Tell me, what is your plan to deal with Harrisburg? They are presently now in the budget phase and what is the advocates' and provider plan for reaching out to Harrisburg and the State representatives from Philadelphia who represent us in Harrisburg?
Well, I would say we probably, as a community, don't have anything like the plan that we should have. I think people go and they speak to their individual State legislators as individuals. We have had some 79 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 meetings with them but I think that, you know, one of the problems that I think we face is that we have an incredibly over-burdened social services and clinical care system, and we need some guidance in what would be the most effective way to get the attention of Harrisburg. And we need some help.
Well, I think the help can come from meeting with the State legislators from Philadelphia to develop a plan, because they know best how to lobby their colleagues. And certainly, when I first came in Council in 1988, I mean, the community was here in City Council en mass protesting additional dollars for health services for money for AIDS prevention. So I think you have to take that show on the road to Harrisburg collectively. And so that means that you all have to organize and begin to develop your own strategy to reach out to Harrisburg, because if they don't see any large lobby or any -- I mean, what happened to the marches that we used to have. I mean, you got to go back to those days so people could understand that. 80 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I could speak to that. My name's Julie Davids, and I'm the Director of the Critical Path AIDS Project, and I've been a member of ACT UP-Philadelphia since 1990. ACT UP-Philadelphia is the nation's largest all-volunteer grassroots AIDS activist group, and many of our members are here today. We have gone to Harrisburg many times, and are going there actually, in all likelihood, next month because of our concern that this city is not going to the block the names-reporting proposal and that this city abrogates its responsibility to protect the confidentiality and the lives of people with HIV in Pennsylvania. Every small town and every rural place in this city is in jeopardy. Of course, we always talk about more funds needed. We have fought for access to HIV specialists in the HealthChoices Program and (indiscernible). We have fought for greater inclusion of drugs in the special pharmaceutical benefits program, which is a joint federal- and state-funded program what provides AIDS medications for those who are under- or 81 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 uninsured. And we will continue to. We also believe that it's important, though, to have the backing of the City to stand by the safety of people with HIV and have really great concerns at this point, when our own public health officials will sit at this table and not guarantee that they will oppose calls for names- reporting, even though they have in the past, even though when it's been opposed by every major AIDS organization in Philadelphia and most across the State, and even when it's been clear that people with HIV in this city have said they would not have gotten tested if they thought their names were going to be turned over. So we see this, as advocates, as a partnership. We see this as a partnership where we work together with our officials, with our legislators to protect lives and to get more money for health care, and that part of that partnership is not taking these easy, shortcut answers that we're kind of handed from the CDC when they say it's better with names, because we don't need names. So we look forward to continue to collaborate in this manner, but we can't split our 82 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 forces by jeopardizing lives in this way.
Because I think it's important that it be on the record. The issue isn't names-reporting or no reporting; the issue is, will people be reported by name, or will we generate what's called "a unique identifier," a number that can only be assigned to a person once to report them. And the way do you that is you do something like their date of birth and part of their Social Security number. There many ways to do it. And there are some -- I think states -- 16 there are people here who know better, but there's 17 something like that 19 states that are doing that. 18 So we don't have the choice of not 19 reporting HIV or names; we have another choice.
Let me ask a question that may be controversial, and certainly it has crossed my mind a couple times, about contracting AIDS -- I mean HIV. How do women transmit HIV since they are the host in a relationship, other than through the needle? I 83 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 mean, sexually, how do they transmit it?
The African AIDS epidemic has always been a heterosexual epidemic, meaning it's been transmitted through heterosexual sex, women to men, men to women. And for many years, there's been this question, well, maybe there's some other strain that makes it easier to transmit in Africa. There was actually just information published in the scientific literature, I think just last week, something like last week, where this question has now essentially been definitively laid to rest. People have thought that the answer to that question was no for a while, but somebody did something, which I don't understand, but they reported that there is no 18 difference in the type of HIV. What is different in the United States is that the epidemic entered the population, in the beginning, in a group of gay white men who rarely had sex with women. That's the only difference. As time has gone on and now there is more heterosexual sex going on among infected people we are seeing increases an specifically, we 84 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 are seeing increases, and specifically, we are seeing significant increases in this city. We actually saw a line crossed about two years ago, I think, with heterosexual sex and men who have sex with men in terms of transmission -- that is heterosexual sex being more common, and that of course includes women. But we are seeing transmission going both ways. So the only reason it didn't happen was because there weren't enough people who were infected or having heterosexual sex. It's believed to be somewhat harder but not so much harder that it won't happen.
I guess my question is, who's transmitting it? Is the transmitter a male or a female?
So how does a female transmit it? How is it transmitted?
I can speak to this biologically, which is that, as many of you know, HIV itself on the surface of the skin is harmless 85 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 and does not enter the immune system where it latches on to key cells, where it regenerates itself. What's necessary is that HIV has to enter the blood stream or via mucous membranes. Because of this, this is why adolescent girls, speaking of some of the earlier questions, are actually at greater risk from the same number of acts of unprotected sex than older women, because they have only one thin later of non-immune-system cells between the cervix, that the immune-system cells are right there and it's easier for HIV to latch on. As women age, the cell barrier gets bigger. So actually, women who are young women can pick it up more easily, so to speak, okay? If men are having sex with women that's unprotected and HIV is in the sexual fluids of women, it can enter their blood stream through a small cut that they may not even know they have, through a sore that may be painless. There's many different ways that it can happen biologically. I think it's also really important to remember that folks who are heterosexual who are getting HIV or who have all kinds of, you know, 86 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 sexual practices or identities, a lot of what's transmitting HIV in this city and in this nation is a needle. And that doesn't have to happen.
You talked about the study earlier in your testimony, you talked about a study where you said that -- I believe, that African-American males were not as careless -- weren't any less careless -- more careless than the other group but the epidemic -- could you explain that a little more to me. How does the epidemic begin, and if their behavior is no worse, then what is their -- how does the epidemic begin?
Well, I think you have to see it as happening over time, and I think what's happened is over time, more and more and more people get infected in a community, and then there's a point at which there was so many people infected that it kind of tips over in terms of everybody's risk. And after that, it isn't going to matter whether you think you're being careful or not because so many people who you might come across are actually infected. It's as if -- you know, in a group of 87 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 100 people and it's 1990 and they walk around shaking hands with each other, whether they're going to get a cold or something. In 1990, ten of them have a cold. So if they only shake hands for a couple of minutes, by the time you're done, maybe twenty will have a cold. But if what happens is that thirty people have a cold, that is one-third, and they walk around shaking hands even with one person, at the end, sixty are going to have a cold. And if they shake hands with two people, probably everybody will have a cold. And it is analogous. I mean, those are exercises we used to do to try to show transmission in the '80s. So it grows slowly, but there's a point at which it starts to take off. And what I think is extremely frightening -- and I've talked to some of the people at the CDC who did this research, 'cause we actually had one of them visiting us yesterday -- is they think it's extremely frightening too, what this could mean. And, again, I think it is very important to emphasize that -- I don't remember the percentage, but it was a very high percentage 88 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 of the young men in this study also had sex with women. And it's unlikely, from what they found in interviews and so on, that they were disclosing their HIV status. And, of course, as has been said before many times, a lot of them didn't know.
I'll just make some brief comments largely based on some of the things that I've heard today.
I'm Julie Davids from Critical Path AIDS Project. Speaking of the assessments of whether programs work or not, I just wanted to point out that Project TEACH is evaluated extensively through knowledge (indiscernible), and behavioral questionnaires and surveys with participants pre- and post-tests and both quantitative and qualitative research and has been shown to increase people's knowledge about HIV and its treatment, to increase their idea that they can take control of their treatment and stay healthy, and to -- and what they have stated change their 89 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 behaviors for healthier practices. So we've been extensively evaluated. I'd like to point out that across the country, it's estimated that 30 to 35 people -- 30 to 35 percent of all people with HIV have hepatitis C. And we believe it's higher here in Philadelphia since a high percentage of our HIV cases are associated with past injection drug use. So I think it's important that we no longer delink these things. It's very clear that in Philadelphia that hepatitis C is not just for firefighters; it's a vast public health problem. And if you ask anyone in here today, What's the hotline to call to find out what to do if you may have been at risk of hep. C, where is the practices that your doctor knows if he or she should or shouldn't do if you're diagnosed with hep. C and HIV? How -- who is going to train you to keep your family safe based on possible transmission risks? because it is much easier to transmit hep. C than HIV. No one in this room 23 would know because there's no answer to those questions. So we cannot talk about HIV without talking about hepatitis C. 90 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 I'd like to quickly move away from Center City just for a moment to talk about a place up where to percent of people are 5 HIV-infected. And even though it's known that 6 they're HIV-infected, they are sick and often 7 dying of preventable or treatable infections. 8 There is a very high rate of stigma 9 where their peers are actually encouraged to 10 stigmatize them and they're further at risk, and 11 they're not told how to protect their families or 12 their partners and kind of left to drift to die. 13 You may think I'm talking about 14 Sub-Saharan Africa, but I'm not; I'm talking about 15 the Philadelphia County correctional facilities. 16 And these facilities have a for-profit contractor, 17 Prison Health Services, that is supposed to 18 provide health care, that is supposed to be 19 overseen by our health department, not just the 20 prevention services and the transition services are provided by the Health Department; our City government is supposed to oversee Prison Health Services and should be able to tell what's going on here and why people are dying. There is a Town Meeting happening 91 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 tomorrow at Temple University where formerly incarcerated people with HIV, who were fortune enough to come out alive from this system, are going to talk about what they experienced and what they saw in terms of misdiagnosis and mistreatment. We have people who are going in and just waiting for a trial 'cause they can't get bailed out, that are missing their treatment and are becoming incredibly ill or even dying. So I won't go into all of the details now, but it's incredibly important.
You know what bothers me about that? That one of the problems is that we asked for information, and the City Solicitor sat there, and they hired a consultant to come in and evaluate that health system and that company and the services that were provided. And they said to us, even though they paid the consultant, the consultant had the study done, that they could not release that study to us. And next time around, when they come forward, we will subpoena the study. Because that's information that the public should know. And if we pay for it, the taxpayers pay for it, 92 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 the taxpayers have a right to understand what they are paying for. And I do not believe that anything of that sort should be privileged and hidden. So next time around, we will get that report in the next hearing.
