is your organization?2

Our organization3 is Projecto SOL Filadelfia. It's an4 organization that it was made to empower5 the Latino community. We teach. We do6 HIV testing. We do counseling, if7 required. We advocate, and we do8 prevention. We do a lot of prevention,9 and we educate the Latino community on10 the issues of disease, and we empower the11 people who are affected or infected by12 the disease on how to get resources and13 how to advocate for themselves.14

Do you get15 funding from the City, AACO?16

No, we don't.17

Have you18 ever applied?19

No, we haven't.20

We have to21 talk to you about how to apply. You need22 to know how to apply for the funding.23

Yes, ma'am.24

Okay.25 181 10/27/10 - PUBLIC HEALTH - RES. 1005651 Thank you.2 Sir.3

Thank you for4 having this opportunity. My name Samuel5 Morales. I'm the co-founder of Projecto6 SOL, one of the co-founders.7 First let me give you a little8 history of myself. I was a drug addict9 for 25 years. I did about 17 years in10 prison. My last arrest was ten and a11 half years in prison. I got my education12 in prison. I started law in prison and13 became a law clerk. I opened support14 groups in prison by fighting for people15 who's HIV positive in prison, African16 Americans, Hispanics, Caucasian, whatever17 the situation, whatever help they needed.18 I did about four years in the hole just19 fighting for their rights in prisons, and20 then I was doing 20 years. I kept on21 fighting for my life.22 I came out after ten and a half23 years and I've been in the streets now24 for going on 11 years. This May will be25 182 10/27/10 - PUBLIC HEALTH - RES. 1005651 11 years since I've been in the streets.2 (Applause.)3

That's4 great.5

I'm also HIV6 positive since 1985. I don't tell my7 story to no one. 10 But the reason why this11 Projecto SOL was accomplished, because12 the lack of information provided to our13 communities. 14 Translation, the language barriers, the15 services not provided in our communities,16 especially around the zip code 134 and17 133, all around that area. And you're18 right, in Germantown, all the way up19 there, I worked on Germantown. I work at20 the bottoms. I work down West Philly,21 South Philly. You name it, I was all22 over the place. 24 Latino populations right now --25 183 10/27/10 - PUBLIC HEALTH - RES. 1005651 and the statistics are every two Latino2 out of five test positive. 7 The Latino population is one of8 the largest populations growing right now9 in here the United States, one of the10 largest. And the point I'm trying to say11 is, this HIV and AIDS does not12 discriminate against no one. This attack13 everybody. I'm not here to say I want to14 fight for Latino. I'm not here for15 African Americans. 19 A lot of these organizations20 that work in Center City are called21 non-profits. How big is non-profit22 organization when you have over 1,40023 employees? 24 What is non-profits in Center City, have25 184 10/27/10 - PUBLIC HEALTH - RES. 1005651 over 1,400 employees, and there are all2 these programs, but they're not providing3 the service that we need. 7 By me, I'm involved with8 different organizations. I'm involved9 with the Mayor's Office Community10 Advisory Board. I'm Advisory Board for11 the Mayor's Office. I'm also Board of12 Directors of Philadelphia FIGHT. 14 I'm also Community Advisory Board for15 University of Penn. I'm involved in a16 lot of stuff here in Philadelphia. 20 Now, the reason why I come up21 to you, because we need to sit down as a22 whole, like a family, and talk about this23 here. What we have on our hands, how can24 we make it better, how can we provide25 185 10/27/10 - PUBLIC HEALTH - RES. 5 For instance, like the School6 District, they have infectious disease7 nurse. They should be educated to teach8 and graph and look at people and see the9 (unintelligible) reduction, the10 prevention, say, Listen, this is what's11 going on. Some of these nurses in12 schools, they're not educated on HIV and13 stuff like that. So education is very14 important. 16 These health centers, they test17 people for STIs. They also should be18 tested for HIV. 21 You name it, it's a lot of22 services that we have with enough in our23 community, and sometimes it's not the24 money, it's some of these organization25 186 10/27/10 - PUBLIC HEALTH - RES. 1005651 opening doors and helping people. And be2 for real in this job. 7 You go some of these organizations,8 there's people outside waiting to see a9 case manager. 11 Don't know nothing about it. 16 That's good. Now, tell me something, do17 you talk to individual to find out if he18 knows how to pay his bills? 20 Does he know how to put the gas on or21 certain things that an individual needs,22 a guidance? 24 There's some people -- there's25 187 10/27/10 - PUBLIC HEALTH - RES. D. from the street. 8 I tell people, I say, You don't9 know -- the people I work with, their10 furniture, sometime they have a can of11 soup or something like that, to hang onto12 the furniture. 14 I'm talking about people -- if15 they get letters through the mail, they16 can't -- understand, they can't read, and17 if it says whatever the situation is and18 it's not translated to their knowledge,19 to their level. 20 For instance, they go to a doctor to get21 medication, and they can't read it or22 it's not in Spanish. You know what I'm23 saying? 24 There's a lot of stuff that we25 188 10/27/10 - PUBLIC HEALTH - RES. 1005651 need to -- I mean, Philadelphia is a2 strong city. We shouldn't be here -- we3 just the fourth highest population city4 of HIV.

6 I think the Committee should7 take a look at where all this money is8 going at and focus how can we make it --9 take that money and put it where it's10 used -- where it's worth -- where it's11 useful at, because a lot of people not12 going to come down Center City, and I13 guarantee you that. 20 This is about neighborhoods, because21 Germantown -- you go Germantown and22 Lehigh, if you cross Lehigh Avenue,23 (unintelligible). If you stay this side24 of Lehigh Avenue, it's another part of25 189 10/27/10 - PUBLIC HEALTH - RES. 1005651 the neighborhood. You know what I'm2 saying? 4 No. A lot of people after Broad Street5 down to the east side is North6 Philadelphia. 8 Talking about statistics by zip codes and9 all that. 11 Look at Philadelphia. They12 should never been like this. 18

Okay. But I'll19 tell you one thing, when I was working20 down there, there was only one program.21 One Day At a Time was there. You22 remember that. You know that. Right.23 So when I was down there, I was working,24 there was no program down there at that25 190 10/27/10 - PUBLIC HEALTH - RES. 1005651 time. One Day At a Time was the only2 program out there working.3 It's a lot of programs out here4 that's not doing their job that's5 supposed to be doing their job.6 But my concern is this: That7 we cannot point fingers. We cannot do8 this. We can do that. The only thing we9 have to do is come together with all the10 resources we have and use it.11 Thank you.12 (Applause.)13

Thank you14 very much. I'm sorry. I hear you. I15 got your point. And you're Mr. Morales?16

Yeah.17

Samuel18 Morales. And we know how to reach you.19 Thank you both very much for20 your testimony.21 Our next panel, Linda Burnette,22 YOACAP; Robert Thomas, Urban Solutions;23 Jose Benitez and Viviana Ortiz,24 Prevention Point; and Carla Fields, Act25 191 10/27/10 - PUBLIC HEALTH - RES. 1005651 Up.2 We're going to call the next3 group, too, so we can -- there will be a4 couple of people. Marie Ranselle and5 Danielle Parks.6 (Witnesses approached witness7 table.)8

