ANNUAL REPORT OF THE EXECUTIVE DIRECTOR
JULY 2006 – JUNE 2007
In July 1981, the New York Times reported an outbreak of a rare form of cancer among
gay men in New York and California, first referred to as the "gay cancer," but medically
known as Kaposi Sarcoma. About the same time, Emergency Rooms in New York City
began to see a rash of seemingly healthy young men presenting with fevers, flu like
symptoms, and a pneumonia called Pneumocystis. Approximately one year later, the CDC
(Centers for Disease Control) linked the illness to blood and coined the term AIDS
(Acquired Immune Deficiency Syndrome). In that first year, over 1600 cases were
diagnosed and close to 700 deaths, due to AIDS related complications, were recorded.
As the number of deaths soared, medical experts scrambled to find a cause and, more
importantly, a cure. In 1984, scientists at Institute Pasteur of France discovered what
they called the HIV virus; it wasn't until a year later that a US scientist, Dr. Robert Gallo,
confirmed that HIV was the cause of AIDS.
Following this discovery, the first test for HIV was approved in 1985. Over the next
several years, medications to combat the virus and prophylactic treatments, to prevent
infections that flourish when the immune system is damaged by HIV, were developed. By
the end of 1987, there were 71,000 confirmed cases of AIDS and over 40,000 deaths
due to AIDS related complications.
So, where are we today? Thanks to an ever-evolving array of new anti-retroviral drugs,
and improved funding for early medical care, AIDS related deaths in the US are declining.
People are healthier and living longer with HIV. But, in other parts of the world, the
pandemic rages on (http://aids.about.com).
Globally, over 42 million people are living with HIV/AIDS; 74 percent of these people –
more than 31 million – live in sub-Saharan Africa. There are 14,000 new infections
occurring every day, with 95% of these being in developing countries. By the year 2010,
it is expected that five countries (Ethiopia, Nigeria, China, India and Russia), with 40
percent of the world’s population, will add a minimum of 50 million – and as many as 75
million new infections to the worldwide pool of HIV disease.
Throughout the world, HIV/AIDS is a “disease of young people.” Each year, half of the 5
million new infections occur among people between the ages 15 and 24. Another grim
statistic pertaining to the epidemic’s impact upon the future of our world is the number
of children orphaned by AIDS. The UN estimates that, currently, there are 14 million AIDS
orphans worldwide and that by the year 2010, there will be 25 million. The matter is
particularly severe in sub-Saharan Africa, where the streets are literally clogged with
children who have lost their parents to AIDS. With no money available for costly HIV
drugs, the epidemic there is expected to get much worse – estimates of 20,000,000 new
infections, in the next 5 years alone, are predicted for this area of the world.
AIDS orphans, with no food to eat and no place to call home, are the most vulnerable
members of our global community. It is easy to understand how, in an effort to survive
another day, they may unwittingly expose themselves to the HIV virus. Once infected,
they – like countless other people living with the virus around the world – unknowingly
become vectors of the virus and go on to perpetuate the epidemic.
In the United States, an estimated one million people are currently living with HIV and an
estimated 40,000 new infections occur each year. Seventy percent of these new
infections occur in men, thirty percent in woman; fifty-four percent of all new infections
occur among African Americans; sixty-four percent of the newly infected women are
African American; twenty-five percent of the new infections in woman are the result of
heterosexual transmission. As in the world at large, HIV in the US is a “disease of young
people” – half of all our new infections occur in people under the age of twenty-five;
however, due to the availability of effective treatment it is increasingly a chronic disease
that people live with well into their middle adulthood and beyond.
Cumulatively, Pennsylvania has reported 31,782 AIDS cases since the start of the
epidemic (31,426 adults and 356 pediatric as of December 2005). Of this total – which
does not include those living with HIV who have not yet been diagnosed with AIDS –
forty-nine percent are known to be deceased and fifty-one percent (16,063) are believed
to be living with AIDS. A full fifty-six percent of the Commonwealth’s cases are attributed
to Philadelphia. Of the remaining forty-four percent, the AIDSNET region accounts for
2,119 cases with 756 (36%) of these cases being found in Berks County and 124 (6%)
from Schuylkill County. Based upon this data, Berks County has the highest number of
AIDS cases in the coalition and ranks 6th among Pennsylvania’s 67 counties for number
of AIDS diagnoses; Schuylkill County ranks 21st among the counties of the
Commonwealth and ranks 5th out of the 6 counties in the regional coalition.