Good. I think it's also really important to remember that what they say they may be doing and they may have stated policies and procedures that absolutely aren't being followed, and we need to go with the overwhelming eyewitness and (indiscernible) evidence in this case. Last, I will end by talking about the importance of going to the route of, It's time to get to the root of these problems. It's absurd to say we need to collect the names of people that test HIV-positive to know how to deal with this epidemic. We know how it's caused, we know how it's treated, we know what works and what doesn't work in terms of prevention and care. The US government has proven in nine well-funded studies that needle exchange stops the transmission of HIV without increasing drug use, and there's no one that can tell me that if you 93 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 collect the names of people with HIV, we're going to start doing more access to needles. So that's a red herring. We need to put the information and services where people are. We need to have prison services at the core of our HIV response, not on the periphery. We need to have at-risk youth talked to -- not at schools where they're not, but where they are. We need to use the Internet to get information to people so they can get to it in the privacy of their own home, because people are getting computers and using them at home. And that way, they can get information that they won't feel comfortable getting in their neighborhoods. We need to go the route of where this is happening and use the innovative things that we've seen work in Philadelphia and elsewhere to do this. And I applaud City Council for having these hearings and hope that we have the courage to look at some of the facts here and move behind the rhetoric and the blame. Thank you.
Thank you. 94 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Hassan?
Thank you. I want to say that I'm extremely nervous. My name is Hassan Gibbs and I am a person that's living with HIV. Thank you for the members of City Council for allowing all of us to address you with this serious matter that confronts us today. This is going to be reading off so that I could stay focused. Once again, my name is Hassan Gibbs. I was diagnosed with HIV in 1985, probably infected around '83, and since 1990, after attending my first support group, I have been involved with the HIV and prevention and treatment and education community, working and volunteering in many capacities, from sitting on boards of directors of AIDS organizations to being part of the most innovative outreach primary and secondary prevention programs in Philadelphia. I need to correct that I am employed by the Philadelphia Fight. And I am the co-lead educator and outreach coordinator at Philadelphia Fight's Project TEACH. I left Midnight Cowboy 95 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Project some years ago, a very great program. Having been around for a while, I've seen this disease, HIV, devastate individuals and families. I've seen the fights at TPAC over money for program and witnessed agencies fold and programs fail, all while more and people, especially low-income minorities, continue to become infected with HIV and die. We are entering into a very rough time ahead. The epidemic has not stopped; it has actually gotten worse. And I predict that within the next five years, all of us will really start to see the full impact as if it were the late '80s or early '90s again. Back then, the gay community empowered themselves to do all they could do to get service to their community, and dozens of agencies were born out of that struggle. Many of those leaders, staff, and volunteers have moved on. Our new clients are people living with HIV that walk through that front door to our agencies today will probably identify as heterosexual, unable to read past 8thgrade level, have mental issues, and may have substance abuse 96 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 or be an abused housewife or live-in lover. Unable, scared or not knowing what to do next, the newly infected will probably roam for two years after diagnosis before reaching out for help from an AIDS service organization. This is the -- they'll probably be infected with multi- drug-resistant, or super virus. This is a mutating HIV virus that is spreading especially in the minority community due to the use and misuse of HIV medications. Due to multi-drug-resistant virus, their first line of therapy will probably fail. Others may fail due to lack of their ability to consume the toxic medications that are required to keep the virus under control. Because of all of these factors, it will be assumed that the medications for HIV do not work, and that unfounded rumor will spread especially in the minority community. Thus, the first encounter for addressing their HIV issue will probably be at their bedside, in a hospital, after their first opportunistic infection. And I know you talked about at this table earlier about minorities getting infected and only finding out 97 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 after they get sick. Now, opportunistic infections are most times totally preventable these days. And all of this will come after they probably infected their spouse or several casual sex problems whose names they cannot remember. Needless to say, prevention programs have failed miserably. Relying on tactics from the earlier epidemic that addressed gay men, it just does not work anymore. Let's take African-American men who have sex with men but don't identify as gay and do not want to be seen, nor cannot identify with the agency that has a gay theme. I refer not to a new phenomena but to something that has been around but seldom discussed for many years: and that is "men on the down low," as they call them today, or men who have sex with men.
Let us not forget that these men are probably having sex with women also, as has been discussed. It will take a special type of program and service worker to reach these individuals. After all, coming into a gay theme agency would confirm that they're having sex with men. They 98 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 are not gay; you're gay only when you say that you are. Just as we allow transgender to identify as "she" or "miss," we must allow and identify with where a person is. This will take a lot of skills-building and a different approach to prevention outreach and education. I believe getting into the heads of these individuals in a way that has never been done before will probably be the only way to reach them. And let us not forget reaching out to the women that these men sleep with. More and more, seasoned staff of AIDS service organizations are moving on due to many reasons. Entry-level folk, who are fresh out of college, are entering the AIDS workforce, many in good faith, just to burn out due to being overwhelmed, or moving on because of limited resources and high caseload. The effect is that the consumer shall suffer because of staff that are overwhelmed and overpaid and made to spend --
Don't let the 99 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 record show they're overpaid. (Laughter.)
You're right. And may have to spend up to 75 percent of their time doing reports or trying to locate services that are virtually at their fingertips. Now, for many small key agencies, the information age has not reached them, so information gets to them by snail mail instead of e-mail. And by that time, many training opportunities, benefits, monies or opportunity to grow has passed. And the client suffers again. Ideally, a one-stop-shopping type agency would be nice, but not even in Philadelphia Fight can we offer all of the services that any particular client may need on a given day. So onwards to some solutions. The need for agencies to collaborate and conduct joint programs. Different agencies are good at providing certain services. Let those agencies join together on projects where they can offer those services to individual clients. Smaller organizations should maybe merge with larger organizations. This will eliminate a lot of 100 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 overhead costs. The result will be that money saved will go into services for people living with HIV/AIDS. And I have a little bit more. Funders, both government and private, need to be more vigilant about how funds are being spent. Agencies that cannot spend their money wisely or who continually come up with the programs that don't work should be defunded. The money should then go to agencies that have sound fiscal policies, who can prove that their programs have been effective. The key here is evaluation. All agencies must be held accountable to prove that what they are doing is have an impact on the epidemic. Provide all of the technical assistance that is necessary, but make sure that we are not wasting money on programs that haven't worked and never will work. I am still appalled that most of the people in the area still do not know the AIDS hotline number. It is a gateway for accessing services in the region. I suspect that this may well be the case in other locales as well. We 101 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 have spent good money for this hotline and its design. The problem is that the number has not been properly marketed, so it is unfamiliar. Maybe, just maybe that SEPTA -- and I notice these signs are on SEPTA, but maybe they should post them for free, and that will allow for more postings about AIDS services in the area. Direct prevention efforts toward people living with HIV. When people are given -- us, people with HIV, are given the adequate training and information, we make the best bang for your buck as far as getting the word out, and there's nothing like a person who's living with HIV going out and letting their status being known to talk to people and convince them about testing and treatment and change behavior. Also, continue to support needle exchange programs and imbed existing services like case management in needle exchange programs and in harm reduction programs. Do not stand back and let the disaster in our prisons continue to go unaddressed -- here's that prison issue again. Rates of HIV in many jails and prisons are as high as Sub-Saharan 102 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Africa; yet, medical care is lousy. In Philadelphia, medical care, once again, provided by the prison system PHS, a for-profit HMO, and they know that if they can delay treatment until someone gets out, they can save money. In addition, there are good infectious-disease docs in Philly jails, but people don't get permission to see them, so they are not getting the treatment that they need. And I'm almost done. Resources. Put the money and the services where the people are.
And I don't mean neighborhoods versus downtown; I mean real funds for real programs for real people, peer educators, prisoners, former prisoners, well-train, funded to help those currently or formerly incarcerated put in resources and staff and to harm reduction programs that are not abstinence only or tough love, and helping people with HIV transition into real staff people and program development roles to be able to amplify and expand good programs. I heard a lot today and one of the issues that I wanted to address real fast is the testing. Across the board, names reporting is 103 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 going to be a disaster. Another thing is that I think that this city really needs to look into the rapid HIV test that is now being used in some states, and the results come back in twenty minutes. I think a lot of people are lost in coming back for their results. This test can be used on a van or wherever, and it can allow people to remain in one place, look at a video while it comes back. It also has been proven to be as cost-effective. And I have that information, if anyone needs it. We also felt a look at teens and designer drugs at this point, and that there are many teens that -- it's going to be a whole new wave with the teens and the designer drugs that allow them to practice unsafe sex become -- get other STDs that lead to HIV. And you're going to see that. So in closing, I just want to say that it's not a really pretty picture, but in my travels all over the country, and I've been all over the country, we're doing a lot better than most cities, a lot better. I pity some of the people who I've talked to from a lot of cities -- 104 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 not just down south but Detroit and in some other areas. You know, this wouldn't even be allowed in some of those cities, what we're doing today. So I thank Councilman Ortiz and everyone for this, but we can do better. Thank you.
Thank you very much. I just want for the record, so we have a clear statement on the issue of names, could you just kind of put it in testimony that tells us what is happening, who is proposing and -- because I've heard it but I really haven't heard clearly for the record what is happening in terms of trying to have people give their names for HIV testing, what presently exists, what is being proposed, who is proposing it. And that's what I would like to have on the record.
