COUNCIL OF THE CITY OF PHILADELPHIA PUBLIC HEARING AND PUBLIC MEETING BEFORE COUNCIL COMMITTEE ON HEALTH AND HUMAN SERVICES - - - Room 400, City Hall Philadelphia, Pennsylvania Tuesday, 5/01/01 10:30 a.m. - - - RES. NO. 010116 - Authorizing the City Council Committee on Health and Human Services to hold hearings to assess the impact of HIV/AIDS on the citizens of Philadelphia and to evaluate the direction, the cost, the effectiveness, and the priorities of City-funded and City-administered HIV/AIDS prevention and treatment programs. PRESENT: COUNCILMAN ANGEL L. ORTIZ, Chair COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN DAVID COHEN COUNCILMAN W. WILSON GOODE, JR. COUNCILWOMAN DONNA REED MILLER COUNCILMAN FRANK RIZZO COUNCILWOMAN MARIAN B. TASCO - - - VINCENT VARALLO ASSOCIATES, INC. Registered Professional Reporters Eleven Penn Center, Suite 600 Philadelphia, PA 19103 (215) 561-2220 2 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 I N D E X Page Panel 1 Dr. Walter Tsou, Commissioner, Health Dept. Joe Cronauer, Co-Director of AACO . . . . . . 24 5 Pat Bass, " " " . . . . . . 27 6 Panel 2 Jane Shull, Exec. Dir., Philadelphia Fight. . 60 7 Julie Davids, Critical Path AIDS Project. . . 80 Hassan Gibbs, Advocate. . . . . . . . . . . . 94 Panel 3 9 Reverend Henry Wells, One Day At A Time . . . 111 Reverend Norris, Open Door Baptist Church . . 111 Otha Brown, One Day At A Time . . . . . . . . 112 Panel 4 Dorothy Mann, Executive Director. . . . . . . 129 Family Planning Council Ronda Goldfein, Executive Director . . . . . 138 AIDS Law Project of Pennsylvania Nurit Shein, Executive Director . . . . . . . 142 Philadelphia Community Health Alternatives Gary Bell, Executive Director . . . . . . . . 145 Blacks Educating Blacks About Sexual Health Issues (BEBASHI) Danny Horn, Education Director. . . . . . . . 157 Philadelphia Community Health Alternatives Albert Barrett, HIV Case Manager. . . . . . . 160 Philadelphia Community Health Alternatives Panel 5 19 Kevin Conare, Director of Action AIDS . . . . 163 Luis Salas, Prevention Case Manager . . . . . 173 Legal Aid Project Greg Goldman, Executive Director, MANNA . . . 176 Gustavo Velasquez, Division Director. . . . . 180 for Neighborhood and Family Development Congreso de Latinos Unidos Susan Higginbotham, Executive Director. . . . 185 AIDS Fund Immy Ferrara, Mothers' Voices . . . . . . . . 190 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 (Index, cont'd.) Panel Damon Rosenweig, Public Health Professional 197 Laura Lau, Program Coordinator. . . . . . . . 203 AIDS Services in Asian Communities Lisa Jordan, Manager. . . . . . . . . . . . . 206 School and Community Training Southeastern Pennsylvania Chapter American Red Cross David Moore, Behold - Bucks County. . . . . . 210 Shahiid Robinson, Ex-Inmate . . . . . . . . . 212 Barry Bush, ACT UP-Philadelphia . . . . . . . 217 4 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 P R O C E E D I N G S
To all of my colleagues in their offices, we're ready to begin. Please make your way down to the fourth floor. - - -
Good morning. Good morning. AUDIENCE MEMBERS: Good morning.
We'd like to welcome you here this morning to the Committee on Public Health and Human Services hearing on the AIDS epidemic in the City of Philadelphia. I'd like to say that we have a quorum in the presence of Councilman Angel Ortiz, who is the sponsor of the resolution; Councilwoman Blondell Reynolds Brown; Councilwoman Donna Reed Miller; and I chair the committee, Councilwoman Marian Tasco. Before we get started, we'd like to have the clerk read the bill into the record.
Resolution No. 010116, authorizing the City Council Committee on Health and Human Services to hold hearings to assess the impact of HIV/AIDS on the citizens of Philadelphia 5 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 and to evaluate the direction, the cost, the effectiveness, and the priorities of City-funded and City-administered HIV/AIDS prevention and treatment programs.
Thank you very much. Before we call our first panel, I'd like to recognize Councilman Angel Ortiz for a statement, and then we will recognize other members of the committee who might want to say something if they'd like to. And then we'll proceed with the first panel. Councilman Ortiz.
Thank you. AIDS has been a problem that began being identified with one community. It has now become the scourge of the Third World, as we have seen in Africa and in other places. But it also has kept on growing in urban areas such as Philadelphia. The gay and lesbian community have suffered from it, African-Americans and Latinos, specifically women, have begun to increase dramatically. The last time this Council held 6 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 hearings on AIDS was in 1987, I think. And we went through a time period in which new drugs came into the market. People really began listening to the educational process that was taking place. And it seemed that people got comfortable with the disease. And then you began hearing reports and you began seeing things and programs such as "60 Minutes," that people were out there beginning the same bad habits that led to the increase and the growth. AIDS could be stabilized, AIDS could be handled, you really -- you know, it's really not that bad, it's really not a disease that is totally fatal, and this and that. And in our high schools, in our young people the issues about safe sex really started going over their heads, the issue about using needles and exchanging needles and sharing them in our communities, and we saw again the curve to start going up. I think it's time that we brought everybody together -- the advocates, the Department, the City, the individuals that are out in the street doing the work -- and see where we're at, see what needs to be done so that we can 7 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 take this process to the next level so that we really can begin to handle it and we can really begin to put pressure in also the powers that be that AIDS continues to be a problem, and it continues to be a problem more so in poor communities than anywhere else, and that we need to be able to begin putting programs, bringing in money, and putting the instruments and the process together so that it becomes less of a problem until we find a final cure. Thank you, Madam Chair.
Thank you. Would there be any comments from any other members of the committee? (No other comments from committee members.)
I'd also like to recognize that we have been joined by Councilman Wilson Goode Jr. and Councilman Frank Rizzo. First we'll have our Health Commissioner, Dr. Walter Tsou come forth. (Witnesses come forward.)
