Testimony by Laray Brown
Senior Vice President, Corporate Planning, Community Health & Intergovernmental Relations, NYC Health and Hospitals Corporation

New York City Council Committee on Health and Committee on Women’s Issues

Oversight Hearing:
The HIV/AIDS Epidemic among Women in New York City

Good afternoon Chairpersons Rivera and Sears, members of the Health and Women’s Issues Committees and other distinguished members of the New York City Council. I am LaRay Brown, Senior Vice President, Corporate Planning, Community Health and Intergovernmental Relations at the New York City Health and Hospitals Corporation (HHC). Thank you for the opportunity to discuss how HHC serves New Yorkers living with HIV/AIDS. Following my testimony, Dr. Tod Rothschild, Associate Director of OB/GYN at Queens Hospital Center, will discuss the care and services provided to women with HIV at HHC facilities.

HHC has been at the forefront of diagnosing and providing an array of services to persons with HIV/AIDS for more than a quarter of a century. Dedicated, comprehensive HIV/AIDS care is provided at State Designated AIDS Centers located within HHC’s 11 acute care hospitals. HHC’s six diagnostic and treatment centers also provide HIV primary care and other related services. Coler-Goldwater, one of HHC’s long-term care facilities, provides specialized care to individuals with HIV who require ongoing medical and skilled nursing care. These sites currently serve approximately 19,000 patients with HIV and AIDS. In addition, through HHC’s health plan, MetroPlus, we operate a Special Needs Plan (SNP) for people living with HIV/AIDS. With more than 1,350 members, the MetroPlus HIV SNP is the largest of the three in New York State.

I’d like to take a minute to talk about the results of HHC’s HIV testing expansion initiative. HHC is committed to improving access to HIV testing so that people are able to learn of their HIV infection earlier in the course of the disease and can be linked to life-prolonging treatment. As you may know, we held a press conference at Gouverneur Health Care Services on the Lower East Side two weeks ago with Speaker Christine Quinn and Council Members Robert Jackson and Alan Gerson to announce that HHC facilities tested nearly 134,000 patients during Fiscal Year 2007 – a 116 percent increase over the 62,023 tested only two years earlier, before our hospitals and health centers began to expand the use of rapid HIV tests and make HIV testing part of routine medical care for patients 13 and above. Of the 134,000 patients tested this year, 51% were Hispanic, 40% were Black, 3% were White, 4% were noted as ‘Other’ and 2% were Asian. 1,630 patients tested positive for HIV; for just over half of these patients, it was the first time they had heard they were HIV positive. Of the patients who tested HIV positive during the last fiscal year, 48% were female. Our clinics and hospitals often provide the first and only medical contact some previously undiagnosed patients have.

With the financial support HHC has received from the City Council, as well as the New York City Department of Health and Mental Hygiene (DOHMH) and the U.S. Health Resources Services Administration (HRSA), HHC readily offers HIV testing to patients in every emergency room and in many inpatient units and clinics across our system. By expanding testing and making it available as a routine medical service, we can help overcome the stigma and barriers associated with HIV and AIDS and reach more New Yorkers who may be HIV positive but do not know it. Routinizing HIV testing, and making results available in less than an hour, offers patients a critical opportunity to know their HIV status so they can protect themselves and others. For FY 2008, we are committed to further expansion of our testing program and expect to reach 150,000 patients.

Within HHC, there are a number of facilities with special programs dedicated to the health needs of women with HIV that illustrate both the unique issues faced by women with HIV as well as some of the creative programs we operate. Many of these specialized programs are grant funded. Without these grant funds, HHC would not be able to maintain the critical enabling and educational programs that are absolutely essential to early engagement and retention in care. At Jacobi Medical Center and North Central Bronx Hospital a Family Service Program provides support groups for adolescent girls and wraps entire families into the care process. The program recognizes that if a single family member is infected then an entire family is impacted. It provides the support needed to ensure that the patient may continue successfully in care and that the support needs of the patient’s family are also addressed.