In Philadelphia is at the present time and up to the present time, what has 105 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 been reportable is AIDS. AIDS means either your immune system has declined to a certain point of or you have had one of a long list of opportunistic infections and specific complications that means you have AIDS. HIV has not been reportable up to this time in Pennsylvania. What the State wants is it to be reported. I think that the other pressure that is on the City now, which is probably more to the point, is that the federal Centers for Disease Control are threatening to withhold dollars from states that do not make HIV reportable. Therefore, HIV reporting is moving along in this state. The controversy, the main controversy in the City now is between whether that should be reportable by a person's name or whether we should find another system that will guarantee that the same person won't get counted twice but will not use their name. And I think it is the feeling of the majority of the AIDS service community, perhaps the overwhelming majority of the AIDS service community, that we want to see unique identifier, not names reporting. 106 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I would just add one thing to that, which is that there's now a 30-day comment period began last Friday about the proposed State regulations which emphasizes names reporting. And we know that Philadelphia's comment in this carries extra weight that will set a tone for the rest of the State. And, unfortunately, we must think not only of our own responsibility to our county and the surrounding counties, but what will happen in rural Pennsylvania if names get reported to the county health department on the way to the State. And, of course, that's your uncle's friend or neighbor works there. I think as scary as it can be for those of us in Philadelphia, it's terrifying for Beaver County, and even if it's two, three, four, of five people, these are people whose lives will be devastated. So must also in Philadelphia, in our policies, bear the responsibility of what can be so harmful for the rest of the State as well.
Have you recommended a process by which this could take place, an I.D. number that the person can have? 107 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 I mean, you know --
That's unique identifier. Maryland, California, and many other states have used unique identifier systems. CDC does not require names; CDC requires reporting. Maryland came and spoke to many of us here and said anything you can do with names, we can do with the code. People give certain things that are non-duplicative if you use names enough variables like mother's maiden name, year of birth, and other variables. We have experience with using unique identifier, actually, in Philadelphia through our needle exchange program, which has been extensively evaluated through the University of Pennsylvania to validate its efficacy in wise use of public health dollars. And as you imagine, people who use a needle exchange really don't want to give their names. And it's worked extremely well, it's been extremely effective at getting information we wouldn't be able to get otherwise. So there's really good models out there. And states as big as California really validates it as being an effective way. 108 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I'd like to just comment that just recently, I got a letter from the Philadelphia Department of Health, and I hadn't gotten a letter from them in years. And in this letter -- and I hope this never happens if name-reporting comes in -- it stated that we know that you're hepatitis C-positive. Now, where and how they got that information, I don't know. But just imagine that falling into the hands -- only saying that it was HIV and falling into the hands of some mother whose child has tested positive but doesn't know it and they're not ready to tell. So that's just another thing.
Have you made your recommendations to the Health Department?
One follow-up. Could you please speck again to this rapid HIV test that you spoke of.
I believe it's Or Shore (ph.) Company, and I don't mean the same test that 109 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 they're testing that needs to go away for a week. There is now a rapid HIV test that can test a person's antigens for HIV in twenty minutes.
I am unsure of the exact cities without actually reading it from the document where I got it from, but I can get that information to you. But I know that it's going on expanded -- it's being used a lot and it's become a very good tool in actually keeping people -- getting people into care and --
And that's based on documented research that it is a very good tool because it achieves the goal of holding on to people?
Could I please hear from any representative in the Health Department with regards to what you know about the test and whether or not the City has looked at it, why or why not. I would think funs may -- or lack of funds may have something to do with that, where 110 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 that might be on the list of priorities.
Hello. My name a Pat Bass, and I am one of the co-directors of AACO. We've certainly looked at the rapid testing. And, as has just been stated, it's still in its toasting stages. It has not been approved by the Federal Drug Administration and, therefore, we will not support the use of it until it has finished getting all of the testing. There are some questions around the validity of that test. And I think that, once again, rather than giving folks misinformation, we would really prefer to be very careful to make sure we're giving people proper information.
Thank you. Any further questions? (No further questions.)
The Chair recognizes the next panel: Otha Brown, Director 111 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 of HIV/AIDS Services, One Day At A Time; Reverend Ronald Norris, Pastor, Open Door Baptist Church; and Reverend Wells, Executive Director of One Day At A Time, if he's here. (Standing ovation.)
While the panel is coming forward, I'd just like to state that I do have to leave as chair. Councilman Ortiz will continue. I have a Finance Committee meeting at 12:30. Thank you very much. (Witnesses come forward.)
Good morning. Reverend Henry Wells, One Day At A Time. (Applause.)
Please summarize. We've got like nine groups of people coming, nine panels. So let us begin. Identify yourself for the record.
Good morning. My name is Pastor Norris of Open Door Baptist Church, also an on-air personality at WHAT and Chairman of Open 112 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Door Community Development.
My name is Otha Brown. I am the Director of HIV and AIDS Services at One Day At A Time. (Applause.)
Yes. I would just like to make a fast comment and let this move along. The one way to get people to understand and to get people to know about this HIV and AIDS is what we're just doing -- and I'm sorry you could not come up with us last Saturday -- is going door-knocking. We canvass the community and we knock on doors, we ring bells, and we take people back into the clinic where we're connected and get people connected, back to services. That's my job. I just want to pass that on. Thank you. (Applause.)
Councilman, my name is Otha Brown. I have with me today Reverend Wells, who you've just heard from. One Day At A Time has been in operation 113 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 since 1983, providing a wide variety of services to Philadelphians seeking recovery from their addictions to drugs and alcohol. We provide outpatient substance-abuse recovery counseling to approximately 600 individuals per year and transitional housing for approximately 350 unduplicated individuals receiving this counseling and. Also provide HIV testing and counseling to approximately 400 people at high risk every year, as well as AIDS education and outreach service to see thousands more. Since the early days of the epidemic, One Day At A Time has recognized that poverty and despair that leads so many of our neighbors into addiction also puts them at high risk for HIV infection. Our primary service area is North Philadelphia, West and Southwest Philadelphia, Germantown, and Kensington. These are the areas where the AIDS epidemic has done its worst. We are proud for over ten years that we've been in the forefront of building concrete practical support services for people living with and at high risk for HIV infection in the places where 114 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 fighting AIDS is most difficult. Over the past decade, under the leadership of Reverend Wells and others, we've established the first neighborhood storefront service centers offering HIV/AIDS education, case management, and access to medical care and other social services to individuals. This approach was the first significant effort to bring HIV and AIDS services to neighborhoods most affected by the AIDS epidemic and has resulted in linkages of thousands of low-income Philadelphians to AIDS education and testing resources, and hundreds of people living with HIV disease to the care and services they need. Unfortunately, despite the expansion of funding for AIDS education and care services by over 400 percent in the past ten years, neighborhood-based programs such as those operated by One Day At A Time continue to struggle. While we are extremely grateful to the City's AIDS Activities Coordinating Office for its continued support of our efforts, we continue to struggle with the burdensome administrative and funding requirements, which sometimes limit our abilities 115 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to be as flexible and responsive as we need to be for the people we serve. The City has made enormous strides in its commitment to building the capacity of minority and low-income communities to combat the HIV epidemic. But, unfortunately, we still have a long way to go. Our comments are not meant as criticisms of the City's AIDS effort, which we believe has set a high standard nationally in their commitment to consumers and neighborhoods, but we must not mistake progress for success. Still many people, especially in poor neighborhoods, get infected with HIV because they are simply unaware of their risk, and we've not provided enough education. Still many people, especially those who have been victimized by a drug epidemic, get infected with HIV, having been robbed of the hope and the opportunity that we pretend is available to every American, and then we blame them for the result. Still many people living with HIV disease are forced to obtain their medical care 116 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 from a fragmented, sometimes inexperienced, and often too expensive health care system that is much more available to those who have money than those who do not. And still many people living with and at risk of HIV disease need to obtain their services from AIDS service organizations that are located far from them homes and far from their realities. We applaud Councilman Ortiz and his colleagues for again raising the public consciousness of the urgency of the AIDS epidemic in Philadelphia.
Some of us remember that it was about 15 years ago that Councilman Ortiz led the effort, which eventually resulted in the creation of the City's AIDS Office, and we continue to benefit from his foresight and leadership from that time. But the battle must still go on. AIDS still kills, despite what the fancy drug companies say. And it's still more likely to kill you if you're poor or black or Latino or a woman or young or gay, or all or part of the above. We hope that the City will redouble its 117 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 commitment to fight HIV. We hope that the City will work harder to ensure that funding for AIDS reaches the communities where the battle really nudes to be fought. We hope that the City will create -- will be creative in finding ways to work through all City departments, not just the Health Department, to provide AIDS services to all of the people who need them. One Day At A Time stands ready to continue to be a partner in that effort and hopes that it will soon see more and stronger partners in all of Philadelphia's most impacted neighborhoods. Thank you very much.
I remember the times long ago, when the only people talking about it at the street corners were Reverend Wells, the casket, and myself. Do you remember that? Yes, Reverend?
Yes, sir. Councilman Ortiz, I thank you for the opportunity this morning to speak before you. My name is R. 118 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Jeremiah Norris, and I'm the Pastor of the Open Door Baptist Church, Chairman of the Board of Open Door Community Development, and a concerned member of the community. And there are some of the things that are occurring in our community that we should claim -- that should claim our attention. The image of HIV- and AIDS-affected persons on billboards send a message that does not reflect the true community. Most persons who are infected have weight loss or some other physical problem that should be recognized. The seriousness is minimized when we look at the image of HIV persons on public display. It's time to deal with the truth and present the right image. A noninfected person looking to the HIV billboard, seeing the healthy and happy person will feel that HIV can't be that bad. As a pastor who has married more people than I care to count, I will take a stand that I am not willing to perform another marriage where a couple has not had a blood test. How can I in good conscience say to a newlywed before God the vows, "Do you promise to support each other in 119 5/1/01 HEALTH & HUMAN SVCS. - RES. " when the blood test could at least give the couple a fighting chance in planning a life together. Motherhood is important in passing the virus on to a baby that was conceived in love is not right. While we are born in sin and shaped in inequity, the curse does not have to continue. According to the AIDS Surveillance Quarterly, the number of AIDS/HIV cases has risen from -- of course we know from 84 to 99. That's the last reporting statistics that I have. And out of the 22,867 cases reported, 12,576 have died, about 55 percent here in Pennsylvania. In an upward shift of AIDS ages at AIDS diagnosis, the evidence in the cases reported in 1999, the highest age group are those between 30 and 39, which are 4,901. At the next highest group, between 40 and 49, are 2,958. And those at 50 years, those at 50 years or older were 1,174. The population of cases reported in patients over 50 years is now greater than in the 20- to 29-year age group. With the possibility of better treatment and education, more people are -- will 120 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 be living longer. And because of -- because of this, Open Door Community Development is actively seeking support for building a transitional home for women and children who are HIV- and AIDS-active. Training and equipping the residents -- equipping the residents of Open Door Community Development will lead to full employment, health care, education, computer training, and other skills that will give the greater self-worth. We of the faith-based community need to partnership with non-faith-based groups because of the red tape and other hurdles that were originally put in place for them. We need to release the properties, we need properties released that are held by the City and agencies related to the City government, properties that now are, at best, sites for dumps and have no 19 active use for anything in our communities except an increase of elicit uses. We need to have the kind of faith-based support that will help all of us develop programs that are needed to address our communities. The need for programs such as Open Door Community Development is recommending is seeking support and 121 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 must be a vehicle for other community organizations such as faith-based organizations.