Good afternoon,9 ladies and gentlemen --10

Thank you11 so much, and we're sorry -- you know how12 this goes, Linda.13

You know I know14 how it goes.15 First, I want to thank you16 again for being at the forefront of this17 disease. A lot of people don't remember,18 I'm 23 into HIV prevention education.19 YOACAP is one of the oldest African20 American -- still headed by the same21 people and having some of the same22 staff -- community-based organizations23 still in existence in Philadelphia.24 We're very proud of that. You honored us25 192 10/27/10 - PUBLIC HEALTH - RES. 1005651 with that, I think, in '94. I was 15.2

Yes, you3 were. And you're 17 now.4

Thank you.5 Today, though, I've listened to6 a lot of statistics, so I'm not going to7 give you the statistics. You've heard8 that. I've listened to and I've been so9 impressed by my co-workers and my10 activists, who are very impassioned about11 this disease, just as I am. But I want12 to give a little update.13 In 1989, YOACAP began providing14 HIV/AIDS and sexually transmitted15 infection and teen pregnancy prevention16 in and around Philadelphia areas, in high17 schools and middle schools, churches,18 community organizations. We are proud19 partners of the Urban Affairs Coalition20 and began our efforts to combat HIV and21 AIDS in collaborations with the AIDS22 Activities Coordinating Office, AACO, the23 STD Control and the Minority AIDS24 Coalition of Philadelphia.25 193 10/27/10 - PUBLIC HEALTH - RES. 1005651 In 1989, HIV was still a bad2 word. People didn't talk about it.3 There was a stigma attached to it, and4 anyone infected was considered to have5 brought it upon him or herself, and we6 didn't take it seriously. It was a white7 gay male disease. Why should we care?8 Then it begins affecting our black9 brothers, our black gay brothers. Then10 we thought, hmm, we might want to look11 into it. Then it became -- it started to12 affect African American women and13 children. And then we galvanized and we14 moved forward and we started demanding15 funding, and I commend the organizations16 and the institutions that went with us17 and marched with us and screamed with us18 and helped us get funding to really go19 out and educate and help our communities.20 And we did that.21 There have been some successes.22 I hear the young lady say we needed to23 have a citywide campaign. We were one of24 the first cities to do that. I'm sure25 194 10/27/10 - PUBLIC HEALTH - RES. 1005651 you all remember, "Time to Get Tested."2 We did that here in Philadelphia.3 We were one of the first4 cities, I believe, to go into the high5 schools and talk about HIV and AIDS. At6 first, they didn't want us to use the7 word "sex." We had to talk about8 abstinence. If you didn't say9 "abstinence," you couldn't come. Then10 kids started coming to the truck to get11 tested, and then we could talk about sex.12 So we've come a mighty long13 way, and I think we should give ourselves14 a hand for what we have done.15 (Applause.)16

And look at --17

Sometimes18 your efforts get lost in time. It kind19 of gets lost in the history, and it's not20 really carried forward. And you all have21 done a lot of work, and I remember when22 Act Up took over this Council.23

Exactly.24 Exactly. We went to City Council. We25 195 10/27/10 - PUBLIC HEALTH - RES. 1005651 died on the steps.2

And I3 remember the students and their4 presentations.5

Yes, indeed. We6 used drama, we used rap, we used whatever7 would reach young people, women. And we8 didn't care whether they were gay or9 straight at that time. At that time, we10 were about saving lives. 23 Blackwell, because I remember you coming24 to us and coming up with us to a school25 196 10/27/10 - PUBLIC HEALTH - RES. 1005651 to let people know, you know what, these2 kids are okay. 16 I believe that community17 engagement -- that's my spiel -- is the18 only way we're going to haunt this19 disease. And by that I mean, instead of20 people coming outside of us, researching21 us, our community, let's research our22 communities ourselves. 24 I point to the Southwest25 197 10/27/10 - PUBLIC HEALTH - RES. 1005651 Community Advisory Board. This is a2 group of people that Ms. Blackwell is3 very familiar with. 18 That community now, they just19 had their third annual meeting. They are20 attacking their priorities. 23 HIV/AIDS, we're on every corner24 in Southwest all the time, and when25 198 10/27/10 - PUBLIC HEALTH - RES. 8 We are in there from 6:00 to 9:00. 12 So there are activities going13 on. 15 I agree with the young man that16 said we need to come out of our office,17 but I'm not in mine, and I don't think18 the other people that are getting funding19 are always in their offices, too. Let's20 don't paint everybody with the same21 brush. 23 Let's bring people together in the24 community who are most affected by this25 199 10/27/10 - PUBLIC HEALTH - RES. 1005651 disease and ask them what needs to be2 done so that you will ask your partner to3 wear a condom. Heterosexual male, who4 will you talk to so that we can bring5 something together that will actually6 work for you? Young men and women, who7 are you influenced most by? How do I get8 you to stop thinking that this is a9 wholesome -- young people probably going10 to say, Ms. B, she's too old, Foxy Brown11 is the one to go. 13 We need to educate parents. So14 let us not forget that we just overcome a15 crack epidemic. 16 Big momma has left the building. 21 So we have a whole lot of22 things to talk about and address, and I23 only ask that we address them together,24 we address them honestly, and we address25 200 10/27/10 - PUBLIC HEALTH - RES. 2 We go in the streets and talk3 to people, focus groups from the people4 that are most affected. We have been5 researched by everybody in the world. I6 don't think Philadelphia has missed not7 one person that does research. I bet if8 you Googled research in Philadelphia,9 you'd find two million pages of this and10 that. And everybody has a11 recommendation. But you will not find12 many that said the African American13 community in Philadelphia, when faced14 with the epidemic of HIV and AIDS, when15 the media started treating it as a16 treatable disease and didn't research17 itself. We have to make HIV -- wrap it18 around other services. We're going to19 have to include blood pressure, diabetes,20 dental. 21 I can't just talk to momma about HIV when22 she's not sure how she's going to pay her23 rent. I've got to talk to her about life24 skills and sit her down at the table and25 201 10/27/10 - PUBLIC HEALTH - RES. 1005651 say, Baby, you know what? 6 There's so much work to do, and7 if we pull together, we can do it. 15

Thank you16 very much.17 (Applause.)18

Who is19 next?20

I'm one of the21 ones that's living with HIV and AIDS.22

Would you23 give me your name.24

My name is Carla25 202 10/27/10 - PUBLIC HEALTH - RES. 1005651 Fields, ma'am, Councilwoman Tasco.2