Good morning, Councilwoman Tasco and members of Council's Committee on Public 8 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Health and Human Services. I'm Dr. Walter Tsou, Health Commissioner. I'm joined by our co-directors of the AIDS Activities Coordinating Office, Pat Bass and Joe Cronauer. And thank you for the opportunity to discuss the impact of AIDS on Philadelphia and the City's approach to combatting this epidemic. It's been over twenty years since the first AIDS cases were reported in Philadelphia, and the epidemic continues to grow and disproportionately our impact most vulnerable citizens. Today, there are over 13,989 cases of AIDS in Philadelphia. Of those cases, 6,905, or 49 percent, are known to have died; and 7,084, or 51 percent, are presumed to be living with the disease. In addition, while HIV is not yet reportable in Philadelphia, the CDC conservatively estimates that 16,000 City residents are living with HIV, many of whom who have not yet developed full-blown AIDS. It has been said that AIDS is an equal-opportunity virus. However, in Philadelphia, those most affected tend to be our city's most vulnerable residents, as Councilman 9 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Ortiz pointed out, poor people and particularly people of color. AIDS surveillance data shows that 74 percent of Philadelphians living with AIDS are African-American, percent are Hispanic. 6 Moreover, every section of the City is vulnerable 7 to AIDS, and AIDS cases are not evenly distributed 8 across the City. Rather, AIDS cases 9 disproportionately impact low-income communities, 10 including Kensington, Northwest and Southwest 11 Philadelphia. 8 percent of all cases 12 within the City are from three zip codes in 13 Kensington and North Philadelphia: 19132, 19133 14 and 19134. Seventy-five percent of those living with the disease are male, and the two major risk factors for AIDS are injection-drug users and men who have sex with men. However, trends show a 17 percent rise in heterosexuals with AIDS from 1995 through 1999. On a positive note, the number of deaths related to AIDS has steadily declined since 1994 due to the effectiveness of antiretroviral therapies. Additionally, as a result of these therapies, fewer of those affected with the virus 10 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 are making the tradition to full-blow AIDS. Unfortunately, this decline in AIDS does not necessarily indicate a slowing of the epidemic. The CDC estimates that 16,000 Philadelphians are infected with HIV and that 7 percent are unaware of their status and likely 8 infecting others. Moreover, a host of national 9 studies have noted a rise in unsafe behavior and a 10 growing complacency about HIV among those most at 11 risk, conditions, which if not addressed, could 12 lead to an exploding rate of HIV within the next 13 few years. Thus, the need for concentrated and 14 effective prevention services has never been 15 greater. 16 In the face of this growing 17 complacency, the City has waged a full assault on 18 the epidemic, and we support a full range of 19 prevention and care activities designed to ensure 20 that every citizen has the knowledge and skills to 21 protect him or herself and others, and that those 22 who are infected receive the care and services 23 that they need to build healthier, longer lives. 24 In Philadelphia, the vast majority of 25 publicly-funded HIV/AIDS services are coordinated 11 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 through the AIDS Activities Coordinating Office in our department. HIV/AIDS services provided through AACO have an annual budget of about $34 million, the vast majority of which is federal funding. Additional service are also provided and paid for through the City's health centers, Behavioral Health Services, as well as through individuals' private and public insurance. 5 million in federal funds through the Centers for Disease Control and Prevention.
We are one of only six cities across the nation to be directly funded by the CDC. However, we are also the only one of those CDCs that does not receive any of our state's CDC dollars despite the fact that more than 50 percent Pennsylvania's AIDS cases reside in Philadelphia. We continue to advocate for our fair share of those resources from the State which they receive from the federal government. AACO does receive a small amount from the State's own AIDS resources as well as $4 million in city general funds that are used to fill gaps in HIV/AIDS care, prevention, and 12 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 surveillance activities. The City's HIV care services are, in large part, provided through the Ryan White Title 1 dollars appropriated by Congress, and they're awarded to Philadelphia through a competitive process. Ryan White funds provide the vast majority of care services through AACO, which is $22 million, and they cover a nine-county service area in southeastern Pennsylvania and southern New Jersey. Philadelphia has competed extremely well for these Ryan White resources, earning a $2 million increase last year and a $4 million increase this year. AIDS surveillance is also conducted through AACO, which receives a $1 million grant annually from the CDC to conduct these activities. Fortunately, due in large part to our innovative planning and programming, AACO has been extremely successful in its efforts to procure increased federal support in a highly competitive funding environment. AIDS funding is used to conduct a comprehensive continuum of prevention and care 13 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 services. The priorities for these service are determined by two planning bodies: one for care and one for prevention. ), and Gloucester and Salem Counties in southern New Jersey. Decisions made by these planning bodies are based on where the epidemic is most prevalent and what services are needed and the availability of resources to support those services. Throughout the nation, Philadelphia's considered a leader in HIV planning. Our HIV planning efforts have been recognized by both the City's primary HIV service funders, and much of the work conducted by our planning bodies has been cited as a model for replication nationwide. Our planning bodies, which determine which services are provided and where these services are provided, base their decisions on science, community needs assessments, and the availability 14 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 of other resources. Our planning bodies are composed of communities memories who reflect the demographics of the epidemic, and they include a majority of people who are infected with HIV themselves. The care services center around medical care and an array of service sites across the City, including the City health centers, local hospitals, federally-qualified community health centers, HIV specialty clinics, etc. Federally-approved standard of care are required to be filed at out of these sites. We fund an extensive array of services to those living with HIV/AIDS to help in maintaining medical care. And in light of the large number of speakers today, I'm going to just simply list them. We provide: Medications; Case management services; Housing services; Emergency financial assistance; Home health care; Dental care for those who are underinsured or uninsured; Care outreach, which links HIV testing 15 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 sites with primary care services; psychosocial services, including drug and alcohol services; peer counseling; Food; Nutritional counseling; Transportation; Complementary therapies; Information and referrals; Day and respite care; Translation and interpretation services; Client advocacy; and A buddy companion service. In an effort to stem the tide of infection, AACO provides a multi-pronged approach to HIV prevention.
All prevention services focus on assisting high-risk individuals and those living with HIV to understand their risk, access counseling and testing, and learn safer sexual and injection behaviors and maintain safer behaviors for the protection of themselves and others. Our prevention efforts target those communities most at risk, particularly low-income people of color, those who have traditionally been disenfranchised 16 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 and hardest to reach. To ensure that our programs are accessible as well as culturally and language-appropriate, AACO has contracted with over 90 community-based providers, many of which are small and minority-controlled nonprofit organizations. These organizations deliver a vast array of care and prevention services directly to the neighborhoods where the epidemic has had the greatest impact. And recognizing that not all individuals respond to the same approach, AACO supports a variety of prevention services, which I will now list. We provide: HIV counseling testing; Prevention and case management; Outreach services; Interventions at the group level; and Health communications, including PSAs and using the mass media. All of these strategies funded by AACO are recognized by the CDC as effective interventions. Most have been scientifically studied and proven to have a positive outcome. In 17 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 the few cases where little documented evaluation exists, AACO is conducting its own outcome evaluation to assess the effectiveness of the intervention in question. Finally, I want to talk about special programs that the City also supports, innovative initiatives designed to ensure that those most affected by the epidemic have access to services that they need. We have, for example, a special program called the "Storefront Model," which has been developed by AACO and brings care and prevention service directly into high-impact neighborhoods where quality medical and social services are scarce. Literally located in storefronts, the program is operated by neighborhood organizations with ties to the community. Each storefront offers a variety of services, including medical evaluation and referral, HIV counseling and testing, care and prevention outreach, food, support groups, laundry, and clothing banks. This comprehensive range of services helps the program attract many consumers who might otherwise avoid HIV services because of the associated stigma or 18 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 because of the pressures of meeting more basic needs. Currently, these storefronts are located in the Kensington, Germantown, and West Philadelphia, cities working with neighborhood-based providers to provide additional storefronts in North and South Philadelphia. An array of services is also available to inmates of City's prisons, many of whom are infected or are at extremely high risk for infection. We have ten AACO employees who are stationed within the prisons and that conduct HIV prevention, education, voluntary confidential HIV testing, and condom distribution. Working with the Philadelphia prison systems, we have also implemented a system that assures that HIV-positive inmates receive uninterrupted medications upon their release. Additionally, a newly funded community-based care outreach program assists those who are released in accessing HIV care and other services. In an effort to harness the power and the influence of the City's many religious and civic organizations in the battle against AIDS, AACO has forged several innovative 19 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 collaborations. The City funds numerous faith-based organizations, including the Women's Christian Alliance, Catholic Social Services, and Positive Effect Outreach Ministry, which are an integral component of service delivery in highly impacted communities.