Estimating the true rate of sexually transmitted disease or infection cases is not a
simple or straightforward task. First, most STDs can be “silent,” causing no noticeable
symptoms. These asymptomatic infections can be diagnosed only through testing.
Unfortunately, routine screening programs are not widespread, and social stigma and
lack of public awareness concerning STDs often inhibits frank discussion – about STD
risk – between health care providers and patients (American Sexual Health Association,
ASHA). According to ASHA, there are at least 19 million new cases of STDs every year, an
estimated 65 million people in the US are living with a viral STD, and more than half of all
people will have an STD at some point in the lifetime. Nevertheless, a national survey of
US physicians found that fewer than one-third routinely screened patients for STDs.
Generally speaking, STD data correlates with HIV/AIDS statistics: ASHA reports that
approximately one half of all new STDs in the US occur among youth ages 15-24; and,
according to the most recent reports (2003) Berks County has the highest number of
Chlamydia and Gonorrhea cases in the AIDSNET region, with Schuylkill County ranking
5th. Combined, these realities underscore the importance of our STD Screening and
Treatment Services in both communities. During the last year, we have screened more
than 2,000 patients in our two county service area and, anecdotally, nurses at both sites
report an increased incidence of STDs which we will be monitoring closely in the coming
In my most recent annual reports, I have touched upon the CDC’s “Advancing HIV
Prevention Initiative” which includes four strategies. First introduced in 2003, these
strategies are: 1) make HIV testing a routine part of medical care, 2) implement new
models for diagnosing HIV infections outside of routine medical settings, 3) prevent new
infections by working with persons diagnosed with HIV and their partners; and 4) further
decrease perinatal transmissions.
According to Dr. Robert Janssen at the Centers for Disease Control, four years after the
introduction of “AHPI”, studies have shown that HIV testing (including counseling) is an
effective HIV prevention strategy, and that the availability of rapid HIV testing expands
testing opportunities. Studies have also shown that infected individuals who know their
HIV serostatus are less likely to engage in high risk sexual behaviors, and it is estimated
that knowledge of HIV serostatus could reduce new infections by more than 30%. These
findings validate, for me, that our efforts to advance HIV prevention in our community
over the last four years are one ingredient in our success. By providing quality counseling
and testing services, making the rapid HIV test available, and prioritizing prevention
services with HIV positive persons we are living our mission. Furthermore, in the context
of HIV prevention, we are able to address the related health issues of STDs and Hepatitis,
thereby living our mission fully.
Clearly, these efforts would not be possible without the sincere commitment of staff,
board and the larger community. This commitment, which allows us to further our
mission in the face of reduced resources, is the other main ingredient for our success.
The following sections will summarize our programs and their effectiveness over the past
twelve months. For a more in depth look at our services, please review the attached
statistics; a full copy of our regional outcome result summary is available upon request.
Additionally, I am always open to your questions!
Two hundred eighty (280) clients (including 72 new) received 5,038.75 hours of case
management services. One hundred ninety-one (191) or 68.2% are HIV+ and eight-nine
(89) or 31.8% have full blown AIDS. Over 98% of our clients are at or below poverty level
and 17.5% have no health insurance. Four-thousand nine-hundred eighty-three (4,983)
meals were served, sixty-one (61) clients received adherence education and fifty (50)
clients regularly attended one of our four on-going support groups.
A Comment on Outcomes & Services: In summary CCWS met the minimum standard for
assessing clients for risk behavior(s) that could lead to re-infection and/or transmission
with documentation of an on-going risk reduction plan with follow-up. We exceeded the
expected number of clients maintaining or improving their Consumer Holistic
Improvement Scale (CHIS) scores, the number of clients anticipated to improve their
CHIS scores by 3 or more points, and the minimum standard for support groups and
adherence objectives. The fact that we routinely refer clients to medication adherence
education/counseling sessions, with one of our AIDS certified Registered Nurses
(ACRNs), is a critical service component that keeps our clients healthy and sets us apart
from other providers. We have a client centered care services model implemented by
well trained and highly professional staff.