Carla3 Fields?4

Yes, ma'am.5

You're6 from Act Up?7

Yes.8 All I can do is tell you my9 story. I'm an activist. I'm out there10 on the street. I'm educating people.11 I'm getting people in there when people12 saying that HIV don't have a face. It's13 just a stigmatism. It's a death14 sentence.15 It's not a death sentence no16 more. Okay? And I've been diagnosed for17 multiple years. I know mostly everybody18 in this room from one form or another,19 because I'm so much out there on the20 pavement.21 Excuse me. In answer to your22 question about Germantown, Germantown do23 have a program up there, okay, that's24 educating the women, as well as men as25 203 10/27/10 - PUBLIC HEALTH - RES. 1005651 well. They knock on the door. They help2 out so much. Germantown is one of the3 communities, even though it's not based,4 they do a lot for their --5

What's the6 organization?7

Liberation8 Fellowship CDC.9

Thank you.10 Because I know that I keep my11 ears open. I might don't have the stats12 with me, but I know that Hispanic and13 black community is mostly affected. It14 went down in the MSM community that --15 they're not infected as much as we are in16 the Hispanic community, and the white17 community is not affected as much or18 Asian. Put them out there, too. Because19 I do research. I go out there. I do20 what I do for my people. I'm here for21 the people. My people are at like --22 they don't want to give housing. I've23 been homeless for two years and I went to24 a DVD shelter, a domestic violence25 204 10/27/10 - PUBLIC HEALTH - RES. 1005651 shelter, and I was discriminated because2 I had HIV from the staff, and that hurt3 me so bad. They dropped me off back at4 my abuser's house. And they couldn't5 tell me why they did it, but I already6 knew why. My medicine was being missing.7 I had to really go into hiding for8 myself, which I am now, fighting for9 housing. And y'all wonder why people10 don't come forth and ask for help.11 Because every time they ask for help,12 they getting the door slammed from AACO13 and all these different agencies that's14 up here and telling y'all half the story.15 Well, I'm out there living this. I'm16 living this, and nobody can tell me it17 don't hurt me. It do. And God is on my18 side every day, because I'm educating my19 own people, and I'm educated in it so20 much that people that know me could tell21 you.22 I'm not just sitting out there23 just laying down to die. I'm not. I'm24 not out there in the street laying down25 205 10/27/10 - PUBLIC HEALTH - RES. 1005651 to die. I'm living this nightmare,2 because I don't want to go back to a3 shelter, how they treated me before.4 I went there with a broken --5 my jaw was broken, and got so much6 criticism from the staff. And what to me7 it shows me, when I offered myself to8 educate the staff, they told me, what9 makes me educated. First of all, I went10 to Project TEACH, outside, inside,11 because I have a college education in12 social work. What makes me educated in13 this? I'm living this. That makes me an14 educator in this, this life-style, how to15 treat your fellow man, for all the ones16 that's dealing with this in here. Okay?17 And everybody sit up there and say, what18 can they do for us? What can you give us19 the tools to do for ourselves.20 Self-education, self-motivation is the21 best key that you can give a person.22 You offer us health, but look23 at this, without housing who is going to24 care about they health? Who is going to25 206 10/27/10 - PUBLIC HEALTH - RES. 1005651 want to go for treatments and the things2 they need if they don't have the proper3 housing? They fill out all the papers.4 They go there, they beg for housing, and5 they just keep on telling them, Oh, you6 got to keep sleeping -- and I'm going to7 tell you, I went to Eliza Shirley. They8 had bed bugs. I had to go back to my9 doctor. I had 75 percent of my body bit10 up from bed bugs from sitting on a sofa,11 what they call the living room. You got12 to sit there for two weeks. I was bit up13 75 percent of my body, where I had to go14 back to my doctor and get creams, like15 five different creams and soaps, so I can16 get rid of this bed bugs bites off of me.17 It's not like I don't take my18 health seriously. Anybody that know me19 in the medical community, I do take my20 health seriously. I advocate. I'm out21 there every day advocating, the young,22 the old. You name it, I'm doing it.23 Nobody don't even got to ask me twice.24

We want25 207 10/27/10 - PUBLIC HEALTH - RES. 1005651 you to kind of summarize your testimony,2 sweetheart, because we have other3 people --4

Okay. Well, I'm5 summarizing my testimony. After hearing6 from everybody in here today, unless7 you're living with this and living8 homeless, dealing with the health crisis,9 you don't know what we go through. And I10 understand you're trying to get to know11 us, but for us, we just want to be12 treated like a human being. Give us the13 tools to advocate for ourself. That's14 all we asking.15

Thank you16 very much.17 (Applause.)18

Are you19 next?20

I am. Good21 afternoon, Madam Chair and members of the22 Public Health and Human Services23 Committee. My name is Marie Ranselle,24 and I am just excited today about all the25 208 10/27/10 - PUBLIC HEALTH - RES. 13 I approved $500 support for a 24-year-old14 woman and her 20-week-old premature baby15 to be buried. She died pushing this baby16 out at one of our local hospitals. The17 baby lived for ten minutes and died. She18 lived for 20 more minutes and she died as19 well. That was in late September. We20 buried her in October, this month. We21 buried her and the baby this month. She22 was HIV positive. 24 I also have the story of a25 209 10/27/10 - PUBLIC HEALTH - RES. 1005651 30-year-old woman who has two children2 who died of a massive heart attack3 December 31st, 2009. She left her4 children behind. She is dead. 6 We buried a 21-year-old7 perinatally infected male. He was born8 HIV positive. And he was tired of taking9 his pills. 11 We are the Circle of Care. We12 are the HIV service delivery system that13 takes care of families. 16 We have our other hats, too. We're also17 funded by the AIDS Activities18 Coordinating Office to both test Hispanic19 and black women of child-bearing age and20 men of child-bearing age who identify21 themselves as heterosexual. We also22 provide services for HIV positive23 pregnant women, making sure that they24 have HIV negative babies and are25 210 10/27/10 - PUBLIC HEALTH - RES. 6 But all my esteemed colleagues7 and my counterparts, there was good8 information and statistical data and9 reports that show you what the true10 epidemic looks like. That is important,11 but I think as you guys ponder what is12 going to happen next, you need to hear13 about the deaths. You need to hear about14 our client who has bed bugs and scabie15 bites because she's HIV positive and in16 need of housing. 19 You need to hear about the20 clients who can't do it anymore, just21 can't do it anymore, and don't know what22 to do, so they call. And we do what we23 can, but it's 6:30 and all resources in24 the City are now closed, or it's Saturday25 211 10/27/10 - PUBLIC HEALTH - RES. 11 We must do this. These agencies that are12 working in the City are phenomenal. We13 have a fraternity or a sisterhood or14 brotherhood. We work hard. We work15 daily. m. So23 evening hours -- when I say "evening," we24 mean late in the evening, everybody. We25 212 10/27/10 - PUBLIC HEALTH - RES. 1005651 mean late. We mean Saturdays when we're2 coming out of our bed, because, yes, we3 work Monday through Friday. We meet4 Sundays at the Mashgiach testing event or5 the church testing event. We meet the6 community where they are. 7 In light of what has been said8 about the funding that's going on and a9 lot of City agencies that are funded, the10 agencies funded by the City of11 Philadelphia that are based downtown,12 they don't stay downtown. We are an13 agency based downtown, 1700 Market14 Street, 18th Floor. We have provided HIV15 counseling and testing services,16 supportive services, medical care and17 services to people in 25 individual and18 distinct zip codes in the City of19 Philadelphia. We are everywhere, all of20 us. 21 I think that the focus is the22 continued press forward and collaboration23 by all the agencies and concerned persons24 involved. We often segment ourselves25 213 10/27/10 - PUBLIC HEALTH - RES. 1005651 about focusing on our group that's most2 important to us. 3 It's all important. But when we don't do4 what we need to do and we miss the mark,5 I am signing the applications for our6 fund for families for support for7 burials. 9 I would like to also address10 the importance of communities of color11 that are emerging in risk.