Additionally, the City has recently contracted with a longtime community advocate to develop a network of influential organizations, including the Black Clergy of Philadelphia, the NAACP, and other religious and civic organizations to fight HIV across the City. And, finally, to protect the City's youth, AACO funds a variety of school-based programs conducted by community organizations throughout the City. The Family Planning Council operates health resource centers in numerous schools that provide counseling for HIV, STDs, pregnancy, and reproductive health, as well as referrals for services. YO-ACAP and PHMC conduct theater presentations in schools to demonstrate the impact of HIV on young people and to teach prevention skills. We also have COLOURS, Congreso, ODAAT, and many others who provide 20 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 classroom trainings. AACO also funds a variety of programs to ensure that hundreds of out-of-school youth, who frequently are at a greater risk, do not fall through the cracks. The Youth Health Empowerment Project and YO-ACAP and conduct street outreach in venues where out-of-school youth congregate. The Attic and COLOURS provide a host of programs targeted to young gay, lesbian, questioning, and transsexual youth. Finally, to ensure that HIV counseling testing is accessible to everyone at risk, AACO funds a network of 40 different test cites across the City that last year provided over 30,000 free anonymous or confidential tests. As important as the quantity of programs, however, is their quality and effectiveness. AACO has developed nationally- recognized evaluation models for both care and prevention. The City also conducts a rigorous quality-assurance program. The agency regularly monitors staff competencies and ensures that all programs comply with standards of care and confidentiality. 21 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 As far as the future of fighting this epidemic, this testimony provides only a brief glimpse to the extent of the epidemic, its impact on our residents, and the many ongoing activities to halt its spread. Despite our best efforts and the efforts of countless experts, researchers, advocates and tireless AIDS workers throughout the City and nation, we have yet to eradicate this virus. Thus, I applaud and appreciate Council for providing -- for its continued ongoing support for Philadelphia programs to not only fight the epidemic but to provide quality care and support for thousands of City residents living with the virus. As the AIDS epidemic grows into its third decade and the number of new infections in Philadelphia continues to grow, especial among ethnic, racial, and sexual minorities, the City is moving forward in expanding services by and for those most impacted by this epidemic. The City is committed to moving forward with increased coordination of HIV/AIDS prevention and care services among the City's various departments, including AACO, DHS and the Behavioral Health 22 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 System. This coordination and collaboration will ensure a broader continuum of HIV/AIDS prevention and care services, reduce the duplication of services, and facilitate a system that can better meet the HIV/AIDS prevention and needs of Philadelphia citizens. Given the important role that the church plays in the life of many of those impacted by AIDS, the City is planning an HIV/AIDS summit to expand the collaboration and participation of churches and community-based institutions in removing the stigma associated with AIDS and to bring additional services to those most at need. In recognizing the need for renewed awareness of the continuing threat of the epidemic on the City and so many of its citizens at risk, the City is currently planning the introduction this year of a large public-health media campaign to bring the message of HIV awareness and prevention to every neighborhood.
This message must include information about HIV prevention, testing, care services, and the need to protect yourself and exhibit responsible behavior. Terms of funding. The City continues 23 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to recognize the need for additional resources to meet the increase in demand and cost for services, particularly care services. This problem is compounded by the fact that this year, our president proposed a federal budget that has level funded all Ryan White Care Act resources, which is a primary source of funding for HIV/AIDS services in Philadelphia. In order to address the growing need, we must continue to advocate with the State, which has thus far refused to provide Philadelphia with any of its federal prevention dollars. The State has awarded this funding based on its total number of AIDS cases and, as I previously mentioned, Philadelphia accounts for more than 50 percent of all AIDS cases in the State. And, finally, as we move forward, we must continue to dedicate available resources to the expansion of services to the neighborhoods most impacted by the epidemic and provide those services through neighborhood-based community organizations, which both science and common sense have demonstrated to be the most effective method of delivering services to those most in need. 24 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Thank you for your time.
Thank you very much for your testimony. Are there comments from members of the panel? Councilman Ortiz.
Yeah, Councilwoman Tasco just leaned over to me and said, "Why don't we get any money from the State?" I mean, what's the rationale, you know? They do it to us in the school system and with children, and so it is part of a pattern. But tell us the rationale for the record.
I am Joe Cronauer, Co-director of AACO. Philadelphia is the only one of the six directly-funded cities that receives no CDC dollars from the State, from its accompanying state. The State's rationale has been because we receive our own direct funding. We have appealed to the CDC to intervene on our behalf, but because they don't have a clear policy on the relationship between cities and states around HIV funding and 25 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 the State is not required at this time to give us funding, they have not intervened. So we remain the only city that does not have --
About $5 million. And they distribute that? Do we have a breakdown on how they distribute that? How much does Beaver County get, for example?
Actually, I don't know that. I know they distribute it across all of their counties, with the exception of Philadelphia.
Well, I would imagine that there are not that many cases in places such as Beaver County and areas like that.
Right, yeah. Fifty percent of the cases are in Philadelphia itself, and if you include the surrounding counties in Pennsylvania or suburbs, that accounts for 70 percent of the State's entire caseload.
Commissioner, you said that the growth in Philadelphia in poor 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 minority communities overall has grown by percent? 4
I said -- I spoke about -- 5 the 17 percent I spoke about is the increase among 6 heterosexuals with AIDS. 7
I'm sorry. I spoke about 10 how there's been an increase among heterosexuals 11 with AIDS, which has grown about 17 percent in 12 Philadelphia. And it turns out to be an important 13 new area that perhaps part of our public-health 14 media campaign will be focusing on. 15
And we can project that in 2002 and 2001, that has kept on growing.
Okay. And most of those heterosexual males that you're talking about, they reside in two zip codes, you said? Or three zip codes? That's the African-American and 27 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 the Latino community in Kensington and North Philadelphia.
The majority of our cases are in those zip codes, as you mentioned before, Kensington and North Philadelphia.