The agency provided prevention services (ILI, GLI, Outreach and HCPI) to 20,987
individuals utilizing 4,043 hours of prevention staff time. We distributed 24,289
prevention tools, 14,808 pamphlets and 571 promotional materials. 1,003 HIIV tests
were performed - 672 were traditional blood draws, 294 were Rapid Tests and 37 were
Orasures - with a 3% positivity rate (29 out of 1,003). The STD Clinics were extremely
busy with 1,653 patient visits at the Berks Office and 418 in the Schuylkill Office for a
total of 2,071 patient visits.
A Comment on Outcomes & Program Highlights: All minimum prevention outcomes were
exceeded with the exception of outreach which was nearly met. The target was 25% of
outreach contacts would progress to an Individual Level Intervention (ILI) and we
We are using HHRP material in three settings (ADAPPT, BCP Respect, and BCP G Unit –
all populations at high risk for HIV with a significant percentage of HCV+ participants) on
a weekly basis. This is a significant step in utilizing material from the CDC’s proven
effective interventions. We continue to hold monthly sessions with residents of Easy
Does It, Inc (EDI, a recovery community) and will strive to develop a more collaborative
relationship with EDI in hopes of developing some new and innovative programming in
the coming year. We continue to concentrate our prevention efforts on reaching those
highest at risk. Some of our on-going program locations include: Caron Foundation,
Wernersville State Hospital (where we hold a regular intensive 12 week cycle for
residents that struggle with triple diagnosis (HCV/MH/D& A or HIV/MH/D&A),
Supported Work, Teen Works @ Arbor Education & Training Center and Berks Women in
Crisis. In Schuylkill County we have a consistent presence at Penn State where outreach,
health communications & small group sessions have resulted in students seeking STD
services. The relationship with PFLAG (in Schuylkill County) has helped our outreach to
the MSM population as has the “Take Pride” program (a weekly small group for GLBTQ
youth) in Berks County. Our relationships with Spectrum (a drop in center, in Reading, for
GLBTQ youth) and the Reading High Gay Straight Alliance are also helping raise
awareness about our services among this high risk population. Our prevention staff
willingly works long hours, outside the traditional work day, to make sure that the
prevention message is heard by those at highest risk.
Overall the past fiscal year was a very good year for the agency. We began the return to
both staff & fiscal stability. More focus was placed on adhering to the strategic plan and
we were able to execute a few enhanced contracts, with existing funding sources, that
allowed us to further diversify our income streams.
This annual report would not be complete if I did not take a moment to remember
Margaret Aronson, our Director of Development for the past 18 years, who passed away
from complications of pancreatic cancer on July 6th. CCWS/BAN has lost one of our
strongest and most dedicated team members. Those of you who knew Margaret
understand that the title does not describe the true scope of her responsibilities. Every
aspect of our organization has been impacted by her expertise and talents. I have had
the privilege of working with her since 1995, when I was hired as the Executive Director
– I learned so much from her over the years and know that a part of her will always be
with me & guide my decision making.
I ask that you support & value each other as board members, staff, colleagues and
friends so that our work together will honor the extraordinary investment Margaret made
on behalf of CCWS/BAN. She loved her work, she was devoted to our cause and she
especially enjoyed the challenge of helping us all do our very best. In her memory we will
continue to strive to meet her standard of excellence
Who could have foreseen that a mysterious illness, affecting a few gay men in 1981,
would become the epidemic of the 20th century and continue to confound the science of
modern medicine into the 21st century? Remember the words of John Ruskin … “What
we think, or what we know, or what we believe, is in the end, of little consequence. The
only thing of consequence is what we do.” We have made much progress by doing over
these past 22 years, but still so much remains to be done. As long as the epidemic
endures, our work goes on, and we will continue to do until all is done.
Carolyn M, Bazik, MBA
July 31, 2007
Sources: American Social Health Association
American Sexual Health Association
Centers for Disease Control
PA Dept of Health – Bureau of Epidemiology