Our brothers12 and sisters at the Southeastern Asian13 Mutual Assistance Associations14 Collaboration, SEAMAAC, the African15 Family Health Organization and other16 service agencies that serve Hispanic17 individuals, people from the Caribbean,18 West African individuals and other19 distinct populations. 25 214 10/27/10 - PUBLIC HEALTH - RES. 1005651 And I know we have a lot of2 testimony to continue to go through, so3 I'm going to be brief. But, Madam Chair,4 I don't want the deaths and these5 applications that I'm signing for to6 support these persons to be in vain. I7 don't. 10 Not just more hearings, not another11 committee after this, but a strategy that12 we can all -- and I tell you, we will13 all -- and people in the room will agree,14 we will all get behind this, every last15 one of us. We will make it work. 20 There is something -- everywhere I go,21 including to the CDC, which is where22 other co-workers are right now, because23 we have been funded for a program that24 targets heterosexual and MSM African25 215 10/27/10 - PUBLIC HEALTH - RES. 1005651 American males, and they're being trained2 on the interventions as we speak, what we3 need to have are mobile units, Madam4 Chair. We need the ability to go into5 the neighborhood. 15 We're going to have them where they are16 and they're going to trust our faces, if17 we could test and treat on the block,18 there will be no loss to care. 20 I can't take it. I can't take21 it anymore. The baby did me in. So when22 I saw that this resolution was presented23 and had the opportunity to testify, I24 really needed to tell you about that25 216 10/27/10 - PUBLIC HEALTH - RES. 4 I thank you. I thank you. 13

Thank you14 very much.15 (Applause.)16

Councilman17 Jones, you have a question? We were18 waiting until the end of the panel, but19 if it's a pressing question.20

Yeah, it's a21 pressing comment, because I have to go.22 I have a 2 o'clock.23 I just want to thank you and24 the members of this Committee for25 217 10/27/10 - PUBLIC HEALTH - RES. 1005651 bringing this issue forward, pushing this2 resolution. It's important that we hear3 this. It is important that we know that4 the war isn't over, that somehow there5 was victory declared. This reemphasizes6 that for us.7 As we compete with funding8 sources of different problems that we9 have to face, we have to know and10 constantly in the forefront of our minds11 that this is a problem that persists.12 I think I've taken a couple13 comments from this, that there has to be14 a connectivity at the local level. We15 can legislate stuff from mount high, but16 if it don't get down low into the nooks17 and crannies of the community, it's less18 effective.19 And the other thing that you20 just said that I really want to emphasize21 support for is the mobile units. I22 believe telemedicine time has come. We23 have to go to where the problems are.24 And then, finally, my only25 218 10/27/10 - PUBLIC HEALTH - RES. 1005651 comment is this: These hearings are2 important. What we need to do is lock3 ourselves in a room for a day or two, go4 by issue, because I heard a lot of good5 comments, and then figure out an action6 plan, because other than that, we're7 doing groups.8 (Applause.)9

And we10 really need to kind of figure out and11 marshal resources that are out there in12 different aspects and bring them together13 and say, here's the three things we can14 do, here's the ten things we can do over15 the next year, here's the things we need16 to do over the next five years, just like17 you would do a business plan, and put it18 in different categories and for different19 people's responsibility.20 So I want to thank you, Madam21 Chair and members of this Committee. I'm22 not on the Committee, but it's heightened23 my awareness of the issue. So thank you.24

We thank25 219 10/27/10 - PUBLIC HEALTH - RES. 1005651 you. You were not here when we talked2 about the follow-up process earlier. We3 talked about once we have the hearing and4 gather the information, then we try to5 figure out how we develop an action plan,6 but it takes everybody, because there are7 different opinions about different8 things, but we have to come together and9 kind of figure out what is it we want10 to -- what the end product should be,11 what we want to do, who can do it, who12 can't do it, where do we -- but it will13 take a further discussion about that once14 we finish.15

I'm in,16 Madam Chair.17

Madam Chair, I18 just want to say one more thing. The19 program that I alluded to about taking20 care of positive pregnant women in the21 City of Philadelphia, the CDC-funded22 initiative, we have serviced 500 women in23 the past five years and there has not24 been a positive baby in our program yet.25 220 10/27/10 - PUBLIC HEALTH - RES. 1005651 Not to say that there's been no positive2 babies born in the City of Philadelphia,3 but we have significantly reduced, in4 conjunction with AACO, the number of5 babies born that are HIV positive. So6 that is something, I guess, to hang our7 hats on related to the work that we do.8

Well,9 thank you. I was on the Family Planning10 Board many years ago.11

Madam12 Chair.13 COUNCILWOMAN TASCO:14 Councilwoman Blackwell. I'm sorry.15

Thank16 you for your compelling testimony. And17 let me say that what we as leaders have18 to realize, we're fighting -- I have a19 meeting this afternoon in about 1520 minutes dealing with the overall issue of21 lack of shelter beds that we have in the22 City. So if we have lack of shelter beds23 for people who may have been burned out24 or people who have been evicted or people25 221 10/27/10 - PUBLIC HEALTH - RES. 1005651 who just don't have, what can it be for2 this population? And I say to my3 colleagues, whenever there is a need for4 special housing for people with special5 issues, they come to me. I got6 everything in my district. I got vets, I7 got all level of homelessness, and I have8 many -- I have drug and addicted homes.9 And I say this to say that it's not easy,10 but all of us have to rededicate11 ourselves to do what we can. All of12 these people are not going to be in one13 Philadelphia nursing home or in one14 place. We have got to support people15 being able to live in the cities where16 they're born, and that's something else17 that we as leaders have to deal with,18 because people don't disappear. I say it19 all the time. But people don't20 disappear, and people need support, and21 they've got to be able to live in the22 neighborhoods from whence they've come.23 So everybody comes to me. They24 say, We know you'll take this population.25 222 10/27/10 - PUBLIC HEALTH - RES. 1005651 And I try to get my community to accept,2 but it's all of our -- it's not just mine3 or not just yours or Councilman Goode or4 Blondie's. It's all of our5 responsibility to share the resources of6 our community and try to get our7 communities to welcome their own children8 and neighbors back into their blocks.9 Thank you. Thank you.10