If you have AIDS in North Philadelphia, where do you go for treatment?
I'm going to let either Pat or Joe -- we have many places go for treatment.
Good morning. My name is Pat Bass. I'm the other co-director of AACO. We actually fund many of the programs in the North Philadelphia and Kensington and West Philadelphia area. For primary care, we fund the North Philadelphia Health System, APM. And, Joe, help me, are there others for primary care?
And the health centers. We have Congreso and APM, who provide case management. So that we've tried the make sure that the dollars are in those communities where the services are needed. 28 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Additionally, those providers like BEBASHI and Action AIDS, who are two of our larger case-management providers, also provide services in those areas. So that we are clear that we try to target the areas where the services are needed.
You estimate that at least percent of our population doesn't know 9 that it has AIDS or HIV? 10
And they are now 12 going out and propagating it and spreading it in a 13 sense? 14
Well, it's something that we 18 struggle with. We have looked at prevention, and 19 I think that one of the things that's been very 20 innovative with AACO is that we have now tried to 21 look at primary and secondary prevention. 22
But how do you reach 23 the number to estimate that 25 percent -- that 24 there are 25 percent of our population out there 25 with AIDS that really don't know they have it? 29 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
Okay. That is a CDC number that we get from Atlanta; is that correct, Joseph?
I think it's based on other national (indiscernible) prevalent studies. They can do blinded (indiscernible) prevalent studies about how often they detect someone with HIV. They also know it's sort of something about how much they would estimate the number of people with HIV in Philadelphia and they know how many tests have been done. That's how they can come up with an approximation about how many people do not know their HIV status, because if they know how much has been done, they know how many have been done in blinded (indiscernible) prevalent studies. And from that, they can actually make an estimate.
We've come a long way since 1986. And when I had a meeting here with the then-Commissioner of Health, and we talked about supplying condoms in the prisons, and at that point, that was not done and it was not even thought about it. 30 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 But in terms of AIDS in the prison, how has that -- what type -- do we know the population numbers that have AIDS? How is the distribution of prevention devices such as condoms and other aspects done? And how is the treatment within the prison happening?
Yeah, I can speak on that. Well, the primary medical care services is provided by PHS, Prison Health Services.
And we've had many complaints from advocates and other individuals about those services.
Yeah. I mean, what I can personally address are the services provided by the City Health Department, if Walter wants to talk about PHS. But we have ten employees that are AACO employees that work within the prisons, and they do two major tasks: One is education and skills building amongst inmates that are within the prisons; secondly, we provide all of the HIV testing in the prisons on a confidential basis so 31 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 that we encourage people that are at high risk for HIV to get tested, and we distribute condoms to prisoners who ask for condoms.
And I know that there's this issue of confidentiality, but do we have any idea of individuals within the prison system and those individuals that come out of the prison systems that are infected with AIDS and how do we monitor that situation?
Yeah, that is a real challenge. We have a few programs that are specifically addressing that issue. One is a program that we developed with the prison system so that when people with HIV are released, they receive a supply of medications when they get released. And we ask them for where they would like to go for medical care once they are out in the community. We have a medical summary that's provided by the prisons, and the Health Department will send that, after the person signs a release, 32 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to the medical-care provider that they intend to go to, to ensure that there won't be any interruption in the medications or in primary medical care. The challenge is working with individuals that are released to encourage them to actually access that care. That in all of the priorities the individual has upon their release, maintaining primary medical care and maintaining their medications is something that is very important that we have to focus on.
Commissioner, we've had experience now since, I would imagine, '86, '87 with AIDS funding and AIDS programs and HIV prevention. Do we have any data, does the Department have data in terms as to the effectiveness of the programs that we have, the effectiveness of the funding that we do? And if that data is available, can you make it available to us so that we can see it and study it. Do we have that type of ongoing evaluation of programs taking place?
Well, the short answer is, yes, we could have that data available. 33 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I think it's fair to say that in terms of HIV prevention dollars, we follow CDC best practices in terms of programs that have been shown to be effective. And those are the program that we actually implement in Philadelphia. In terms of HIV treatment dollars, I think the truth is that we have done a remarkable job in trying to make sure that we can provide HIV primary care services to individuals, including an extensive case management program, what we call "Care Outreach," to try to get people into care.
How do you measure effectiveness? You fund a program, that program comes back to you for re-funding or more funding. How do you measure whether the goals that they put forward and the objectives were achieved are being achieved and the dollars that you are giving and that we're dispensing are being used to the best 34 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 of our ability and getting the most use for it?
Okay, we have quite an extensive continuous quality improvement program where we have set standards for all of the service categories that are identified through the Planning Council. And we have a system where we go -- we have outcomes for each of those service categories. And annually, we collect data primarily in the case management and primary care areas and the dental as well as nutritional counseling. But we monitor all of our agencies for their service goals as well as the quality of the services they are providing. Our outcomes are primary care-focussed, and so whatever the service category is that we're funding, the goal is that folks will be connected through primary care, understanding that the clients will have to be connected when they are ready to be connected -- sometimes that takes a little more time that we would like. But, certainly, we spend a great deal of time and effort looking at continuous quality improvement. Any program that does not meet our standards is given a report with the corrective 35 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 action that they work with their program analyst to make sure that they are correcting their services, and then they get reports back. Additionally, I give a report to all of providers to let them know where they stand in terms of how their quality of care is being rendered. So I think that in general, we do a very good job of that. Annually, we require that the agencies, as part of our procurement, file a continuation application. And their continuation application, in addition to looking at what they've done in terms of meeting their goals, we also consider their quality of services, and that determines the level of funding that they will receive for the next year.
Thank you. Good morning, panel. I'd like to go 36 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 back to the conversation and discussion regarding the State's involvement or lack thereof. Did I hear you say that 50 percent of the cases for the entire state are in the City of Philadelphia?
And in recent years, the City has received no support from the State for AIDS prevention service medical activities?
We receive from State-supported tax dollars about $970,000 that has been level funded since the early '80s.
Yeah, that continues to today. And that is disproportionately low in terms of the actual State dollars that go to HIV prevention and care. Our main issue is around the federal dollars that have come to the State.
Which are the federal CDC dollars that every state gets and every territory to do HIV prevention across the state. And are the only -- we have 50 percent of the cases, and out of all of the -- there are six cities directly funded; we are the ones that receive no State federal funding, in Philadelphia.
And did I hear you say that that was partly because the CDC has no 11 clear policy across the board for how cities should receive dollars from the state? Did I hear that correctly?
Have you had an opportunity or thought about having conversations with the leadership of the Philadelphia delegation and/or the legislative Black Caucus to probably enlighten them and inform them and then ask them for their help as it relates to this, given the harsh reality that 50 percent of the cases are in our city? Have you had an opportunity to do that yet?