Lincoln Medical and Mental Health Center’s HIV program sees patients and their affected household members who come from diverse ethnic backgrounds and cultures. Lincoln’s staff have specialized training to assist these patients. In a joint project between HHC and DOHMH, Lincoln runs a treatment adherence program to help patients take their medications regularly. Lincoln’s staff visits the patient’s home and observes the patients taking their HIV medication. Lincoln's Bronx Family and Adolescent Children's Consortium Program (providing care for HIV positive children and affected family members) is supported in part by a sub-contract from Montefiore Hospital. Montefiore is the lead agency of this Ryan White Part D consortium which includes Lincoln.

Both Bellevue Hospital and Harlem Hospital run a Transitions Program for older children who were infected perinatally. These programs work with adolescent patients as they ‘age’ into adult services and teach them to use self-care management techniques that are appropriate for their young adult status. Bellevue is also part of a consortium led by the AIDS Service Center, a Manhattan Community Based Organization, which provides services to women, youth and families. This is supported by funding from the Ryan White Part D program.

In Queens, Elmhurst Hospital also has a Ryan White Part D Program for women and children where social workers work closely with parents and children in families affected by HIV. A special aspect of this program is the Family Matters Program Partnership with the AIDS Center of Queens (ACQC), which focuses on individual and group counseling for infected parents to help them improve their parenting skills and more importantly, provide the mental and emotional support their children need. At both Elmhurst and Queens Hospital Center, the Ryan White Part D Program also provides counseling support groups for women and adolescents.

Both Woodhull Hospital and Cumberland Diagnostic and Treatment Center (D&TC) participate in the New York State Department of Health’s AIDS Institute’s Project WAVE to increase community awareness about access to care, prevention and testing. Both also participate in the Brooklyn Prenatal Care Consortium, a community development project in which community based organizations, hospitals, clinics and faith-based organizations work collaboratively to serve pregnant women in North-Central Brooklyn. In addition, Cumberland D&TC offers special prevention services to educate African-American and Hispanic women of childbearing age, including their sexual partners, about HIV risk behavior, prevention, and transmission.

Harlem Hospital has a Mom-Baby clinic where services are co-located for both adult and child patients making it easier – and therefore more likely - for patients to obtain life extending care. Funding for this program is provided by the New York State’s AIDS Institute.

I mentioned the HIV SNP, our managed care plan operated by HHC’s MetroPlus Health Plan. Women living with HIV have an increased incidence of cervical cancer and cervical dysplasia. One of the unique services offered to members in our SNP is intensive staff outreach and education that encourages female members to receive annual gynecologic examinations so that these health conditions can be detected early. Women who have not had their annual visits are educated through mailings and telephone contacts on the importance of cervical cancer screening. Moreover, female members who are not actively engaged in care also are targeted in community canvassing efforts if more conventional outreach activities are unsuccessful. The SNP helps ensure patients obtain care by scheduling members’ gynecology appointments and arranging for transportation to the medical visit if required.

To give you an example of some of the challenges of working with pregnant, HIV-positive women I’d like to describe one case: a woman came into care and through our routine HIV screening, was determined to be HIV positive. She was counseled about the availability, desirability and benefits to herself and her unborn child of taking antiretroviral treatment during pregnancy. Although she continued to receive prenatal care, she decided not to initiate treatment for her HIV infection despite repeated counseling throughout most of her pregnancy. Late in pregnancy, she agreed to initiate a course of HIV medications and her care continued. Nevertheless, her child was born HIV-infected. This woman subsequently came into care again for a later pregnancy and this time, chose to take HIV medications immediately - from her first prenatal visit. Between 2003 and 2006, out of approximately 300-400 HIV-positive women giving birth each year, 47 children were born to HIV-positive women in New York State. As Dr. Rothschild will note, only a very small number of the infants born to positive mothers actually are truly infected themselves; this one case illustrates the tremendous importance and impact of ongoing care for both mother and child.

This concludes my written testimony. I would now like to turn to Dr. Tod Rothschild, Associate Director of OB/GYN services at Queens Hospital Center. We would be happy to answer any questions you have at the conclusion of his presentation.