We hear11 you. We're struggling with that in my12 district in terms of trying to share with13 the community the importance of opening14 up their eyes and ears and hearts to the15 plight of the people who have stumbled,16 but who are trying to get themselves back17 together. And but for the grace of God18 goes a member of their family who would19 be in that situation.20 So it's a part of a struggle21 and an education process, and we22 appreciate what you do, Councilwoman23 Blackwell.24

Thank25 223 10/27/10 - PUBLIC HEALTH - RES. 1005651 you.2

Next is3 Mr. -- who is next? You want to be next?4 Are you Jose?5 MR. De MARCO: We both are.6

Go ahead,7 Whoever you are. Identify yourself for8 the record, please, and proceed.9 MR. De MARCO: My name is Jose10 de Marco. I'm with Act Up Philadelphia.11 And I'm glad to hear Ms. Blackwell speak12 about the homeless issue, and we've tried13 to meet with you four times and it's14 never happened. So hopefully this time15 we can schedule a meeting where we all16 can meet. I've been --17 COUNCILWOMAN BLACKWELL:18 Everybody can meet with me on19 homelessness. So you don't have to --20 MR. De MARCO: Okay. We've21 dropped by your office --22

But23 you don't have to go there, not with me,24 not when it comes to homelessness.25 224 10/27/10 - PUBLIC HEALTH - RES. 1005651 MR. De MARCO: Well, maybe we2 can find a time we can meet with you now3 before I leave.4

I got5 a meeting with Dainette Mintz at 2:00 on6 this issue. But ask anybody. I've been7 doing this for a million years. You8 offend me when you say you can't meet9 with me on homelessness, because it's my10 passion. We do -- we're getting ready to11 do 4,000 people at Christmas and kids and12 everybody. I do my thing.13 So you offend me when you act14 like you can't meet with me, because15 anybody can meet with me. Go down there16 and get in that line of people who try to17 get someplace to stay every day. I do it18 every day.19 MR. De MARCO: I'm not arguing20 with you. We would like to meet with21 you. We've tried four times.22

I23 think I made my point. Don't offend me.24 MR. De MARCO: I'm not trying25 225 10/27/10 - PUBLIC HEALTH - RES. 1005651 to offend you. I'm trying to get a2 meeting with you.3

I4 dedicate my life to it, in season, out of5 season. It's my life's work. So don't6 act like --7 MR. De MARCO: I'm not doubting8 that.9

-- you10 can't see me, because everybody can see11 me.12 Sorry. Sorry, Madam --13 MR. De MARCO: Okay. Well,14 maybe your staff should tell you when we15 come to your office on four different16 occasions, people with AIDS, and ask to17 speak to you.18

Sometimes19 it's best to call and make an20 appointment. It's very difficult to walk21 in on a Councilmember, because they do22 have schedules. So they do have23 scheduling staff. It's best to call them24 and get an appointment.25 226 10/27/10 - PUBLIC HEALTH - RES. 1005651 MR. De MARCO: We've done that2 and had appointments.3

Well,4 certainly you'll try and work that out.5 MR. De MARCO: Well, anyway,6 let me make a long story short. We're7 working right now on a housing --8

What's9 your organization?10 MR. De MARCO: Act Up11 Philadelphia and Projecto SOL as well.12 We're working right now on a13 housing demonstration, and it's been --14 study after study after study has proven,15 if you house people with AIDS, it's16 prevention and it's treatment. Last17 year, according to the City Health18 Department -- I mean, this is as the19 numbers that we know -- six homeless20 people died on the street with AIDS.21 Those are the numbers we even know about.22 We know that people that are on23 the street do all sorts of things to get24 off of the street, and unfortunately25 227 10/27/10 - PUBLIC HEALTH - RES. 1005651 people do sex work, people take drugs,2 they drink, because living on the streets3 is no -- is really, really not a place to4 be.5 We know that many of our6 members who are homeless come and tell us7 what life is like in the shelters, from8 bed bug bites to scabies to tuberculosis.9 So people would rather not go into10 shelters.11 There's a Housing First model12 that a lot of other cities use to house13 people with AIDS, which I think14 Philadelphia should actually be looking15 at and seeing how we can get money to16 actually house people that are actively17 using drugs, because people that are18 actively using drugs don't have access to19 treatment, and we know treatment is20 prevention.21 We've tried to impress this22 upon -- we've met with City health23 officials. We're trying to impress upon24 the Mayor, people with AIDS need to be25 228 10/27/10 - PUBLIC HEALTH - RES. 1005651 housed. They don't need to die on the2 street.3 I see a lot of it where I work.4 People come in every day that are5 homeless with HIV or AIDS. They have6 nowhere to go. In fact, they don't even7 know that the services exist for them.8 So it's hard reaching out to people that9 you can't let them know this exists, that10 exists, that exists, this exists. People11 don't know. One by one if they come into12 our agency, we can let them know. But13 it's obvious like not a lot of effective14 street outreach is going on at this time.15 And right now our waiting list for AACO,16 it needs to be funded, because there are17 people that are waiting on a housing list18 for housing. Some people are waiting for19 subsidies, and there are homeless people20 that are waiting to be housed. I think21 the waiting list is now probably three22 months or so. I mean, which has been23 brought down from two years, but that's a24 long time to wait for housing if you're25 229 10/27/10 - PUBLIC HEALTH - RES. 1005651 sick. It's an awful long time. People2 have died waiting for housing on this3 list.4 One member of our group, his5 wife died. He contracted scarlet fever.6 So what I'm trying to impress7 upon you, shelters are no place for8 people with weakened immune systems. No9 place at all.10

So are you11 saying that some of the shelters should12 be dedicated specifically for people with13 AIDS?14 MR. De MARCO: No, that's not15 what I'm saying. What I'm saying is, we16 have to find an alternative for people17 with AIDS so they don't have to go into18 shelters. We need to find housing for19 them. We need to find places for them in20 their own communities. I don't want to21 set up a concentrate camp for people with22 AIDS.23

Well, you24 just heard Ms. Blackwell talk about the25 230 10/27/10 - PUBLIC HEALTH - RES. 1005651 difficulty in trying to identify a house2 or home in neighborhoods where the3 community is not -- the NIMBY, not in my4 backyard, and that is what -- and even if5 you have a group who may want to do that,6 it's sometimes not as easy as said.7 I had the privilege of visiting8 a home that was built in West Hollywood.9 This is way back in the '90s.10 Beautifully constructed home for people11 who had AIDS, and that was -- and that12 whole community was certainly more open13 and receptive to people who have HIV/AIDS14 or particularly those who have AIDS.15 And so it's not as easy as16 said, and usually what happens, you work17 with the local community or community18 group to identify someplace and then seek19 the funding. It's a whole other process.20 You need to talk to Ms. Mintz in the --21 Dainette Mintz.22