No, and I think that it's something that we should definitely do. 38 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I would -- we would encourage that, because granted, there's a lot on their plate, but they respond to issues that are brought to their attention, and they can be helpful. Since you say that these dollars come through the State from the feds, the same might apply with regards to the Philadelphia delegation on the federal level. Congressman Bob Brady and Congressman Chakka Fattah and Congressman Bob Borski -- a conversation with them might be helpful. And I read with interest the green booklet that you provided to us, particularly on the prevention side on what's happening. And you say that a lot of the cases are in the North Kensington section of the City. And when we think about prevention and the next generation, of course, for me, the following question is, And what's happening with high schools, if not citywide, in that area? Is there any relationship conversation, discussion, about informing high school students? Since those areas are highly targeted and there 39 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 are high schools in that area to get -- to just to inform them, enlighten them about this reality. Anything happening in that area?
Yeah. We have a variety of providers that are located either directly in some of the schools.
Or they are provided ongoing education at the classroom level or at like an assembly level, if it's something like a dramatic presentation, to enforce -- to reinforce with people their individual risk of HIV and to build skills.
Is there evidence 40 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 -- you mentioned best practice in prevention. So if I hear you saying that there is activity and a presence in area high schools, then there is best-practice evidence that says to the extent that you enlighten and inform high school students, it works with regards to not ultimately ending up with the disease. Is there supporting evidence to support that?
Yeah. Well, all of the interventions that we do, whether they're group level or individual one-on-one interventions, are all done based on methodologies that have been scientifically proven to be effective. So that we will not fund a provider to do something with a particular community, including youth, unless research has already shown that that is an effective way to create and sustain behavior change with that particular group of people.
And my final question is, these programs are located in schools citywide or only in targeted areas where there's a high presence of the disease?
I would say nearly all schools have some form of program or another 41 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 around HIV. And all schools are also required to have HIV education as part of their curriculum. That's something that happened, I think, in the late '80s or early '90s.
Thank you, Madam Chair. Good morning. Commissioner, during your testimony, you said something that interests me and I'd like to pursue. You mentioned that there are a number of people in Philadelphia that have AIDS, have HIV, and don't know it. What could we do better to identify that number of people? What can we do to encourage people at risk to come in and identify or test? It seems as though that's an area that really we should be concerned about, the people that have AIDS and don't know it. 42 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
What are we doing to encourage that test? I know early on when AIDS first became --
Well, I'll start and then I'll ask Pat Bass to finish. I mean, clearly, our goal is to try to encourage HIV testing, and it starts really at the school level where we -- it starts at the school level, where we encourage people to learn than more about the risk factors for HIV, and we ask those people who might engage in those factors that they get tested. And we have, in fact, as we mentioned, 30,000 tests that were done last year. We have over 40 test sites throughout the City. We have both anonymous and confidential test sites. But I'm going to turn to Pat; maybe she can explain a little bit more about some of the other efforts we do on that.
Before you go forward, could you just refresh the numbers. Could you tell me how many people you speculate -- and I guess it's speculation or data that you 43 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 receive from Atlanta. How many people in Philadelphia do you believe are infected that don't know it?
Well, we estimated that percent of the people who are at risk. Now, 7 what that number calculates to, I wouldn't 8 remember -- I wouldn't know off the top of my 9 head. 10
Well, it would be 25 11 percent of 16,000, which is 4,000. 12
So we have 4,000 13 people potentially affected that don't know it? 14
So what would you 16 do, or what are we doing to make sure that 4,000 17 people know that they're sick, that every time 18 they have a contact, that they're -- that to me is 19 one of the most important things I think that we 20 can do at this moment. 21
It's certainly one of the 22 things that we've struggled with, and we have 23 looked at outreach from what we do in Philadelphia 24 and also with what's happening nationally. 25 Additionally, this year, with the 44 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 reauthorization of the Care Act, one of the things that Congress has said is that we need to address outreach in such a way that we are identifying the folks who are HIV-positive who are not in care. To that end, we have completely revised our care outreach model, meaning that now our care outreach workers are in the community, they're connecting both primary care and counseling and testing. And so that we actually see this as a continuum, and the continuum being that once folks are tested and there's counseling, that we will stay with them until they become connected with a primary-care provider. We understand that folks may not be ready the day that they find out that they're positive; there's a time frame. And so we're clear that we have to do the supports that are needed to make sure that folks have the support so that they can then be connected to primary care. All of our outreach contracts now require that there's collaboration between the testing and counseling centers as well as primary-care providers. Additionally, most of these providers are now either working with case 45 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 management agencies, some of them are also case management agencies. Because I think the problem has been that HIV is not just a disease; it's also a social ill. And there are many things that we have not addressed around HIV disease.
The 4,000 that we're discussing here, at what point -- and forgive me for not knowing this. At what point once -- and they don't know that they have HIV, at what point do they start to decline or get sick where it becomes then aware to a physician or to the patient that they are HIV-positive. I understand that there's people that have had it for years and years and years and years that don't know.
I think certainly the folks who are HIV-positive, who are healthier when they start, probably stay healthier longer. Those folks who have other barriers and who are sick because of co-morbidities are folks who probably will exhibit the symptoms and will then decline more rapidly. We certainly know in our community that African-Americans and Latinos who come into care 46 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 frequently are sicker and that we have to -- and, therefore, they require a more intensive kind of care. And it's not just primary care: They need case management, you know it may be other issues around housing and food. So there are other things that we have to address.
The minute a person is identified, what happens with that information? If a person goes to a doctor, they're sick, and the results are that they test positive for HIV, could you tell us what the requirement is of that physician to report that, or is it confidential? I'd be interested to know how that's dealt with.
Right now, HIV is not reported, but there is a proposal for doing reporting come January 2002. The physician, of course, is obligated to know something about HIV, and our hope is that those physicians who know something about HIV would provide initial therapy, counseling on the disease and education, because that's really one of the most important parts. Those who don't know the care for HIV should, in fact, refer patients 47 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to people who do know. And strongly encourage that and we, in fact, fund a variety of very excellent care programs in the City of Philadelphia. But your whole gist of what you're describing, I think, is the whole purpose of this hearing today, which is, there is a complacency out there that people don't fully understand, and that by raising this awareness today, we hope to reinvigorate the Philadelphia community to realize that HIV still is out there, people need to come in and get tested. You might be one of the 4,000, for example, and that we need them to come in and get tested, and if positive, to get treated.
Doctor, could you give us a sampling of some of the diseases that a doctor is required -- I believe some venereal diseases, there's a mandatory reporting requirement.
Right. There's like 60 different diseases, so there's quite a lot. But, I mean, it starts from A to Z anthrax to --
And HIV is not one of those? 48 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
Currently, AIDS is reportable; HIV is not reportable. We anticipate that that will change sometime in the next year.
Thank you. You say that you ask people to come in and be tested. Why would -- what would prompt someone to get tested for HIV? I mean, if they believe that they don't have it, what would prompt them to do that? Because they don't feel well? Or maybe they're healthy. Like you say, you have healthy people who may have HIV. And, of course, I think Councilman Rizzo raised some issues of privacy. How do you assure that the issue of privacy will be addressed? But if I hear a commercial, Well, go get tested for HIV, does that mean that all single people should go get tested or all -- I mean, who would go receive testing, and how do you get that 49 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 message to them about why they should be tested? Do you give certain circumstances as to -- under which they should be tested?
