1996
Stephen Nicholas, M.D., Director
The Department of Pediatrics has played a significant role in the creation and support
of Incarnation Children's Center (ICC), New York City's only residence for HIV-infected
children. Located on Audubon Avenue at 172nd Street in a 4-story red brick
former convent, ICC's residential and outpatient programs have provided care for over 600
HIV-positive children since opening its doors in 1989.
In the mid-1980's, children with HIV infection and AIDS were often homeless and foster
parents were in very short supply. As a result, hundreds of AIDS boarder babies languished
for months to years on hospital wards because they had nowhere else to live.
In 1987, Dr. John Nicholson, Professor and Attending of Pediatrics, after finishing a
month as ward attending at Harlem Hospital, which had the greatest number of AIDS boarder
babies in the city, had an idea to use Incarnation Convent, which was empty, as a home for
AIDS babies. At his prompting, a collaborative group formed: Monsignor Thomas Leonard,
then a rector of Incarnation Church; Sister Una McCormack, executive director of Catholic
Home Bureau, a foster care and adoption agency of the Archdiocese of New York; Dr. Michael
Katz, then chairman of the Department of Pediatrics; Dr. Margaret C. Heagarty, Director of
Pediatrics at Harlem Hospital; Jack Rudin of the Samuel and May Rudin Foundation; Brooke
Trent, then Deputy Commissioner of the Child Welfare Administration.
This collaborative group envisioned a sanctuary of love, a home-like nurturing
residence where HIV-positive children would receive the best possible nursing and medical
care while awaiting placement into foster homes.
Dr. Stephen Nicholas was recruited to become the founding medical director. With his
assistance and together with cofounders Sister Bridget Kiniry, M.Ed., Sr. Constance
Gaynor, M.S.W., and Pamela Clark, R.N., M.P.H., the program was created.
During its first two years, ICC became the Ellis Island for homeless children with
AIDS. One hundred and sixty children were admitted to ICC from all five city boroughs.
During this period, ICC worked with the Child Welfare Administration and a large number of
foster care agencies to encourage foster parents to accept HIV-positive children. As a
result, foster parent recruitment increased at an astonishing rate. After three years, a
surplus of foster parents existed for all but the sickest children. New York City's AIDS
boarder baby crisis had ended. ICC had played a pivotal role in this success story. Having
accomplished its goal, ICC would have happily closed its doors had it not been for an
unexpected discovery.
Pediatric AIDS was first recognized in 1982-83. Early in the epidemic, HIV disease of
childhood was considered to be down-hill course leading to death. But in the late 1980's,
before AZT was available, many very ill children admitted to ICC got dramatically better
with proper nurturing and high-quality medical and nursing care. As the importance of
convalescent care became clear, many of the sickest HIV-infected children in the city
began to be referred to ICC for temporary care.
In 1992, an outpatient clinic for HIV-positive children was established; the same year,
with funding from the National Institute of Allergy and Infectious Diseases, the clinic
became a sub unit of the Columbia University Pediatric AIDS Clinical Trials Unit, directed
by Dr. Anne Gershon, Professor of Pediatrics. In addition, ICC from its earliest days has
worked in close collaboration with the Harlem Hospital Pediatric AIDS Program, directed by
Dr. Elaine Abrahms, Associate Professor of Clinical Pediatrics.
Today ICC is an internationally-recognized model of community-based care for children
with HIV/AIDS. It's 1996-97 operating budget is $2.0 million for the residential program
and $756,899 for the clinic program ($286,087 of which is for clinical trials). A staff of
70 provide a full array of medical, nursing, child care, social, nutritional and
developmental services. Approximately 70 volunteers supplement staff activities. The
Friends of Incarnation Children's Center, a newly-organized non-profit organization for
publicity and fund-raising, raised $334,818 in 1996, of which $100,000 was donated by The
May and Samuel Rudin Family Foundation for the support of Columbia University medical
staff salaries.
ICC medical personnel include three pediatricians, two research nurses, two-field
nurses, one senior clerk and one part-time psychologist.
During 1996, ICC's average residential census was 88.6%, with 42 children admitted for
an average length of stay of 82 days.
During clinic sessions each week, 1438 evaluations were given in the past year to 133
HIV-positive children, 118 children were referred for HIV testing. Under the direction of
Dr. Nicholas, 34 children are currently participating in 7 clinical trials, including ACTG
219 (Pediatric Late Protocol); ACTG 240 (zidovudine vs. D4T); ACTG 245 (comparison of
didanosine, zidovudine and nevirapine in children/adolescents with advanced HIV diseases);
ACTG 254 (atovaquone/azithromycin vs. trimethoprim/sulfamethoxazole to prevent serious
bacterial infections); ACTG 300 (zidovudine/3TC vs. didanosine/zidovudine/didanosine);
ACTG 327 (a continuation of ACTG 240), and a Roche-sponsored trial of DDC monotherapy.
ACTG 338 (zidovudine/3TC vs. D4T/ritonavir vs. zidovudine/3TC/ritonavir), the first
phase II pediatric trial of a protease inhibitor, will start in early 1997. The ICC
clinical trials subunit was awarded funding from NIAID for an additional three years
(1197-2000).
Dr. Nicholas was promoted in 1996 to Associate Professor of Clinical Pediatrics and
Associate Attending. He was listed among The Best Doctors in New York in New York
Magazine, and in the 1996-97 edition of The Best Doctors in America.