The Open Door Community Development mission is: Develop a strong educational program for those in the Open Door Community Development HIV community, such as computer literacy, GED readiness, test-taking skills, training for a new life; Provide a place to live for those who are infected and have nowhere to lay down safely; Provide counseling that will help reshape and focus for living; Set new dietary guidelines and physical recreation activities; Provide onsite medical evaluations and treatment. These are some of the mandates that face our community right now in the area of Open Door Community Development. 99 percent of HIV-positive persons. At present, there are between 182 to 122 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 398 persons who are living with AIDS in Philadelphia. The total of those living with AIDS is 6,220. Open Door Community Development is a faith-based community project that will service as a model for the entire faith-based community. We no longer can preach and teach the wholeness of the relationship with God and not reach out to the HIV community. " That's in the Old Testament and also in the New Testament. But Jesus gave us an example of how to deal with such problems: to touch them with compassion, prayer, support, and love. It worked for those who received his blessings and they were able to go back to their own communities and earn a living. Matthew, the 25th chapter, the 45th verse says this: "For I was a hunger and you gave me meat. I was thirsty and you gave me drink. I was a stranger and you took me in naked and you closed me. I was sick and you visited me. I was in prison and you came unto me. Then shall the 123 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 righteous answer him saying, Lord when saw we thee in hunger and fed thee, or thirsty and gave thee drink? When saw we thee a stranger and took thee in or naked and clothed thee? Or when saw we thee sick, in prison, and came unto thee? And the king shall answer and say unto them verily, I say unto you. Inasmuch as ye have done it unto one of the least of these, my brethren, you have done it unto me. Then shall he say also unto them, On the left hand, apart from me, ye cursed into everlasting fire, prepared for the devil and his angels, for I was in hunger, and you gave me not to eat. I was thirsty and you gave me no drink. I was a stranger and you took me not in. Naked and you clothed me not. Sick and in prison and you visited me not. Then shall they also answer him, saying, Lord, when saw we thee hunger and thirsty and a stranger or naked or sick in prison and did not administer unto thee. Then he shall answer them, saying, Verily I say unto you inasmuch as ye did it not to one of the least of these, you did it not unto me. And I say all of that to say this: that we can no longer in the faith-based community 124 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 hide behind our churches and just preach on Sunday and go home. Amen. We need the support of the City, as we step forward by faith, to develop programs that will help in our communities to bring about a wholeness and a healness [sic]. We need the kind of red tape and some of the pressure that is placed on the faith-based churches or faith-based organizations so that we can proceed with progress and become a viable entity in the community for healing.
I want to recognize that was good. And we are happy to have you with us, and hope here at One Day At A Time -- I think it's the faith-based organization that you got and with the church and that we can come together closer than we normally come together, because the rubber meets the road out here where we at. And I want to really thank you for bringing this to City Council because, see, I know who you are. You the man that go where the rubber meet the road, and I know you'll be coming back, 125 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 joining up with us to do some more things. I know this is a little off the record, but Thacher Longstreth was out to see us and I just -- you know, we are praying for him, and we just love City Council people. Mr. Cohen, how you doing, sir? And we are going to continue to do what we've always done: go where the rubber meet the road. And as far as faith-based, boy, if we ain't got faith, we couldn't last because we were there when people thought we were out our minds and crazy with a casket, telling people when eleven children got killed that one week that said no to drugs and yes to life, this could be your child. We were knocking on doors then, we will continue to knock on doors. And we know that you do whatever you can, we know you will pushed whatever you can. And we're planning something really big in North Philadelphia. We want you to come and be a part of that real kickoff. We love you, God bless. And we all come together. The young man said let the small 126 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 organizations join together with the large organizations. Don't be afraid to join. Don't be afraid that you'll lose some money. God's got this, it is all in control. (Applause.)
Someone said we need to give our people, and especially our young people, something to hope for, the poor people something to hope for. Well, I can tell you what you can hope for: You can hope to have God in your life, and things will move forward and you will be able to do the will of God. God bless you, I love.
Councilman Ortiz, may I just say this. In preparing to hear the questions, that a lot of people question ministers and say, Well, how could you say certain things and how could you be involved and you have no 23 knowledge of it? But I am one who is not ashamed to be transparent, and I have been drug-addicted and was delivered through the power of God. And I 127 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 thank God for Reverend Wells and One Day At A Time, for it was Reverend Wells and the One Day At A Time program that helped deliver my son, who was drug-addicted and now three years clean. And I thank God for the program. (Applause.)
Thank you, Reverend Wells. We have been together for a very long time.
And I thank you for your work, I thank you for being here, I thank you for being on the corner.
If you had not been on the corner, a lot of kids would have been lost in this city. Thank you very much.
Ronda Goldfein, Dorothy Mann, Gary Bell, Anthony Harris, Nurit Shein, Danny Horn, Albert Barrett. 128 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 (Witnesses come forward.)
I'd like to get us -- let me -- so that I can begin putting it together, when we first got this idea to have these hearings, we know what your organizations are doing, so we don't need to really -- what I want to focus on is where do we go. We are here now. We have had some successes, we have had some failures. And what I'd like to hear from the panel as they come up is where is it that we need to be looking at? There are problems that are confronting us and I'd like to begin so that as we write our report, as we write our report that we can then send to the Mayor and the Health Department and others. We know that after ten years, from 1987, '86 to today, this city has been really much further ahead. We have more organizations doing teaching and prevention. We have some funding -- not enough funding as we would like. But I would like to see where it is that we need to go to the next level, the next step. And if you can direct to that, I think we will accelerate every panel because we have ten 129 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 panels to hear from, and I don't want to be repetitive, every panel saying the same thing, but let us shape our comments as to direction, changes that need to be done, places that we need to be. Ms. Mann, do you want to begin?
I will do that and then sort of summarize my testimony. My name is Dorothy Mann. I'm the Executive Director of the Family Planning Council here in Philadelphia, and one of our major programs at the Council is the Circle of Care, which assists families affected by HIV and AIDS. The focus is primarily women, children, and their families. For the circle -- last year, the Circle of Care provided services to a thousand families. But what I really -- in answer to your question, I think -- and what I want to talk about today is prevention, because prevention is the key. First of all, prevention works. And second of all, it's the key to slowing down and stopping this disease, at the same time that we care for people who are infected with HIV. 130 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 I'll give you the perfect example of a huge success story in prevention. Pregnant women who are HIV-positive can transmit the disease to their unborn children. " In 1994, the National Institute of Health did a study that demonstrated that if HIV-infected pregnant women take the drug AZT during the pregnancy prenatally, it is administered to them during labor and delivery, and the infant is given this medication for six weeks, that you can reduce the transmission from mother to child; in fact, almost eliminate it, which is a huge success story. Now in the nation, there are probably less than 500 infants born with HIV. And in Philadelphia, since 1998, our records indicate that there were -- from 1998 through August of 2000, there were 31 HIV-positive babies born in the City of Philadelphia. But from what we know now, one infant born with HIV is too many. So in mother-to-infant transmission is almost entirely preventable. But still, babies are being born with this disease. So we have great science, we know what 131 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to do, and it's not yet entirely working. Is it better than it used to be? Absolutely. But we still have a way to go. With funding from AACO, the Circle of Care has a media campaign that I want to show you the posters for. That's the English version; this is the Spanish version. And I've just given you some more materials that you might want to make available to your constituents. Every pregnant woman in the City of Philadelphia needs to be offered an HIV test when she is in prenatal care -- if she is in prenatal care; and, of course, we have major programs to try to get women into prenatal care. Frankly, that's not happening now. We have to do a much better job in our OBGYN departments and with individual physicians, making sure that every single pregnant woman is offered an HIV test, and explain to her that if she is positive, that there is something now that can be done to prevent her from transmitting this disease to her infant. I'm a woman, I've had two children, and I think I can generalize to say that the vast majority of women who are pregnant want to have 132 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 healthy children. That is their -- it is one of the most important things in their lives. And so when offered this test and when offered this medication, the vast majority of pregnant women will avail themselves of it. My concern is that women who are pregnant in this city are not being offered this test sufficiently and routinely as part of their prenatal care. Now, moving on in other areas of prevention. This is a perfect example. HIV infection is a disease that is transmitted from an infected person to an uninfected person. That's pretty simple, that's how you get it. Councilwoman Tasco asked, how do women get it? They get it from an infected partner. Most of all prevention efforts in the City and nationally have been directed at the uninfected. What I am here to talk to you about is my desire and recommendation to change that paradigm to a degree so that prevention and care come together.