Yeah, I mean that really is one of our most major challenges, and we are actually in the process of -- we have one program developed, and we're developing a another one, to specifically address that in addition to all of the outreach and all of the education we do on a group level and on an individual level. You know, the storefront model that we described before, where we have a variety of services, not all of which are HIV-specific, based in neighborhoods so that people can come in and get services and not necessarily be identified or have to even identify themselves as being at risk for HIV, but we can get them a message about their risk for HIV, and if they should be tested and are willing to be tested, that we can provide the testing onsite. The second effort that we're doing that will be initiated in a competitive process this summer is pairing our community-based providers with mass-media experts to deliver very targeted, 50 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 clear messages to those at risk about the value and importance of getting tested for HIV and messages to people who already know they're HIV-positive about the value of staying in medical care, and if they're not in medical care, getting into medical care, and the value of safer sexual and injection drug use behavior, if that is what they're doing, so that they can protect themselves and those around them in their community.
This is an additional follow-up for clarity with regards to the school. You mentioned that in the late '80s, it became a mandate for the School District to infuse in their curriculum AIDS education, if you will. So it's incumbent upon the School District to make sure that that happens, or is it incumbent upon the Health Department to make sure that happens? 51 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
They're audited by the Department of Education and so it's incumbent upon the School District.
And how they do that is left up to them, which could include interfacing with agencies funded by the Health Department?
Charter schools came later, but do you know if that mandate includes charter schools?
One last in the same frame of mind here. In terms of the young people in high school and junior high -- I have a daughter now that's 11 and it really worries me, the things that she is bombarded with and continuously sees. Have we seen any increase in sexual -- or maybe you may have some data on that, on sexual experimentation at that age? Because 52 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 it's through sexual intercourse and the sharing of needles that AIDS is transmitted. And do we see any incidence or rise along those lines in the ages of to here in the city? 6
I mean, we're very concerned 7 about young teenagers who might in fact be 8 involved in sex. We strongly support that people 9 should abstain from sex as the only way in which 10 we can guarantee that -- 11
I understand that 12 that's what we do, but do we see -- is there any 13 information coming into the Health Department that 14 says we're going to have to do something in this 15 area in terms education, in terms of condom 16 distribution, in terms of this, you know, in terms 17 of several things that need to be done. 18
We have -- our surveillance unit certainly trends all of this information, and we can make sure that -- we are very concerned about the youth population, and certainly this has been a concern for us for a while, and we are seeing this as an area that we need to continue to address. What I will do for you is to make sure 53 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 that we get the information from our surveillance unit to tell you what the incidence is amongst the youth and we can give that you information.
Later this week, I'm going to be giving testimony about sexually-transmitted diseases in Philadelphia and the epidemic we have in this city, and I think that it will illustrate some of the points that you are raising here and the importance that we have in the City of trying to be more vigilant about STDs in general.
In the issue of confidentiality, would name-based reporting be seen or could be a cause or a deterrent towards testing?
Yeah, there have been studies that have had mixed results, and I'm sure there will be a lot of people discussing this issue today. Certainly for some people, we would expect the possibility that it would be a deterrent for that individual getting HIV testing. Right now the regulations that the State is proposing, the State Health Department does include HIV name reporting, and we have 30 days to 54 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 respond at this point, and we're taking a look at how --
If you make it mandatory, how would that affect the individuals who want to come forward to test themselves but don't want to really put their names out there in that manner? And would that be a deterrent to testing and would that affect adversely our ability to be able to take a hold and manage the disease?
One thing that we are definitely doing, no matter what the state of HIV reporting is, is maintaining all of our anonymous HIV-testing sites, which means that anyone can go in and get HIV testing and not give their name. They can do it anonymously, they can do it for free, they can do it in a variety of --
I understand that, but if legislation is passed that says it has to be name-based and your name has to be given, would that act as a deterrent for our citizens going forward and getting tested? Your opinion, your stand.
My opinion is that the 55 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 results are mixed and that we need to take steps such as maintaining anonymous testing to ensure that people with HIV can continue to -- or that people at risk of HIV can continue to get testing without having their names reported.
Thank you very much. Councilman Rizzo and then Councilwoman Brown.
Thank you. Could you possibly address this, and I truthfully may have missed it. Could you tell me, is there any data on HIV that indicates whether -- and I know that there's been a lot of controversy and discussion many years ago. Is there any way -- is there any knowledge on whether HIV is contracted through heterosexual sex or other -- is there a big difference? Have we been able to identify the community where it is most a big problem? But is there any way -- you know, it's a difficult question to ask, and we're here to learn, at least I am. 56 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Is there a way that we can determine how HIV was contracted?
We know that HIV is a virus, that it's found in body fluids, including blood, that the most common methods that have been identified for contracting HIV, including sharing needles and men who have sex with men. We do know that heterosexual activities is also a way in which people can contract HIV. The way we know this is that we actually, when we get test results that are positive, we do interview individuals about some of their risk factors that they -- and we have a pretty good idea of what are the most common trends in Philadelphia in terms of what are the risk factors that lead toward HIV. And from that, of course, we use this knowledge to try to direct our prevention programs most effectively.
My colleague and sponsor of this resolution raised an important public-policy question for us, and that is around 57 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 this notion of legislation as it relates to privacy. And I heard your opinion and, of course, I consider you an expert, but I think implicit in your opinion for me is the question, has the Department as of yet decided a policy with regards to the issue of privacy and the assistance or not that could bring in -- bring forward those who are affected? Have you --
Well, I think it's fair to say that the State has a State requirement on HIV confidentiality.
Which is known as Act 148, which is very, very good, we think, in terms of making sure the only way that HIV information can be released is through the written permission of the person with HIV.
Or in the case of physicians who are directly involved with the medical care of that individual, they can -- and in that situation, they can talk about it. There are major, major restrictions on how and who may have access to the HIV 58 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 information, and I think that part is good. In terms of the recommendations in the future, we strongly support -- and we don't believe HIV testing will ever work unless there are strong confidentiality laws that protect that.
And we strongly support that, and we anticipate that under the new HIPA regulations, that those confidentiality laws are going to be reinforced again, and we're going to follow those rules -- not just HIV but all test results of patients should be confidential information.
I have just one final question. I want to go back to the State funding versus issue. You receive funding from the CDC, all right.
And then the State receives funding from CDC. Those are the dollars you're talking about?
So you get money from CDC, then they also give the State funding, and so you want to get funding from CDC as well as from the State's CDC funding.
Yeah, that's correct. In all other instances, the cities also get the CDC funding that the State has, a portion of that as well, because when the states apply to receive the dollars from the federal government, they do it based on the entire state's number.
But then they don't give you any of the money that they received.
Okay, thank you. Any other questions? (No further questions.)