Madam23 Chairman, I have to leave to go to a24 meeting in my office with Dainette Mintz,25 231 10/27/10 - PUBLIC HEALTH - RES. 1005651 but my staff reminds me that we did meet2 with them. We even set them up a meeting3 with the Mayor. Now, if the Mayor didn't4 satisfy them, I don't know. They wanted5 a meeting. The issue was on funding, and6 we got an appointment with the Mayor for7 them.8 So I rest my case, sir.9 MR. De MARCO: Thank you.10

Thank you11 very much.12 (Applause.)13

Thank you14 very much.15 MR. De MARCO: You're welcome.16 Thank you for hearing me and thank you17 very much for having these hearings.18 It's long overdue, but sorely needed, and19 thank you so much for being the catalyst20 for this to happen.21 Thank you.22

One23 recommendation I'd like to make for all24 of you -- and I should have done this25 232 10/27/10 - PUBLIC HEALTH - RES. 1005651 much earlier -- is that during the course2 of the budget process, you need to come3 in and testify as to what's going on,4 testify what the needs are, so that the5 Health Department can hear it, so that6 the other Councilmembers can hear what is7 going on, because we have not had a8 hearing around this issue for a long9 time, but the needs are there. And we10 certainly have -- as people call our11 attention to it, we'll meet with the12 Health Commissioner. But there's a13 public process for you to come in and14 express your concerns about any issue,15 and particularly this issue, when the16 Health Department testifies. We have a17 public schedule for the public to come in18 and testify on any of the issues that19 have been raised during the course of the20 budget, and we need to hear that. So as21 we move forward and plan, we can take22 that testimony into place. We hear from23 individuals, but collectively at some24 point we need to hear from you.25 233 10/27/10 - PUBLIC HEALTH - RES. 1005651 MR. De MARCO: Thank you very2 much.3

Thank you.4 Yes, sir.5

Thank you for the6 opportunity. I'm Jose Benitez, the7 Executive Director of Prevention Point8 Philadelphia, and I wanted to thank you9 for the opportunity to testify today.10 We do have some success in11 Philadelphia. So I want to talk about it12 just a little bit. If you flip the13 epidemiological data back to the early14 '90s, what you will find is about 4715 percent of the people who were newly16 diagnosed with HIV were from IV drug17 users, sharing needles essentially. If18 you look at the data today, the latest19 data that's available, which is 2008, we20 have that down to 12 percent. So --21 (Applause.)22

Thank you.23 Because that's huge. And really I think24 the Commissioner talked a little bit25 234 10/27/10 - PUBLIC HEALTH - RES. 1005651 about it in his testimony this morning,2 that it was largely due to syringe3 exchange. The syringe exchange program,4 which is Prevention Point, exchanges5 about 1.6 million needles a year. We do6 that with a really tight budget. We do7 it in mobile vans. We do it in various8 areas in the community, and we do it with9 about 3,600 people.10 My elevator speech, because I11 know it's been a long day of testimony so12 I'm going to be quick, is basically a13 syringe costs us 7 cents to give out to14 trade with someone. Taking care of15 somebody with HIV is a little over16 $200,000 if they have an illness going17 on. So the math is really simple.18 We see this. I know that this19 is still seen in some areas and in some20 communities as a controversial issue, but21 it is an effective issue. When I walk up22 and down the line or we're doing23 exchanges, one of the things that has24 gotten through a drug-using community is25 235 10/27/10 - PUBLIC HEALTH - RES. 1005651 the fact that they're not to share. They2 know not to do that, and the only time3 that they do share is when they're4 desperate and they don't have other5 needles available. And that's a cost6 issue for us.7 So we do have some8 interventions that work in the City of9 Philadelphia. This is one of them, and10 it should be continued to get funding and11 to expand and to move around some of the12 sites that we currently have, because13 some of -- the epidemic is moving into14 different zip codes. We should sort of15 reexamine -- so this is a recommendation16 for City Council. We should reexamine17 where we have syringe exchange sites at18 this particular point, because they're19 not all in the areas where there's the20 most prevalence of HIV.21 And with that --22

How are23 those sites determined?24

They were25 236 10/27/10 - PUBLIC HEALTH - RES. 1005651 determined back in the early '90s with2 the Health Department and the Office of3 Addiction Services. And back then, they4 were certainly put in areas where there5 were high prevalence of HIV through IV6 drug use. That is no longer true today.7 So we're going to have to do -- we're in8 the process of -- there is a study that's9 available to us that make recommendations10 to move some of the syringe exchange11 sites to more appropriate communities.12

Have you13 talked to the Health Department about14 that?15

We have, and16 we're in the process of working that out17 at this particular point.18

I mean,19 that's where you would go. I mean, our20 message would be to the Health Department21 to see if you could address this issue.22

Right.23

But I'm24 glad to hear it.25 237 10/27/10 - PUBLIC HEALTH - RES. 1005651

Right. I just2 wanted to testify that we do have some3 successful kinds of interventions. One4 of them is the syringe exchange program,5 which is something that -- about a third6 of our clients each year go into drug and7 alcohol treatment. So there's a lot of8 surrounding services. We test around9 1,100 people a year. Four percent are10 HIV positive. So we're finding a lot of11 new positives that way.12 These are untraditional kinds13 of services that we provide. We do it14 through a social network essentially. So15 there are some models out here for us to16 sort of copy from and share with the rest17 of our other AIDS service organizations.18

Thank you.19 It seems to me from today's20 testimony, there are a lot of21 organizations doing a lot of work around22 this issue and in the community. I think23 the question that has not been raised or24 the issue not raised today is the issue25 238 10/27/10 - PUBLIC HEALTH - RES. 1005651 of confidentiality. Do people not want2 to get tested because they're afraid that3 someone -- they might not want to tell4 someone, but are they concerned that5 their test results are shared with6 anybody else? Because, you know, with7 the Internet and all the stuff going on,8 people are very nervous about having9 their business in the street. And so we10 haven't talked a lot about11 confidentiality around this issue,12 because part of it -- I think the major13 portion of addressing this issue is14 education and getting tested and why15 people should get tested and the16 assurance that their information will be17 kept confidential.18

One of the19 things -- I'm glad you asked that20 question.21

Identify22 yourself.23

And you're24 right, but one of the things that --25 239 10/27/10 - PUBLIC HEALTH - RES. 1005651

Identify2 yourself.3

Linda Burnette4 with YOACAP, the Youth Outreach5 Adolescent Community Awareness Program.6 To the issue of7 confidentiality, AACO has done a8 wonderful job of helping create a system9 of care, would you not agree, where we10 use unique identifiers to identify people11 who are tested. So your personal12 information is not revealed to -- the13 average Joe would not be able to get it.14 Only the person who would be entering15 that information -- is that the same for16 your organization?17

Exactly.18

That's not an19 issue anymore. Back in the early days,20 you're right, that was an issue, but21 that's something that we've kind of22 overcome.23 People are still a little leery24 about getting their test results, because25 240 10/27/10 - PUBLIC HEALTH - RES. 1005651 they still don't want to know a lot of2 people, but the fact still remains --3

