By Benjamin Tsoi, M.D., M.P.H.

Director of HIV Testing, Bureau of HIV/AIDS Prevention and Control,
New York City Department of Health and Mental Hygiene (NYC DOHMH)

On National HIV Testing Day in 2008, the New York City (NYC) Department of Health and Mental Hygiene launched The Bronx Knows, a large-scale public health initiative to increase voluntary HIV testing, so that every Bronx resident learns his or her HIV status and has access to quality care and prevention. The Initiative is part of the Health Department’s efforts to stop the spread of HIV and to help link infected persons to life-saving treatment.

HIV continues to disproportionately affect New Yorkers more than the rest of the country. In 2007, New York City had the highest number of reported AIDS cases among metropolitan areas in the United States. While we saw a decline in the number of new HIV diagnoses by about 500 cases annually between 2001 and 2004, the decrease has been smaller between 2004 and 2007. Overall HIV diagnoses rates are declining in NYC during this time. However, persons aged 20–29 have seen increases in HIV diagnosis rates since 2005.

As a pilot initiative, the New York City Health Department launched The Bronx Knows HIV Testing Initiative in 2008 to significantly increase HIV testing in one of New York’s most heavily impacted boroughs. The Bronx is a borough that bears a particularly heavy burden of disease: nearly 25% of all NYC HIV diagnoses occur in the Bronx and almost one in three people who die from AIDS in NYC are Bronx residents.

The Bronx Knows brings together the Health Department with community-based organizations, community health centers, hospitals, colleges and universities, and faith-based organizations to make an impact on an important public health issue facing the city of New York. Hospitals and community health centers are working to offer HIV testing as a routine part of medical care for all patients, regardless of risk, consistent with the CDC’s revised recommendations for HIV testing in health-care settings. Community-based organizations continue to provide targeted outreach to at-risk populations and to provide HIV testing and linkage services to their clients.

As part of the Initiative, some agencies are offering HIV testing services for the first time. In addition, agencies in the Bronx are collaborating with each other on testing events and in coordinating services. A year since the launch of The Bronx Knows, we have more than 68 community partners, testing in over 140 locations. Their hard work has resulted in nearly 160,000 HIV tests conducted. Over 1,500 confirmed positives were detected and 63% of positive cases were linked to medical services. Of the confirmed positives, 689 were new HIV diagnoses. Overall, partner agencies have seen a 28% increase in testing compared to baseline.

As a partner of this Initiative, the Global Community Core of the HIV Center for Clinical and Behavioral Studies has provided consultative services to the Health Department in designing its evaluation plans. The Center’s expertise in research methodologies and practical research experience has contributed to the development of survey instruments to evaluate the success of the Initiative. The Bronx Knows initiative provides a new model for the Health Department on collaborating with its community partners. As a side benefit, community partners have engaged in increased collaborative activities with each other.

Through the relationships created and/or enhanced by participation in this Initiative, other collaborative public health interventions have formed. The Bronx Knows testing initiative strengthened the health department’s relationship with providers and stakeholders in the Bronx. The health department has found new agencies and groups to work with. For agencies where relationships already exists with the health department, we were able to build upon them to allow for better communication and increased collaboration.

In addition, we have seen relationships emerge between partner agencies. For example, an emergency medicine physician who felt he was unable to provide adequate HIV prevention services to individuals being tested in the emergency department partnered with a neighboring CBO to makes referrals for a number of supportive services. In turn, the CBO is now linking many of their clients to the hospital’s outpatient clinics for medical referrals.

The visibility of the campaign in the Bronx has also helped some agencies in better reaching their community. Many CBOs are reporting that their affiliation with The Bronx Knows initiative has facilitated their outreach to some businesses and residential groups that were hesitant to work with them in the past. The Bronx Knows community partners are conducting HIV testing events and health fairs in colleges, hair salons, churches, and local shops.

Since the launch of The Bronx Knows initiative, other municipalities have launched similar testing initiative. Evaluation of The Bronx Knows initiative will provide valuable information on the efficacy and cost-effectiveness of a jurisdiction-wide public health intervention. Collaboration with the HIV Center has provided the health department with expert to consult on better monitoring and evaluation activities.

For get more information about The Bronx Knows, you can visit www.nyc.gov/bronxhivtesting or email questions to bronxtesting@health.nyc.gov.

Benjamin Tsoi, M.D., M.P.H.  joined the New York City Department of Health and Mental Hygiene (NYC DOHMH) in 2006 and currently serves as the Director of HIV Testing in the Bureau of HIV/AIDS Prevention and Control. He oversees HIV testing programs and initiatives within the Bureau, including The Bronx Knows. Prior to this position, he worked for the Centers for Disease Control and Prevention as an Epidemic Intelligence Service officer in NYC DOHMH's Bureau of Communicable Disease.