Next panel. Thank 60 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 you very much.
One of you may want to stay around in case there are other questions. I know you have busy schedules, so --
Okay, thank you. We next call Panel 2: Jane Shull, Executive Director of Philadelphia Fight; Julie Davids, Philadelphia Fight, Project TEACH; Hassan Gibbs, Midnight Cowboy Project. (Witnesses come forward.)
Good morning. Could the Sergeant-at-Arms get the testimony, please. (Copies of written testimony distributed by Sergeant-at-Arms.)
Good morning. Would you state your name for the record. We welcome you to City Council one more time -- again and again.
Good morning, Councilwoman Tasco and members of the committee, my name is Jane Shull, and I'm the Executive Director of 61 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Philadelphia Fight.
What we'd like for you all to do, if you possibly could, is summarize your testimony. We have the copies written that will be entered into the records as presented. But in the essence of time -- we have a number of panel presentations -- we would like to have you summarize your testimony. Thank you.
I just want to briefly say that Philadelphia Fight is an AIDS service provider in Philadelphia. We have several programs. They include the Jonathon Lax Immune Disorders Treatment Center, and I provided you with our brochure. We care for 1100 people in Center City. We offer HIV primary and specialty care with infectious disease providers, mid-level practitioners. We have other services on site as well. Our programs are available to everybody, without regard for ability to pay. We see a great many uninsured people. We see many 62 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 people who are not only uninsured but uninsurable because of some issue, like they have been convicted of a felony in the state at some point in their lives. We also have a wide menu of consumer education programs, including: Project TEACH, which stands for "Treatment Education and Advocates Combatting HIV," which you will hear more about today, has graduated 600 people from an intensive nine-week training program over nearly seven years and provides peer counseling at 45 outreach sites. The Youth Health Empowerment Project, which was mentioned a couple of times before, is another one of Fight's programs. YHEP has 12 outreach sessions each week in neighborhoods throughout the City. They reach about 20,000 high-risk youth each year. They have a drop-in center that they just started. They have counseling and so on. We sponsor the AIDS Library, which is a library -- I won't go into it more. About 3500 people use it each year. We sponsor the Critical Path AIDS 63 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Project, which allows people free dial-up access to the Internet if they are affected by the AIDS epidemic. It sponsors 131 nonprofit Web pages. I should actually say we have free dial-up access in the 215 area code; we are hoping to expand to 610, 856, and maybe 600. And we also do research, which is probably the least relevant to what we're talking here, so I will skip that part. I think as look at the AIDS epidemic in our city today, it's important to recognize that not only is it not over, not only is it not nearly over, but recent reports presented at scientific meetings suggest that if anything, the epidemic is about to become unimaginably worse. In order to see what could happen here, we need only look at Sub-Saharan Africa. There are million people 19 with AIDS in Sub-Saharan Africa, of 36 million 20 worldwide. In many countries on that continent, 21 an average 15-year-old has a better than 22 50 percent chance of dying of AIDS. 23 There are seven countries where 20 24 percent or more of the people are infected. Two 25 years ago, for example, 35 percent of the adults 64 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 in Botswana were living with HIV, 20 percent of the adults in South Africa were living with HIV, and that number had risen from 12 to 20 percent in just two years. The economic, social, and human costs are staggering, unacceptable, and --
-- and very possibly unavoidable. That there should be any question whatsoever that we in the so-called developed world should not be doing everything we can to provide to these countries the drugs that will keep people alive at a cost they can afford is reprehensible. Yet, in spite of a huge international effort on behalf of affordable drugs for the less developed world, we have as yet seen only symbolic victories. So as things stand, tens of millions of people will die who didn't have to. What does this have to do with 65 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Philadelphia? There weren't million affected in Africa 10 years ago, and there are African countries, including countries in Sub-Saharan Africa where, in fact, it didn't happen. So what happened there was not inevitable and it isn't inevitable here either. The first conference I ever was involved in with AIDS was in 1987, sponsored when I was still at the Institute for the Study of Civic Values. A physician, Dr. Robert Swenson, who is still a physician at Temple University, gave a little presentation, and he said, you know, an epidemic starts with one little group of people and then it expands and then it moves into a second wave and then it moves into a third wave. Where Africa was at that time is where North Philadelphia, Kensington, West Philadelphia are today. That's what it has to do with Africa. There was some truly terrifying epidemiology presented at the Eighth Conference on Retroviruses and Opportunistic Infections held in Chicago this past winter. This is the most prestigious American meeting on HIV. There were two studies presented there of young gay men of 66 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 color who have sex with men. One of the reasons we use the terminology "men who have sex with men" is that particularly in communities of color, people who do have sex with men do not identify as gay. And if you talk about people who are gay, you're going to miss the overwhelming majority of people who are at risk of contracting and then passing HIV. Both studies found that one-third of young men of color who have sex with men were infected. Six American cities. One-third of young men of color who have sex with men were infected.
We were not included, but there is no reason, given everything else that goes on. The cities were cities like New York, Chicago, Los Angeles, Atlanta, Newark. There is no reason to believe it's any different here. Further, because they saw this statistic, which surprised even them, they had a statistician go back over the data to try to figure out why this might have happened, and this 67 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 is the part that I think is the most scary part. They wanted to see if perhaps these young men were infected because their behavior was exceptionally reckless. The young white men who have sex with men had rates way, way lower than this. So they asked, did they have more unprotected anal sex? No, they had less protected anal sex. Did they have more sexual partners? No, they had fewer. Were they more likely to share needles? No, they were less likely. So what that means is, when you start to have this kind of infection rate in a community and one out of every three people you encounter may be infected, it doesn't matter if you're more careful; the epidemic is just going to keep growing and growing and growing. And a second fact, which is not from particular studies but which is well-known, is that there are very high rates among these groups of people of also having heterosexual sex. And we've talked a lot about who are the people who are infected and who don't realize that they are at risk. From our experience in the Lax Center in treating women with HIV, a lot of times it's 68 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 because they're having -- they have behaved in ways that are absolutely not outside the standard behavior in their community, simply not outside. And yet, one of the two or three sexual partners they've had in their lifetime, to one of whom they might be married, had HIV and did not tell them. What can we do about this? First, we really do have to remember that in every country of the world, regardless of how HIV first enters the population, as the epidemic matures and begins to concentrate among the poorest and most disenfranchised people, and the same thing has happened in the United States. In Philadelphia, as the Commissioner did mention, we've seen the epidemic go from an epidemic that appeared to be concentrated among gay white men to an epidemic of the disfranchised, the alienated, and the poor. If you use street drugs, you are at huge risk. If you are non-white, especially African-American or Latino, you are at huge risk. The highest percentage increase in the second half of the '90s in Philadelphia, over 60 percent, occurred in that kind of Frankford-Kensington area of the Lower Northeast and was actually higher 69 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 than the percentage increase which was in North Philadelphia of 48 percent.
Do we have any data, besides that it's a poor community and so on, that can explain that?