They4 probably don't want to know themselves.5

They really6 don't want to know, and that's why it7 makes our job a lot harder. And I think8 one of the things that we all can agree9 on is that when people do know their10 status, they're less likely to spread the11 disease. And I hope -- that's been said12 a couple of times today. But13 confidentiality is no longer an issue,14 and I commend AACO for developing that15 system for us so that we could talk to16 our --17 (Applause.)18

Because19 sometimes your funders get a big slap on20 the wrist. They get a big slap on the21 wrist, and through this last funding22 cycle -- I have my concerns just like23 anybody else, and I want to make that --24 I don't have everything I need. YOACAP25 241 10/27/10 - PUBLIC HEALTH - RES. 1005651 is still, just like you guys, looking for2 money, and every other group in here.3 But we were hit by the recession just as4 you all were. We were at the budget5 hearings, and we understand that there6 are a lot of things that couldn't be done7 that we're still working on, and we8 appreciate the help that the City is9 giving us. And I do hope that Ms. Baker10 will come back and explain the -- we had11 a meeting on yesterday when they were12 talking about how you guys could help us13 get nominated to different committees,14 federal committees, and organizations15 that would assist us in getting funding16 for the City, but we have to be nominated17 by a Mayor or -- and I don't want to give18 misinformation -- by a Mayor or a City19 Council person.20 So this is something that will21 be an asset to the City. I know I'm22 offline now, but I do hope that she23 will -- if she doesn't explain it today,24 will call someone at your office so that25 242 10/27/10 - PUBLIC HEALTH - RES. 1005651 we can get those recommendations.2 But, no. Confidentiality is3 not an issue. I think we're still facing4 the stigma of HIV and AIDS and we're5 still facing the stigma of how to engage,6 educate and get the community to embrace7 their own health.8

Someone9 was going to talk about aging and10 HIV/AIDS, because there are a lot of --11 with the Viagra and Cialis and everything12 else coming down.13

That's right.14

I mean,15 particularly women who are widows and who16 get into relationships.17

Yes.18

They need19 to understand what that means in terms of20 their --21

People don't22 stop having sex because they get older.23

I beg your24 pardon?25 243 10/27/10 - PUBLIC HEALTH - RES. 1005651

People don't2 stop having sex because they get other,3 but -- is the person here who is going to4 speak to that?5 (No response.)6

We do go to --7 because we are in the community, we do8 get to talk to a cross-reference of9 people, and we do talk to the older men,10 who are oftentimes having an affair with11 a younger woman and they have a long-term12 affair or marriage with Deaconess13 Burnette. So when he drops her off at14 church a lot of times -- and this is just15 an example -- he's going back under the16 bridge or going back to his younger17 lover's house and it's in exchange for18 money and it goes like that.19 But the elderly are at risk,20 because they really don't think that HIV21 affects them. That happened after they22 took off their rock and roll shoes. So23 now everybody in their group is okay.24 And one of the hardest things to do with25 244 10/27/10 - PUBLIC HEALTH - RES. 1005651 the elderly population -- and I hope --2 this has been for us -- Diane, I know3 that's your group too, and, Tyrone, I4 know that's your group.5 The elderly generation is6 getting them to embrace, to embrace7 healthy attitudes, not just about sex but8 about diabetes, high blood pressure,9 eating well, getting exercise. So when10 we're addressing the elderly population,11 what we do is talk about all of those12 things, and then we wrap HIV into it and13 then we talk about Viagra and then we14 talk about making wise decisions at15 whatever age you are.16

Okay.17 Thank you very much.18

Two19 questions.20 COUNCILWOMAN TASCO:21 Councilwoman Brown.22

Madam23 Chair, let me just add that -- this is24 Brenda Cooper, even though she's on the25 245 10/27/10 - PUBLIC HEALTH - RES. 1005651 floor. She runs Horizon House. We have2 the only cafe that's in existence 24/7,3 because most of them close when the4 weather is good and all of that, which is5 night emergency, evening emergency6 shelter. But we deal a lot with mental7 health and people with special needs, and8 she's offering to help people -- she's9 offering to be a part of this group and10 to help in any way she can.11

Okay.12 Thank you very much.13 We will be working with14 Councilwoman Blackwell, because she15 co-sponsored this resolution.16

I've been working17 with people with HIV for 21 years, and18 when they come to the cafe or they need19 someplace that they need to stay, that's20 where they stay, with me, until I can21 place them. There's housing, and I think22 AACO does just a beautiful job. They all23 know me.24 And if Councilwoman Blackwell25 246 10/27/10 - PUBLIC HEALTH - RES. 1005651 had an appointment and knew that someone2 was coming in there with HIV or anything3 or any problem, I will come there and4 handle the situation. But she's been5 doing an awful lot of work with HIV. I6 know because I'm the one doing it, and7 everyone in the City -- I've gotten every8 city and state award. AACO and some of9 the people that are here know me.10 But the Councilwoman is very,11 very concerned about that. I'm at 330912 Melon. Whenever someone finds out that13 their lover or whatever, somebody is HIV,14 they come there, and I take care of them15 24 hours a day. They come in there 616 o'clock in the evening. I have a case17 worker that's there every day and I also18 have a psychiatrist is there on Mondays19 and a doctor on Wednesdays. You have to20 have these type of things in order to be21 able to move people along. And if you22 don't have these things -- they test23 people there. Everything is24 confidential, because if you say25 247 10/27/10 - PUBLIC HEALTH - RES. 1005651 something, I don't care what agency you2 with, you lose your job.3 So I'm willing to work with the4 agencies and help. I already do, but I'm5 willing to even do more for the ones that6 don't know me and know what the7 Councilwoman does.8

Thank you9 very much. Thank you.10 A couple of questions from11 Councilwoman Brown.12

I have a13 number of follow-up questions, but I am14 going to wait and anticipate the15 follow-up, I will call it planning,16 strategic planning session, that we'll17 do. I very much want to be a part of it.18 One recurring theme for me was19 the importance of having the services20 that you provide in neighborhoods, in the21 trenches where many of our persons are.22 What about those residents who23 are not comfortable going to the services24 in the neighborhood? They're just, quite25 248 10/27/10 - PUBLIC HEALTH - RES. 1005651 frankly, uncomfortable and, therefore,2 opt to, choose to go downtown where they3 can maintain a sense of anonymity?4 Comment on that, if you would.5

We have a6 program just for that. We have a7 specialist, and I'm probably using the8 title wrong, but a lot of people, as you9 would know, on our truck when we're out10 at night, they don't want to get tested.11 So we give them a card. They come to12 1207. It's very discreet. People don't13 know why they're coming there, because14 we're doing youth development. There are15 other people on the floor. We are very,16 very -- and I'm sure you guys are. We're17 very, very sensitive to the fact that18 this person has made a decision to come19 in our office and get tested for HIV.20 We're going to go get a glass of water.21 We're going to do whatever we can to make22 this person feel comfortable. And then23 they're enrolled -- if they're positive,24 we refer them to the case management25 249 10/27/10 - PUBLIC HEALTH - RES. 1005651 system, which has worked for us. And if2 they're not, then we enroll them in a3 series of workshops to teach them how to4 maintain their negative status and to5 adopt --6