Thanks to improved medications, people with HIV are living longer, they are living longer, and they are healthier, and they do look 133 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 better and they feel better and they are better. And I think it's a complete misstatement to say that that is not the case. In general, individuals react differently, but in general, people with HIV are living longer and more productive lives. But, some, because of this success of drug therapy, are, in fact, engaging in risky behaviors. These are infected people. Some believe that because they are taking the medication and their viral load is lower, that they can't transmit the infection. That is completely untrue. A rise in risky behavior by infected individuals can erase the potential benefits of these combination drug therapies by increasing the spread of this disease. So I am strongly advocating the following in answer to your question, Councilman: We've got to increase counseling and testing programs. More people need to know of their HIV status. Like these kinds of campaigns and others. In particular, I wanted to comment on what you were talking about this morning, about 134 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 programs in schools. There are a lot of kids that aren't in school, that have dropped out of school, and we can to focus -- and they may be at higher risk than the kids who are in school. So just doing school programs does not address or focus and reach a whole lot of hard-to-reach young people who are out of school. We need to have greater efforts to get HIV-infected individuals who know their status into medical care, and we need to provide them the support to stay there. Nationally, it's estimated that 50 percent of people who are infected by HIV are not in care. I don't know the statistics for the City; I hope we're better than that. But even if we're better than that, we're nowhere near where we ought to be. And we must require HIV caregivers to include prevention messages in their care that they give to HIV-infected individuals. Don't misunderstand me, I'm not advocating laws or policies that criminalize or stigmatize HIV; just the opposite. I'm talking about interventions that help HIV-positive people reduce their risk behaviors and protect their partners. 135 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Fully integrating prevention into care is one proven mechanism to prevent the spread of this disease from the infected to the uninfected. Prevention should be a part of every AACO-funded care-provider. Here's another example -- I mean, part of it is the City. The City has a struggle here. Prevention is funded by CDC, care is funded by another part of the federal government, but at the local level, we have to integrate these things. Another example of this is that STDs -- science has told us that if you screen and treat STDs, you will presented the spread of HIV and. Yet, STDs and HIV are not integrated in our programs either, the way they should be. And I really, really want to recommend that every care program funded by the City assures that HIV-infected people getting care be screened and treated for other STDs, which I do not believe is happening at this point in time. I'm not going to tout the fact that the Circle of Care does this, because we do. And I think it's an important part of our program. Finally, the Center for Disease Control 136 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 now indicates that 40,000 Americans will get HIV this year. That is, over 100 people will get HIV in this country today and tomorrow, and 100 people got it yesterday. That's an completely unacceptable level. However, it is much lower than it was when these hearings were held first in 1987. Unfortunately, in the face of 40,000 new cases a year, the Bush Administration has proposed level funding for care and prevention in its new budget. Somebody has to pay for this tax cut. So I'm worried about two things.
One, that we don't let the administration get away with that, that we pressure our Congressional delegation, both House and Senate that this is unacceptable to the City of Philadelphia because there are no cases. If you have new cases and no 20 more money to treat people, what happens? Either the people that are getting care get less care, or the new people don't get any. You can't do it. When you have new cases all the time, you need more money to care for people. That's all there is to that. 137 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 The other thing that worries me is a trade-off between us giving money to take care of AIDS in Africa and in other parts of the world and not in this country, that there is somehow a zero-sum gain regarding AIDS in other parts of world versus AIDS in the United States. And that is exactly what, unfortunately, the Secretary of HHS said the other day. In testimony in front of the United States Senate, he said, We don't need any more money for care. They've had a lot of money. The only thing that's going to save us is a vaccine. And we're giving all this money internationally. , the newly infected versus the person in care -- is outrageous. So one of things that I think that it behooves this City Council to do is to use its influence and to raise its voice with our Congressional delegation to assure that AIDS prevention funding and AIDS care funding in this country increases -- or the City will bear the burden. 138 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Thank you. )
Thank you. Good afternoon, Councilman Cohen. My name is Ronda Goldfein, and I'm the Executive Director of the AIDS Law Project of Pennsylvania, an agency in Center City that employs six full-time lawyers, the only independent, nonprofit, public-interest law firm in the United States dedicated soley to the needs of people with HIV. Last year, we received 1800 calls for assistance. But during my eight years at the AIDS Law Project, I've witnessed a huge transformation in the AIDS epidemic and in the needs of our clients. Eight years ago, our clients were focused on planning for death, but today, they are planning for their futures. Before, they were concerned with shifting from work to disability leave; but now, in the era of (indiscernible) inhibitors and combination therapy, we are advising people who once thought their lives were ending on how to return to work. 139 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 We offer two monthly seminars: one on how to leave your job and one on how to go back to work; or for some people, how to work for the first time. And each month, twice as many people show up to hear about planning to work as those who are leaving a job. To help people with HIV plan for their future in this way was unimaginable eight years ago. But as we all know, the more things change, the more they stay the same. And as we are helping people plan to return to work, we are still receiving complaints from people fired because their employers discovered their HIV status. In the first four months of this years, 16 people have already lost their jobs simply because they have HIV. Five people have called us this year complaining of denial of health care because they have HIV. That's five different health-care providers, whose job it is to treat the sick, refused care because people with HIV are a little bit too sick, or perhaps they're not the right kind of sick. Already this year we've heard of 32 140 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 breaches of the confidentiality, including a doctor who faxed medical records to the patient's workplace; hospital workers telling friends about a neighbor getting HIV care; a pharmacist who shouted in a store full of customers, "Your HIV medications are ready"; or prisoners forced to stand in medication lines in full view and earshot of other prisoners and staff. We hear of disclosures in homeless shelters and halfway houses and group counseling sessions, all the places people turn for help, all the places people will not return if they don't feel safe. And in the month of April that has just passed, we've heard of three different complaints of harassment of neighbors once someone's HIV status has become known. So we must continue to spread the word that discrimination is wrong, not only morally wrong, and ineffective from a public health standpoint, but that it's illegal. We need to be able to fully pursue all of those claims so that doctors dentists and nursing home operators and schools and employers are forced to stop discriminatory practices -- if not by decency 141 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 concerns, then perhaps by financial ones. And we must continue to vigorously remind people of the legal obligation to keep HIV information confidential. A person will get tested and treated for HIV, the sure path to ending the crisis only if it can be done in a confidential setting. That's why the AIDS Law Project, like many other AIDS service-providers, are in support of unique identifiers instead of names-reporting for HIV. No one in this room would be eager to seek help if our health needs were shared with an unintended audience. Instead, like the 32 people in the Philadelphia area who found that their sources for care not secure or not private, they will wait until it's too late.
And as a unique law firm devoted to people with HIV, the AIDS Law Project has devoted 13 years to fighting discrimination and the illegal disclosure of the information and assure that people get care and treatment. At a time when many people with HIV are contemplating a future instead of an early grave, these services are more crucial than ever. 142 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Thank you for your attention. )
My name is Nurit Shein. I am the Executive Director of Philadelphia Community Health Alternatives, PCHA, and we have been around for years -- first as a health 9 organization for the gay and lesbian community, 10 and when the AIDS epidemic hit that community, we 11 incorporated the AIDS task force and became the 12 first AIDS organization in the Commonwealth of 13 Pennsylvania and the fourth in the United States. 14 So we've been around for a while. We have a 15 continuum of services from testing to early 16 intervention and triaging into care, to case 17 management, to intensive housing, to regional food 18 bank, to home care to mental health, etc., etc. 19 I'm going to be very brief today. I 20 would like to speak about two things that I see as 21 service gaps, in answer to your question, Councilman Ortiz. As Dorothy said before, prevention -- and my other colleagues -- prevention works. And in the last five years, we've had level funding from the CDC through the 143 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 City of Philadelphia. PCHA has the largest anonymous test site in the City of Philadelphia. We test percent of all people in Philadelphia, 5 over 3,000 every year. We have been level-funded 6 for the last five years, testing more and more 7 people -- and not just testing more people. 8
But you haven't been 9 level-testing right? I mean -- 10
No. It's level funding; it's not level testing. So we are called to be more and more creative. Also, the epidemic is changing. We need to create prevention messages that answer the needs of the high-risk population that we want to reach. So today we are, at 1 o'clock in the morning, doing outreach and testing in the bathhouses in Philadelphia, which we didn't do five years ago. But that takes effort, energy dedication, and funding. We know that the holistic approach of treating an individual as a whole person works as well. The service gap that Dorothy talked about of STD and HIV connection is not there in the City. PCHA is the only AIDS organization in the 144 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 City of Philadelphia that also provides STD services. We chose to specifically target the gay, lesbian, transgender, and men who have sex with men population, but we provide STD services to these people, and the crossover is enormous. Most of the people who come to us through what I call "the STD door," we also counsel them and urge them to take an HIV test, and many of them do. Many of the people who come to us for an HIV, because they perceive that they have been at risk for HIV, also choose to take an STD test because the two of them are definitely connected. Hepatitis. We talked here about hepatitis. We also urge people -- the gay community, for example, is not really aware of their risk for HIV and -- for hepatitis C.
Sorry, hepatitis C, and what is the connection between hep. A, B and HIV and what the meaning of it is.
That's one of the things that came out today that I was not aware of. I'm sure the firefighters of this city are not aware of that. 145 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
And it really -- it is something that we have to begin addressing and publicizing and putting it out the connection between hepatitis C and HIV and how do we handle that, and that's something that came out of the these hearings, that really, if we come out of that with this, I think we've done something.
Well, we're lucky to be a part of collaborative effort of other organizations in the City and the Health Department to do some awareness around hepatitis and HIV, but we need to see more of that collaboration happening at the local level of both the Health Department -- two different hats of HIV and infectious disease. We need to start talking to each other and providing services in a much more holistic way.
My name is Gary Bell, I'm the Executive Director of Blacks Educating Blacks about Sexual Health Issues, otherwise known as BEBASHI. Briefly, BEBASHI offers a continuum of 146 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 prevention and care services --
All right. It has been since 1985. I don't want to go over the things that have been covered, but I do want to focus again on testing and prevention. One of the statistics I didn't hear mentioned -- and maybe I missed it because I was a little tardy -- is that 40 percent of the people who were diagnosed with AIDS in the last statistics that the AIDS Activities Coordinating Office put out had tested positive six months before that. So essentially, what we're taking about are people who are just testing, getting tested, and probably getting tested because they were already starting to get sick, and then going right into full-blown AIDS. The efforts to get people testified, we still haven't found enough success in. BEBASHI offers testing -- and I want to disagree with one thing that Nurit said. We do offer some limited testing for STDs, syphilis, and chlamydia. And it is true that there isn't a coordination between 147 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 those units of the Health Department that are doing AIDS and doing STD testing -- at least not enough. We had a young woman come in who was 6 years old, and she had presented -- this was her 7 third STD she had been infected with. She had 8 been -- at least according to what she said, she 9 started to become sexually active when she was 10 10 and a half years old. And not with 10 and a 11 half-year-old boys, but with 16-, 17-, and 12 18-year-old boys.