" And I think that that's really the point, that the reason for what we are seeing now is an epidemic of people who are vulnerable. The information on how not to get infected has been out there a good long time now. And I would say that I do disagree a little bit with some of the -- one of the things that the Health Department people said. From my understanding of public health, there is not a lot of evidence that simply giving people information is going to change behavior. They have to have another reason to change their behavior. 70 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Two of those reasons that are very important that I think we cannot neglect is that behavior does not change for individuals; it changes when it changes in the community context and in the family, etc. And the second point is, behavior will change when people think there is a reason to change their behavior; there's a reason that they have a future. And, you know, we've been hearing about this great economy in the last presidential election, but as we all know, it kind of passed a lot of our neighborhoods by. I think the third thing, which is more anecdotal, but I think that, you know, we are all, who treat people with AIDS, seeing far higher percentages of people with mental health diagnoses, with substance-abuse issues and so on, and the issue is that these were people who were vulnerable in the first place, and we don't have adequate services for that, we don't have adequate ways to address it. And so people become reckless, lose control of themselves temporarily. I mean, there's big, big, big correlations that have been found over and over again between ingesting alcohol on the same night that you have 71 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 unprotected sex, for instance, many studies. And if you're interested, I can send you studies. And it makes people vulnerable. My second point is, we need to remember why there are over drugs to treat AIDS, a 7 disease that's been recognized for over twenty 8 years this June -- although it is twenty years 9 this June -- while there are only a handful of 10 drugs to treat, for instance, tuberculosis, a 11 disease recognized since Biblical times. 12 Unlike any other epidemic or disease in 13 human history, the difference has been consumer 14 involvement at every level of the AIDS epidemic. 15 People with AIDS, beginning in the '80s, 16 continuing to the present day, have refused to see 17 themselves as victims and behave passively. 18 Instead, they saw themselves as consumers, 19 activists, participants in the decisions that 20 would affect their lives, and they demanded their voices be heard. We in Philadelphia have contributed enormously to this by working hard as a community to racially, ethnically integrate the service system, to train consumers, including many people 72 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 of color with limited formal education, to understand the natural history and treatment of HIV, to learn to advocate for themselves, but also to advocate as a community, in doctor's office, the hospital, and collectively influence public-policy decisions. It's not possible to make a decision, including how the federal government spends its science dollars and how local government spends its service dollars, without the involvement of consumers and people representing organizations of people living with AIDS. And of all the work that Philadelphia Fight has done, I think the most important thing that we have done and what we are proudest of is Project TEACH, because we have contributed, through that, 600 graduates of people who have participated, who have advocated, who have been involved at every level as consumers and policy decisions. And there's many graduates of Project TEACH here now, and actually the current class is here -- and I'm not going to ask them to stand up because of confidentiality issues, but they are 73 5/1/01 HEALTH & HUMAN SVCS. - RES.
010116 here participating in this hearing because they've gone through this program and I think they understand now -- they understand how important it is. This city and this community have done better than most in transforming our local service system, and it's something we really should be proud of as a city and that really needs to be supported. But, third, we need to remember that the AIDS epidemic has really -- what it's done is exacerbated the problems of an already- overstrained public-health system. We talked a lot in this hearing so far about how prevention dollars don't come to Philadelphia. We should also remember that we live in a state that has historically have very low Medicaid reimbursement rates, little interest in the welfare of poor people or people of color, and a legacy of a series of governors who believe that saving a few tax dollars and generating these enormous budget surpluses was much more important than saving lives -- in any social service program. As a result, the resources to provide 74 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 for people with AIDS are not there, and I don't think we should lay the fault for this with the local AIDS service system or with the Health Department or the AIDS Activities Coordinating Office. In fact, I think it's important to acknowledge that the current co-directors of AACO, Pat Bass and Joe Cronauer, have taken very significant steps to professionalize the AIDS service system, that its history of petty squabbles and warfare is really now a thing of the past, and that there is a service system in place that care for people with HIV, which there really wasn't in the past. But we don't have enough resources for these service that are really a matter of life and death because we argue over the small -- the ; $22 million in Ryan White dollars, where there are hundreds of millions of dollars in Medicaid dollars -- in Medicaid that are now HealthChoices over which we have no influence. And one thing that I want to say to members of this committee is, we really need help. In clinical care, the State of Pennsylvania reimburses about $10 per patient per month. We 75 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 had occasion recently to do a computer run of all the recent visits entered in our database. We had about 1,000 patients at that time -- we now about or 1200 -- and 7500 visits entered over an 8- 6 or 9-month period less than a year. So we were 7 seeing our patients an average of seven times -- 8 actually, some had twenty visits because a lot of 9 times, these people are really sick people. They 10 can't be taken care of for $10 a month. This is a 11 life-threatening illness. And the issue is HealthChoices. There has been a coalition of AIDS service providers that's been meeting with Pennsylvania HealthChoices with the support of the current and past commissioners of the health for several years now, and we can make a few small changes, but we really can't get very far, because the real decisions are being made in Harrisburg by a legislature which is unwilling to appropriate sufficient funds to take care of sick people who happen to live disproportionately in the southeastern corner of the State or who are African-American or who are Latino or who are poor. And I think that this is probably the 76 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 single biggest issue. We are at a time now where if get yourself to HIV specialty care, you will live, you will live. But if we don't have the resources to take care of people with the growing epidemic, then people will die, who really will die needlessly. Another example: In the year 2000, the reason used up its original medications allotment from federal funding in less than three or four months, and it was for the same reason: people need access to HIV medication or for common complications of HIV such as hepatitis C, for other conditions that they might have such as diabetes or high blood pressure or if they are uninsurable.
And the problem is, again, the overall lack of funding for these services. Everybody had to scramble to make up the funds, and remembering that this is always a zero-sum gain. During the eight years of the Clinton administration, there were two huge increases in Ryan White funding, and there were small but steady increases during the intervening years. 77 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 The Ryan White funding pays form, among other things, medical care, case management and so on and services for people with AIDS. So we seem to be in relatively good shape, but we will not be for very long because now George Bush is president, Republicans control Congress. There will not be increases. And unless we as a community and the communities like us all over the country and all over the state can find ways to effectively organize, we will be playing in a zero-sum game, and we will be in a situation where the resources will, in effect, shrink per person because the numbers of people with HIV are rising. One small thing that I think this city could conceivably do to address it is at the time when then-Mayor Wilson Goode provided City general fund money for the HIV epidemic, he was the first mayor in the United States to do so, and it was the largest allocation for several years. That allocation has apparently not changed at all since whenever that was, which was around like '86 or '87. So if that could happen, if we could see an increase in general funds, it night to some extent 78 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 serve to mitigate the problem. But I think basically, the issue is we really all do need to stand together, we really all need to work particularly in relationship to Harrisburg to get more dollars into this city, and we absolutely -- we really need to remember that we are not going to stop the AIDS epidemic unless we understand that we must concomitantly address all the other problems that are making people vulnerable to HIV. Thank you very much for your attention.