1 HIV/AIDS and Student Health Care at T.R.H.S. John P. Tornifolio

2 Introduction: The Social Problem The juvenile population of the Fordham-Bronx Park section of the Bronx, NY, ages 0-19 years, has the highest number of reported living AIDS cases in Bronx county at 423 or 18.65% of the total reported living cases of AIDS in the Bronx (CDC, Atlanta, GA).

3 The Community The Fordham-Bronx Park section of Bronx County includes Postal Zip Codes 10467, and 10458, the Zip Code of Theodore Roosevelt High School (T.R.H.S.) T.R.H.S. is centered in the vicinity formed by the intersections of Fordham Road with Southern Boulevard to the East and Third Avenue to the West. This section of the Bronx is renown for the Bronx Botanical Gardens and the Bronx Zoological Park. The majority of public school students in this section of the Bronx attend Theodore Roosevelt High School located at 500 East Fordham Road. The demographic make up of the high school is 67.5% Hispanic, 28.0 % African-American and 4.5% other ethnic and racial groups including Native American, Asian and White (T.R.H.S. Profile).

4 Results of the Problem  High cost of medical care from opportunistic diseases;  Premature death rate of HIV/AIDS infected teens;  The spread of HIV to other teens and infants (Perinatal);  The high mortality rate of children 5-14 resulting from perinatal infection;  The high mortality rate of young adults ages resulting from infection during adolescence.

5 The Problem Restated: The Fundamental Cause The lack of information available from parents and from public and private sources to adolescents regarding AIDS prevention, diagnosis and treatment results in one of the highest incidence rates of reported living AIDS cases in Bronx County, NY.

6 Ten States/Territories Reporting Highest Number of AIDS Cases State/Territory # of AIDS Cases  New York128,675  California110,056  Florida70,276  Texas48,350  New Jersey38,230  Puerto Rico22,297  Illinois21,684  Pennsylvania21,040  Georgia20,007  Maryland18,716

7 Ten Metropolitan Areas Reporting Highest Number of AIDS Cases Metropolitan Area# of AIDS Cases New York City109,050 Los Angeles38,670 San Francisco26,332 Miami21,502 Washington, DC20,121 Chicago18,776 Houston17,585 Philadelphia16,123 Newark15,426 Atlanta14,217

8 Gathering Evidence of the Problem In New York State there are 128,675 reported living cases of AIDS, the highest number of reported living AIDS cases in the United States. 109, 050 or 84.75% are in New York City or 8.7% of those cases in NYC was reported in the Bronx or 23.86% of those reported Bronx cases are in the Fordham-Bronx Park area. 202 or 8.9% of these 2268 AIDS cases are children (0-12 yrs.) and 221 or 9.75% are adolescents (13-19 yrs.). At a ratio of 4:1 HIV+ to reported living cases of AIDS & based upon a census of 3200 students enrolled at Roosevelt High School, approximately 884 or 27.63% students at Roosevelt High School are HIV+. (NYC Dept. of Health, Office of AIDS Surveillance, Publication “Estimates of Persons Living with AIDS in New York City”, 1998 ed., Issued 3/99.)

9 Identifying the Causes of the Problem  Lack of information regarding prevention, diagnosis and treatment of HIV/AIDS;  Increase in IDU (Intravenous Drug Use);  Limited access to prophylactics.

10 Evaluating Existing Public Policies: SPARK Program Advantages of the SPARK Program  Provides information to students in the classroom regarding the prevention, diagnosis, and treatment of HIV/AIDS;  Provides 1:1 counseling for students who may be suspicious of having been exposed to HIV or infected by the virus;  Provides students access to information on clinics and hospitals which provide HIV testing and HIV/AIDS treatment;  Encourages student openness in discussing HIV/AIDS and related issues by maintaining student confidentiality and providing emotional support from concerned staff and peers;  Provides counseling, social and emotional support for students who may have relatives that are victims of HIV/AIDS;  Provides condom distribution to students on a free and confidential basis.

11 Evaluating Existing Public Policies: SPARK Program Disadvantages of the SPARK Program  Under utilization by students of on site instruction, counseling and related services;  Inability to guarantee proper use of condoms by students outside of SPARK personnel supervision;  Low attendance prevents students from realizing full benefits of the SPARK program through instruction and consistency of counseling;  Inadequate staffing of the SPARK program prevents exposure of many students to the program and its offerings.  SPARK occupies space in a building where classroom space is held at a premium due to overcrowding.

12 Developing Public Policy Solutions Public Policy Alternatives  The NYC Health Department could rent space in the area outside of the school to provide anonymous and confidential HIV testing of students school;  The NYC Health Department could provide a van to provide information and services during non- school hours;  The NYC Board of Ed could sponsor an annual HIO (Health Information Orientation) every September to advise parents and students and to enlist the aid of parents and guardians in safeguarding the students of the high school.

13 Preferred Public Policy The first and third alternatives are preferred because they:  Provide needed services without straining limited facilities;  Provide students immediate access to testing services;  Maintain the confidentiality and anonymity of students;  P rovide students with counseling and medical services in the event that testing is positive;  Are recommended by a recent CDC study, which included test subjects from the Bronx, suggesting children whose parents are actively involved in HIV/AIDS information dissemination are less likely to be at risk for exposure and infection.

14 Selecting the Best Public Policy Solution The three public policy alternatives identified above are:  Rental space in the area outside the school;  Mobile Van Services;  Annual Orientation focused on Parents and Guardians, especially Mothers.

15 Matrix Rationale A. Renting Space: 1. Effectiveness is high because space is available at Fordham Plaza, adjacent to THRS where St. Barnabas is located. Space would be more professional and would allow for a broader spectrum of services in a more confidential atmosphere. 2. Feasibility is medium due to financial underwriting by the hospital and budget concerns on the part of Board of Ed & NYC. B. Van Services: 1. Effectiveness is low because the services would be limited, would not be targeted to a specific T.H.R.S. audience and can not guarantee student anonymity. 2. Feasibility is medium. Even though the vans already exist, would not entail a major cost and could visit the school reducing the need for students to travel to clinics, the vans would be present at the school resulting in reduced student use because their anonymity may be compromised. C. Annual Orientation: 1. Effectiveness is medium because attendance by parents would be subject to their availability and there would be the need to rely on students to disseminate information accurately to parents who are unable to attend the orientation. 2. Feasibility is high because a school orientation program already exists and this health orientation would become a part of that program.