She was 10 and a half years old when she first became sexually active, but she was 12 when she came in to get tested. She had never had an HIV test, even though she had been tested three times for STDS. When I first came to BEBASHI, we had 9 African-American women on our caseload, and at that time, we served about 300 people for case management. Now 45 percent of the cases we serve 148 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 -- we roughly serve about 500 a year -- are women, the majority are African-American women. And what I'm seeing and what I'm hearing time and time again from the people we're working with, and we're working with -- the majority of them are minorities, African- Americans, Latinos. The main thing we're hearing from many of them is that they don't think they can get HIV. They think there's a cure, they think that Magic Johnson is cured, they think there's some conspiracy. They think everything about except what we know. They still don't think they're at risk. One of the successful things that we're doing is working in prisons. We're working in the State correctional institutions. Sixty-two percent -- 63 percent of the people who are infected with HIV who are in the State correctional, State correctional institutions, 21 return to the Philadelphia area, and the rate of 22 HIV has been estimated at least 14 times what it 23 is in the general population. We're getting in 24 touch with them six months before they're getting released. Because what do you think the first 149 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 thing someone does, especially a man does, when he gets out of prison? So we can't wait for that --
We can't wait for them to get out of prison. And it works. We're getting people before, we're giving them HIV information. When they get out, we're linking them with a doctor, getting them health insurance, finding them a place to live. That is a system that is working. And, finally, I just wanted to say two things. One is we vigorously oppose HIV name- reporting. I know we need to know how many people are HIV-positive, but I don't think we have to know their names. We can't keep government secrets, we can't keep secrets about our nuclear technology secret -- and we're going to keep names of people with HIV secret? I just don't believe that. And, finally, I think this city needs to understand that HIV is not just the Health 150 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 Department's problem. You know, we look at the Health Department -- and I think they're doing everything they can with the funds that they have, but it's not just the Health Department.
But the funding has been level since 1980-something, right? I mean the HIV --
For prevention. (Unintelligible, parties talking over each other.)
And we have a pretty good care system. But my fear is that how long -- when we look at the federal government and we look at who's in charge there and we look at who's in charge of the State government, how long are they going to keep paying 12 to $15,000 per person per year for poor minority people to get the state-of-the-art care? I'm afraid that that won't last forever. We have to start preventing this thing. And the City has to make HIV a priority, not just the Health Department, but every aspect the of City government. Every aspect 151 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 of the City government should create a plan. How are they going to ensure that everyone walking in the doors of any City agency, everyone that works for every City agency knows something about HIV, knows how to get it, knows where they can go to get tested? That's something that can't be that hard to do. June 27th is "National HIV Testing Day." I've been working with a coalition of folks who have been sitting around the table trying to figure out how we're going to raise visibility about that. We have no money to do this. You know, we are basically lending ours to see this initiative. If the City could step in and say, you know, We want to be a national model for -- we want to be a destination city, we want people to come here for tourism, we want people to come here to -- we want people to exercise and drink their water and all that, we want to have great schools. It isn't going to matter if everyone is sick, it isn't going to matter if everyone is doing. None of that is going to make a difference. June 27th should be the first day that 152 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 the City steps forward and becomes the national model for HIV prevention. (Applause.)
It starts with having enough money, and we're never going to have enough money. It's the will. We need to have the will to do something about this. Uganda, who has a fraction of the resources we have, have cut their HIV infection rate in half because they made it a national priority, and they're one of the few African countries we're seeing that has really stepped up to the plate to do this. We have, you know, many more resources than they can. This is something that can be done, but the City of Philadelphia has to decide that this is a priority for us.
Yeah. Well, I would agree, certainly, with Gary. There were a couple of other things, though, I also wanted to mention. You asked about 153 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 the Prison Health. Prison Health is a disaster. In my opinion, it is a scandal.
Right, and they just re-upped it. What I think is important to understand is that that contract was just renewed.
And they refused to give documents that are supposed to be public.
But we have an administration that likes to keep things hidden, and I don't like that at all.
Well, somehow it seems to me that somebody has to hold accountable to folks that re-upped that contract and --
And to look at that. I think that the issue that you've heard a lot about today in terms of HIV reporting, I want to clarify a couple of thing about it. First, it is -- the reason we're in this fix is 154 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 because the Centers for Disease Control, which gives out the money for HIV prevention, the federal money for HIV prevention, has in fact said, We have to have HIV reporting in the nation. Currently, up until then, about 32 states had voluntarily adopted HIV reporting. And with the reduction in the number of AIDS cases because of the medications that we have and the advances we've had, CDC has said, If we're going to track this disease nationally, we need HIV reporting. States have a choice, which CDC has let them have, about how to do it, and I think Jane mentioned it earlier. And the problem is that this state is one of the last states to even take on this issue at the threat of losing their CDC funding. CDC said, You have to report to us HIV. The state has made the decision to use name- reporting. I don't think there's an organization that I have seen in Philadelphia that supports it. None of us support it. The Board of Health, I don't think, supports it. Yet the State is sort of inexorably moving in this way. So it does seem to me that this issue -- there is a way to report HIV without names, 155 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 there is a way to report HIV without risking -- we're talking about the fact that percent, if 4 not more, of HIV-infected people don't know their 5 status. Well, how the heck are we going to 6 encourage people to be tested, which we've been 7 talking about, if even -- even if one person says, 8 "I'm not going to be tested because I'd have to 9 give my name," that's one too many. 10
So, somehow as a city 12 council and as a city, we have to stand up and be 13 counted in dealing with the State Health 14 Department and the Governor that this is something 15 that this city, which has the cases, is totally 16 opposed to. And we have not had a public 17 statement about this, and it seems to me that it's 18 time that City Council in fact took on this issue 19 and stood with the HIV/AIDS community and said no 20 to names-reporting. 21 (Applause.) 22
I think since the 23 State is moving in a way that is quicker than we 24 thought moving in that direction, maybe, David, 25 what should come out of these hearings, at least 156 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 before the report comes out, is a sense of the Council resolution --
-- as to this issue that says to the Governor and to the State Health Department, This is not the policy that we should follow. And I would like the help of you here in the drafting of that resolution so that perhaps we can submit it next week or the week after that, if we have it at hand.
If I may, as I said, we test over 3,000 people a year. We did a survey amongst the people that we test. Overwhelming, over 90 percent said, We will not come to get tested if our name was reported.
And we need a statement from our administration that if the State moves toward that, that we will not comply.
Great. (Applause.) 157 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I'm Danny Horn, the Education Director for Philadelphia Community Health Alternatives. Nurit Shein, our executive director, spoke a little bit about our agency and about some of the work that we do. I just wanted to talk briefly about our experience in doing some of the outreach to high-risk populations in the bathhouses, men who are having sex with men, or gay and bisexual men. There are a number of things that I worry about when I go to the bathhouses to do outreach and to link people to HIV testing onsite that are at the bathhouse. I worry about men who, after years, still don't know some of the 18 information, and we're really happen to provide 19 that. I worry about men who are afraid to come to 20 our clinic, even though it's an anonymous clinic. And so it's a great job to kind of link those directly to HIV testing and to care right there, in the bathhouse when we're there. The thing that worries me the most is when we talk to gay and bisexual men or men who 158 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 have sex with men who think that getting AIDS is inevitable for them, who think that that is just a natural part of their lives that will happen, and who really don't plan on living past 30, 35, 40, who don't plan really on living much past the next three to five years. That worries me a lot, and it makes me think that AIDS actually is not really the disease that we need to fight; AIDS is the symptom. The disease that we need to fight is poverty, it's sexism, the disease is racism, and the disease is homophobia. When we have a community where, as some of the speakers who just spoke talked about, 10-year-old girls are having sex with 18-year-old boys, HIV and sexually- transmitted diseases is only, I think, a small part of what needs to happen to help those girls. What needs to happen is that they need to know that they have a future that doesn't involve being taken advantage of sexually by older boys. And those boys need to know that they have a future and that their community has a future that doesn't involve sexual exploitation of girls. And I think that gay men and the men 159 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 who have sex with men that we work with need to see that they have a future that can be a healthy future and that can be a future that involves them being out of the closet, if that's possible, and staying healthy and staying safe and staying connected to their community. And I think that the City needs to not just look at HIV as a viral infection that needs to be suppressed but that we need to look at those social ills as well, and to encourage in our schools an din all of our community organizations and in our faith-based organizations to start talking about the future of gay people, the future of bisexual and lesbian and transgender people, the future of women, African-American people, poor people, Latino people, and to look at those issues as social issue and not just as a public-health issue or a viral issue. So I'm proud that we're doing that work, but I think that that prevention work goes beyond just talking about HIV. We also need to be doing more education about those larger social problems. That is an investment that will ultimately lead to, I think, a future for our 160 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 community -- health people -- both healthy gay people, healthy straight people, healthy people of all races and genders, a healthy future for Philadelphia. So thank you very much.
Good afternoon. My name is Albert Barrett. I'm an HIV case manager with Philadelphia Community Health Alternatives. Despite the system or quality of care, there are still many barriers that the people with HIV as an epidemic changes. People with HIV are faced with multiple issues. Through my work over the past three years, all of these individuals that I have encountered are not only dealing with HIV, but they are also dealing with homelessness, mental illness, and drug addiction. Usually these people take priority over the HIV and interface with the HIV care -- interfere with the HIV care. When I met meet with a individual at Ridge Avenue Shelter, my dilemma is what to do with them first; first find them permanent housing 161 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 arrangements or refer them to medical care? And how can they adhere to a regiment of drugs when they don't even have a place to store them? And how can someone who has dual mental health diagnosis and who are found wandering the halls of shelter remember to even take their medication. As an HIV case manager, I still see the stigma of AIDS when trying to secure services for my clients. I often encounter a lack of knowledge or fear about HIV and a lack of willingness to work with people with HIV. Over the past few years, there have been an increase of collaborations between the HIV system of care and other systems such as the Office of Emergency Shelter Services and the Office of Mental Health and the Coordinating Office of Drug and Alcohol programs. Yet a better integration of these systems must happen to maximize resources, and much more resources must be earmarked to create holistic treatment strategies that help individuals with all of their needs. There is one -- when one is homeless and hungry, HIV becomes the least of their 162 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 problems. We must create those bridges across the services to better provide for our citizens of Philadelphia who are most vulnerable. Thank you for giving me this opportunity to speak.