So that's7 addressed?8

Yes.9

Thank you10 for sharing that.11

Because the idea12 is to have all kinds of interventions13 available to people. So that depends on14 where you're at is -- if you don't15 feel -- in our vans, if people don't feel16 like getting tested right then and there,17 we can easily make an appointment for18 people to do it in the office.19

Very well.20 My last question is, there is21 an AIDS Coordinating Office, and clearly22 there is a wide reach of services23 provided throughout the AIDS24 prevention/treatment community, which is25 250 10/27/10 - PUBLIC HEALTH - RES. 1005651 wonderful. My question is, how often do2 all of the stakeholders get together to3 just review and update what's happening4 and the like? I'm curious. And let me5 further clarify that. The academic6 community, because they have a role in,7 an important role; the direct service8 community, because you have an important9 role; and any other community where there10 is dialogue across all, for lack of a11 better word, professions. Because silos12 doesn't get us there anymore.13

I know --14

Why don't15 we have Ms. Baker come back up here.16

I think so,17 because I can only speak to the meetings18 that I am a part of, and information is19 transferred by e-mail or made available20 to all the providers and we self-select a21 lot of time what to attend. But I can't22 answer as to what all the type of23 meetings that they have.24

That would25 251 10/27/10 - PUBLIC HEALTH - RES. 1005651 be very helpful to know.2

And3 anything else you'd like to say, because4 you're going to be -- anybody else here5 to testify on this bill?6 (No response.)7

She will8 be our last witness.9

Great.10 (Witness approached witness11 table.)12

Thank you. I would13 like to say again, I so appreciate you,14 Councilwoman Tasco and Brown and the15 Committee, for bringing this resolution16 to the forefront and giving it the17 attention that it's receiving now. We18 needed to have this here happen.19 I concur with a lot of the20 testimony that I heard. I wish I could21 do more about it. There are some things,22 it's like we're going to look at these23 recommendations. Again, we have enlisted24 the support of Dr. Amy Nunn. But we do25 252 10/27/10 - PUBLIC HEALTH - RES. 1005651 talk to our community partners. We just2 had our Directors Forum yesterday. We do3 this quarterly. But in addition to that,4 we have prevention meetings where they5 meet with our prevention coordinator. We6 bring providers in for individual7 technical assistance. But we have an8 open-door policy. Any provider can9 contact us. We're readily accessible to10 them for concerns that they may have.11 And I do take these concerns very12 personal. It's like this epidemic is13 just totally out of proportion.14

So the15 quarterly meetings with all stakeholders16 that care -- and that's across17 disciplines, was the word I was looking18 for? That's across disciplines --19

Yeah, care and20 prevention services.21

Forgive22 me?23

Care and prevention24 services. So you have clinical25 253 10/27/10 - PUBLIC HEALTH - RES. 1005651 providers, community-based organizations,2 you know.3

That care4 for patients, and then there are the5 prevention programs.6

Got it.7 And so all of those meet quarterly, and8 then minutes are taken, I imagine, and9 shared with the entire composition of10 that coalition group so that folks are11 always -- I'm trying to -- is there a12 formal process? Because that then just13 helps minimize one other hurdle or14 criticism that any organization might15 get. To the extent that you can keep16 your constituents informed, it just helps17 in keeping the thread, the glue stuck18 with all of those who care about it.19

We don't take20 minutes at our Directors Forum, but we do21 disseminate information that is generated22 in those meetings. For consumer23 constituents, we have our Ryan White24 Planning Council, as well as our25 254 10/27/10 - PUBLIC HEALTH - RES. 1005651 Community Planning group that looks at2 prevention services and is made up of3 providers and consumers representative of4 the community, and they're open and5 welcome to anyone who is interested in6 that information. There's also a website7 for that for people to go on it, but8 there's plenty of literature about that.9

Okay,10 then. Thank you again.11

Again, with this12 here testimony, it's like -- I think it13 needs to just be put out there, that14 because of the progress with15 antiretrovirals, people are living long16 with the virus. They're an aging17 population. So I think some of the18 urgency has left in that regard, because19 people are living longer. Twenty, 2520 years ago people contracted HIV, they21 died right away. They lived a year, two22 years. Now people are living 25, 30, 3523 years on with quality of life because of24 these antiretrovirals, and that is a25 255 10/27/10 - PUBLIC HEALTH - RES. 1005651 success, but it's not a cure and we still2 need to do more. But I think it's lost3 some of that sense of urgency because4 it's moved from being an acute disease to5 a chronic illness. 8 I'm appreciative of our Mayor,9 who actually raised a flag that brought10 awareness this month of October. In my11 history, I have not seen that done12 starting from the top down. So I applaud13 that effort. And that the Mayor has been14 very much involved, having a liaison,15 Gloria Casarez, who works with our16 community organizations and very closely17 with AACO. We're very responsive to City18 Council when they have requests. We have19 worked very closely with Councilwoman20 Blackwell on the housing issue. The21 Commissioner, myself and Chief of Staff22 have met with Act Up to address these23 concerns. And certainly it is a housing24 problem, but, again, it's all of the25 256 10/27/10 - PUBLIC HEALTH - RES. 1005651 above. 12 AACO doesn't control that. 19 But we are going to take these20 recommendations seriously and try to see21 where, with our planning grant, where we22 implement some of these here things. We23 know that some of the interventions don't24 work. Part of that concern is is that we25 257 10/27/10 - PUBLIC HEALTH - RES. 1005651 receive our prevention funding largely2 through the Center for Disease Control,3 who has implemented the compendium of4 effective behavioral interventions. And,5 no, they don't work. There is not a one6 size fits all, but when we receive their7 funding, we're told that we have to8 select these here canned interventions in9 order to use their funds because they're10 evidence based. We do tell our providers11 if they have interventions that are not a12 part of that compendium, that they can13 bring them to AACO. 25 258 10/27/10 - PUBLIC HEALTH - RES. 1005651 We have several organizations located in2 Center City, but as the testimony you've3 heard, these organizations aren't just4 sitting in their offices. They are out5 in the community. And what we do find is6 is that, yes, you should have services in7 most of the areas, but a lot of times8 because of that stigma, people do not9 want to go in their neighborhood, because10 they don't want their neighbors or people11 that they may run into to know that12 they're going for HIV care services. 17 So I want that known, that we18 do have providers all over the City and19 they are trying to outreach to different20 communities. And we've done a lot of21 work, but, yes, there is a lot of work to22 be done, and I recognize that and I23 welcome this Committee and the follow-up24 actions that are going to come out of25 259 10/27/10 - PUBLIC HEALTH - RES. )4

Thank you.5 Thank you so much.6 Yes, ma'am.7

I just need8 one second.9