Could I have the next panel. Kevin Conare, Greg Goldman, Alfredo Salas, Gustavo Velasquez, Brunilda Reyes. (Witnesses come forward.)
Susan Higginbotham and Immy Ferrara. (Witnesses come forward.)
Very good. Thank you for coming and thank you for waiting. I really want to thank everybody who's come and stayed. I believe that you helped shape the direction of the hearing, you helped develop the way we structured it, and I'm very glad that you are here because I believe it's about time that we started putting this back on the priority list. Who wants to begin? 163 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
I'm Kevin Conare. I am the Director of Action AIDS. I'm also a person living with AIDS.
And if I may, you know, instead of just reading and giving me about the -- we know your organizations, so let's get into your -- you know, where we're at right now and where we're going to go and what happens with some of the problems, but let's look at solutions to really make this very visible because I think each of the individuals that has come before us -- like Dorothy Mann said, some people think that the AIDS crisis is over, and it isn't, and we have to make that very clear across the whole city. But go ahead.
So I know that anything more than a page is more than five minutes.
So I do want to say a little bit of who we are. We serve 3,000 people living with HIV every year, and 38 percent of them 164 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 are women, 76 percent are people of color, and we do that out of locations. That includes the 4 four prisons, our three offices in the Northwest 5 and Center City, and sixteen clinics and 6 hospitals. 7 I say that not because I'm going to 8 talk about our services, but I think we have 9 experience throughout the City with all of the 10 geographics and demographics of people affected by 11 HIV. And in fact, I would like to really address 12 what I think the City could do that could be very 13 specific. And not actually the Health Department, 14 because I think that's where the conversations 15 gets down to, and some of the issues are bigger. 16 Most of my peers that work with me know 17 that I don't like to be melodramatic, but I do 18 believe that we have a crisis here, and I think we 19 have a crisis that is brewing that is going to get 20 much, much worse. And one is economic and one is 21 health. 22 I'm going to start off talking about 23 the economic -- 24
I think Jane said 25 that it's at the level of really exploding so -- 165 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
Right. Well, I just want to do some math with folks just to help, just to -- the economic piece is probably the easiest piece to talk about. Fortunately today, most people are not dying of AIDS -- today. The medications are working, we're seeing incredible advances in HIV. And as Ronda pointed out, we have people going back to work, we have people in transitional housing. We even had amongst our 1,000 people getting housing counseling, one or two that got mortgages. Even though that's a small amount, that was unthinkable five years ago. So that's great news. However, people are living at a cost of 10 to $15,000 a year to take care of people. Ninety percent of the people who are getting HIV are low-income, and they are either uninsured or they have Medicaid. If you do the math, we have about 1,000 people a year that are coming down with AIDS that we know of, probably the same amount coming down with HIV, and 1,000 x $15,000 is $15 million a year. One year. And if we do our jobs right and 166 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 they live, that's 30 million, 45 million, 60 million, 75 million. I just really want to impress that this is -- you know, we feel kind of good because -- and I will commend AACO and the Health Department, and they got, along with the Planning Council, a $4 million increase in Ryan White this last year, 2 million the year before. But we will not be able to keep up with what's happening economically, and I see three areas that we look at. There's the federal, and there's the state, and there's the local. And at the federal level, as people have pointed out, the Bush Administration has not put any additional monies into Title 1, or very little into Ryan White Title 1, where 75 percent of the cases of HIV are still occurring in the cities in this country. And we will not get that $4 million increase next year. I admit that the whole $15 million of care that need isn't all going to come out of Title 1, but to million, or 22 million is, and we will not get that increase. 23 I believe that the City needs to 24 advocate with other cities to ensure that we get 25 that money. We do it individually as providers, 167 1 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 2 AACO does it, Pat Bass goes down to Washington, DC, but it would really be good to see the City and the Mayor really pushing for that, as well as us working with our local legislatures. On the state level, Jane pointed out the hundreds of millions of dollars that are in HealthChoices and we've had an ongoing problem with this. We are spending millions of dollars, increasingly more out of our own City funds to provide people with medications. The State has not yet made a carve-out that's sufficient enough that really says, Let us pay more for these patients. And that's another place where the City push for a change at the State level. Again, I say we're doing a lot of the advocacy ourselves. And then at the local level --
What is the cost of medication per individual, let's say, for somebody on average?
It's $600 to 1,000 a month. If you're like me, which I'm relatively healthy, it's only about 6 or $700 because I don't 168 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 have a lot of other secondary things -- a month, only, I'm saying.
And that's if you're insured, you're okay, but if you're not insured --
Right. Well, right now, we've been managing between City funds and Title 2 funds, and we've been managing, but this is what I'm saying about the impending economic crisis, because we're talking about what's going to be, you know, tens of millions of dollars increasing every single year, and there has to be a way for us to figure out how to do that. And that has to from a combination of federal and state and local monies. Philadelphia's never going to be able to afford it on their own, so -- but I think some of the advocacy has to from the City to the State and to the federal government. Then there are places where I think, on the City level -- and I'm not going into detail on this, but because so many people are multiply diagnosed, there's a lot of work we could be doing with DHS, the mental health systems, the shelters, where we are coordinating in a way that we do it more efficiently and really get -- that we're not 169 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 only looking at HIV dollars to give care to people that, in fact, have needs that would have been there anyway. So we should be looking at how we can supplement that with some of the other funding that's out there. The second half of what I wanted to talk about was the health crisis, and I want to -- I really wanted to talk about one issue that really didn't get brought to the table, and that has to do with drug-resistant strains of the virus, and it did get spoken about, so please forgive me if you spoke about it, but I wanted to really make sure that people understand what that means. Right now, if you take meds, a combination of meds -- well, first of all, HIV's a retrovirus, which basically means it's a very smart virus and it --
So they found, of course 170 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 -- and a lot of people probably know this but I'm still going to go through it. We found, of course, that if you give somebody one med, HIV mutates, figures out how to deal with that med. So now the therapies that people -- that are working are three or four or five combinations of meds. They only work if people get -- consistently take those medications, not if they take every other dose, not if they take a full dose one day and a partial dose the next day. That will become -- that is going to be our next greatest crisis if we don't deal with it. That will be where we have drug-resistant strains of the virus and we have them spreading. And given that HIV has not declined at all, those strains will be spreading, and we'll be exactly where we were ten years ago, exactly, with nothing offer people. We'll be back in the business that we were in ten years ago of helping people die with dignity. And, you know, that was a good thing to do when that was the only choice, but it's a terrible, terrible solution now, when there's better things that we can do. 171 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 How does that work out practically? I'm going to bring up that old prison issue again. And I think there's some conflict there because there's some doctors in the prison who are really excellent. The Health Department has made sure that all of the health districts will take care of prisons right away, on the spot. AACO's worked to get some medications -- I don't think enough, but some medications that discharge if know when they're being discharged. I'm talking about the county prisons right now. But there are still a lot of other issues that occur. Lock-downs. Completely understandable; sometimes you have to do lock-downs. In the short term, you might have saved a life; but in the long term, these repeated lock-downs and people not getting access to their meds, or as other people refer to people not even getting to those good doctors aside -- and it's not that I don't care about those lives, it's just those people. But these are the folks -- this is 10 percent of the prison population that are going to be having drug-resistant strains of the virus. 172 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 They're also the folks who are going to be discharged from the system. And some of the good things is -- you know, I'll say Health Department has funded BEBASHI to help people in the (indiscernible). They're funding us to link people from the prisons. So work is being done. Where it falls apart is that AACO can don't do so much. They can only work within the systems they control. Even if you get beyond that, the Health Department can only control so much. It has to be a combination of corrections of that subcontractee, of the parole system, of AACO, of the Health Department. And that takes going up another notch. I'm using the prison as an example, but this is true in the shelter system, this is true when you're talking about DHS and women and children and the growing number of women who now have HIV, all of those issues. It's really true throughout the system, that we have to find ways to start coordinating those services together and not just see it as a nice idea; see it as a way that -- that the integrity of those services is 173 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 what's going to make sure that people do not lose contact with their medications, which makes sure that they do not get drug-resistant strains of the virus, which makes sure that we do not have a new epidemic on our hands. I was going to say something about names-reporting. All I can say is, don't do it.
Good afternoon. My name is Luis Salas. I'm a prevention case manager for the Legal Aid Project. I had my notes here with me, but I'll just present a different testimony. From all that I've been hearing today, since the morning, I'm not going to be bringing statistics. Those are another expertise that is not my own. I believe that as a case manager, I'm in the middle of, you know, a profile within the clients and the system. You know, I'm there, I put my face among the line, trying to provide 174 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 services to people, you know, according to the mandates that the system gives me. And, you know, many times, I feel that I'm (indiscernible) out there, that I can do so much, and that so much is not nearly enough to start addressing needs of some populations. I see -- I feel that the system is -- has been making, you know, huge advances and they've been doing some initiatives that, for some population, has worked with very good rates of -- with very positive outcomes. But there are still some other communities that do not have access to this. I'm talking about communities that are, you know, in poor conditions, drug addicts, sex- industry workers. And I've been here since almost 10 o'clock, and I don't think I've heard the word "immigrant" being spoken here, and this is something that I wish to bring to your attention. This country has a long history of being formed by immigrants. All of us here present came from another place, either us, our parents, our grandparents, you know. By working in this system, I've learned 175 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to hate some words, and the word that I perfectly hate the most is the word "eligible," you know, when it basically, you know, has to do with a green card or with a legal identity in this country. I see those clients coming to my office more and more, clients that come here to the country or clients who do not have all of their paperwork together as to have access to regular health-care structures. And it is my job to try to provide them with those services with access to that. You know, the system has many flaws and also many advantages. One of the flaws that it has is language access, and I believe (indiscernible) for Latino communities but other communities whose language would not be English. You know, even among us, you know, the way we speak Spanish, the way other communities speak Spanish is so totally different, and that prevents the prevention messages to come across when we are trying to help these communities. I don't feel communities that aim its efforts to immigrants, to Latinos, to Asians, to African-Americans should be considered 176 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 (indiscernible) communities. I believe these are the communities that have the responsibility to provide very comprehensive services to populations that otherwise wouldn't have access to these, you know. That's basically it.
Thank you and good afternoon, Councilman. Thank you for the opportunity to testify and the leadership that you're providing and your staff as well. My name is Greg Goldman, and I'm the Executive Director of MANNA. The main issue that I would like to address this afternoon is the issue of leadership. MANNA was founded in 1990, and the first year, we served -- several volunteers served 30,000 meals, about 100 meals a day. Today the organization has more than 1,000 active volunteers, and we serve more than 40,000 meals each month. The number of clients and the number of volunteers that we engage to serve them continues to grow. These facts indicate two very important 177 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 facts for City Council to consider today. The first is that the number of people who need our services continues to rise; and second, that the number of people who are actively engaged in the fight against AIDS, at least from our perspective, also continues to rise. That the number of those in need is rising reflects the fact that the disease continues to spread rapidly to new populations -- this has been discussed. It also reflects the fact that many of those we serve are living longer and better lives as a result of the new medications. Many are doing well enough to work, volunteer, and otherwise contribute to the community but because of fluctuations in their health, they still require the services that we and our counterparts provide. But the good news is that we continue to be successful at recruiting volunteers to our efforts. Our corps of volunteers is strong and growing, and they're people that come from every walk of life, including every age group, also their economic stratus, students and teachers, business and retired people, welfare-to-work 178 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 volunteers, gays and straights, and even many with physical and mental disabilities. The issue I think that is present for us today is that in order for us all to continue to advance this fight, members of City Council like yourself and your colleagues and all of us here today who have leadership roles in the community must do two things: First, we must continue to bring attention to the crisis in whatever ways we have at our disposal. We must inform our constituencies that the epidemic is ongoing and threatens us all. We must call and lobby for and must call for continued concerted action on the part of the public. And, of course, the best way for the public to express concerted action is through broad-based grassroots for ongoing and increased funding. But, secondly -- and I think this is also very important specifically for members of Council -- we must act, continue to act, to destigmatize AIDS in all of the communities, but particularly among those which are experiencing infection at these high rates and do not have the 179 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 community infrastructure to respond effectively. This specifically means the African-American and Latino communities, including their gay and lesbian components. MANNA still delivers its meals in unmarked vehicles and in plain, brown paper bags to protect the confidentiality of our consumers, and we will continue to do this, but I am convinced, as one in this war, that the stigma that still attaches to AIDS prevents many from actively engaging in the fight by seeking and adhering to the treatment that they need. So for our part, we're recruiting volunteers and we're seeking out consumers in lots of different ways, but essentially by keeping our voices high and our energy high to express that the crisis is still here and that there is still work to be done to stop it. The members of City Council, through your words and actions, can also do the same.
This hearing is an example of that, and I think that one of the main things that we do is our public leadership to continue to inform the public that we all have a role to play in continuing to 180 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 fight this disease.
You would think that after all of these years, the stigma would not attach, and it does. And you have it in families, you know, that when somebody dies and, well, they don't want to know, they don't want to say that it was AIDS, this, that. It happened in my family and it was very difficult for my aunt and uncles to come to grips with it. And it was a hard time, I had a hard time explaining it and telling them that it was nothing to be ashamed of. Go ahead.
Thank you for giving me the opportunity to speak today. My name is Gustavo Velasquez, and I am the Division Director for Neighborhood and Family Development at Congreso de Latinos Unidos. I'm not going to give an explanation of services at Congreso. I would like to mention, though, that since 1987, just among some of the HIV and AIDS services that we provide are linguistically and culturally competent outreach 181 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 media, housing advocacy and rental assistance, prevention education, counseling and testing, case management, translation, interpretation, food services, nutrition counseling --
Going into bars and so on. I remember in '87 when some people in Congreso started going to nighttime actually to bars to talk about AIDS and the use of condoms and the use of other methodologies. So since 1987, we've had that, and I'm very much acquainted with it because we make sure that Congreso got that money.
Sure. It's the first bilingual program in the City and in the State as well. I'd like to make two recommendations, but really, before I want to give some striking kind of elements in the relationship between HIV/AIDS and Latinos in the City. Last year, Latinos were 14 percent of AIDS cases in the City; this is just over 1400 cases. 182 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 What is important here to consider is that although we were only percent, we are just 4 8 percent of the City's population. So in HIV 5 epidemiology, if you look at the HIV incidence per 6 100,000 people, our incidence was 800 people per 7 100,000 Latinos versus, for example, 130 8 Caucasians per 100,000 people. If you look at 9 this incidence, Latinos ranked second in terms of 10 people living with HIV and the relationship with 11 the number of Latinos in the city. 12 Unfortunately, if we look at this same 13 factors, we ranked first in the case of females. 14 Latinos are 50 percent -- more than 50 percent of Latinos are females and head of households, which means that given the fact that increasing years the HIV epidemics has been growing among heterosexuals, you know, and females, that's how you can see the relationship between the increase also of cases among Latinos in Philadelphia. Not to say that we are also the 14 percent of pediatric cases in the City. The second point that I want to make is regional concentration. It's really important to know that many, many migrants are rapidly coming 183 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 to Philadelphia, not only anymore from Puerto Rico but also from Mexico, Central America, and some areas of the Caribbean rather --
Right, to Puerto Rico. It is estimated that 100,000 Latinos living in East or North Philadelphia east of Broad and south of Allegheny when there are 120,000 Latinos overall in the region, which means that for HIV/AIDS, this is a very positive factor because the concentration is really in that area, and we are in a good position to fight, you know, with good prevention and care this situation in that part of the City. And my third point is really culture. You know, Latinos have a very special culture, and culture is a vital component to help Latinos (indiscernible) becoming infected or living with HIV. A stigma has particularly affected this population and Latinos literally hide from mainstream systems due to, you know, culture barriers. Not to say, you know, the language and extreme poverty. The reality is that we can 184 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 become much more effective if we have in place linguistically and culturally competent services. So, really, my two recommendations will be first to increase the amount of services that are -- you know, bilingual services. We are struggling. I mentioned that we have over 1400 cases of Latinos living with AIDS. Congreso is serving in its case management program 250 people. And that's just not enough. Not to say that within the 250, we have struggled so much in accessing, you know, primary care, that it's provided in a bilingual way. So I think that would be one strong recommendation. And that is also something also that is that the Asian- American communities are struggling. And, finally, coordination, you know, coordination between City government. We talked before about co-morbidities -- your mental health, drug and alcohol. All the systems need to get together and have a much more coordinated approach. And also coordination between service- providers, you know, that's our responsibility, that's our job, but I feel that also at the City level, it's very needed, the coordination among 185 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 different agencies. One good example is housing. We provide housing, which, you know, funding comes through the Office of Housing and Community Development, and it seems that it's very important to have coordination between the public Health Department and the Office of Housing in the City. So those are kind of some things that I wanted to highlight.
Good afternoon, Councilman Ortiz. I'm Susan Higginbotham, and I have the honor of serving as the Executive Director for AIDS Fund, a community-based organization whose mission is to raise funds for distribution to AIDS service-providers through a competitive grant process. In the interest of time and because I have the good sense not to repeat what's already been repeated -- actually Jane Shull from Philadelphia Fight eloquently articulated a number of the funding issues that I wanted to bring up, but there are a couple of points that I really 186 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 wanted to touch on. Because AIDS Fund raises all of the money that we raise through private sources -- individuals, corporate donations, events such as the AIDS Walk and Gay Bingo, and workplace-giving campaigns, we receive no government money. And in that sense, I'm in a unique position really to say that the funding really has to be increased for these AIDS service providers because we are raising money at AIDS Fund every year through these private sources, and it gets harder every year. Since the advent of the new medications around 1996, it has gotten harder to raise that money through private sources. And one of the things that somebody is inevitably going to say, whether it's City Council or State government, is that whole philosophy of, Well, the government's done enough and now, you know, the private sector has to step up to the plate and, you know, start making the difference. And the reality is because of complacency and because HIV and AIDS is not at the top of the list of the public, that's not going to happen, it's not going to happen. And what I -- 187 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116
It's not going to happen because of the population that it's attacking --
That's exactly right. And so the best-case scenario is when the AIDS service-providers have diverse sources of income, such as a combination of government money, private giving, private foundations. But the truth is, even of the larger foundations, they are not prioritizing HIV/AIDS services, and so it means that the AIDS service-providers are having to work harder for fewer resources. And so the only place to make up that difference is through the state and federal sources. And with all due respect to some Councilmembers who have already left for the day, a number of people were suggesting that the providers need to get together and advocate, and they certainly have done that, and I think what it's going to take is City Council, the Mayor, 188 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 everybody to pull out all the stops and call in all the favors and talk to everybody that you know, because the power that Council has cannot be underestimated to really make a difference.
It can tell you a lot that we have not had hearings in this Council on AIDS since the last time I had hearings in this Council on AIDS, in 1987, '88.
That's right. Well, thank you for your commitment and your stamina.
Exactly. One other point I wanted to make -- and thank you to Gary Bell, if he's still here, for bringing up National HIV Test Day, because it is a collaborative effort. AACO, AIDS Fund, and a number of counseling and testing providers are working on promoting events and offering testing during that last week of June. We are working very hard to promote that. 189 5/1/01 HEALTH & HUMAN SVCS. - RES. 010116 And the truth is, I mean, we could really use help from City Council and from the Mayor's Office. You know, if you could help us get the Mayor to a press conference, we could ensure the fact that we would have the press there to help promote what's going on, because all the providers are doing special events to try to encourage people to get counseling and testing. And certainly if the State goes to names-reporting, that's really going to harm those efforts.