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Leadership Award

 Stephen W. Nicholas 

Doctor of Pediatrics
Harlem Hospital
Casper College, WY

By Evelyn L. Kent
Community College Times
March 29, 2005

"U.S. Close to Eliminating AIDS in Infants, Officials Say," read the headline in the New York Times on Jan. 30.

Two factors account for the decline in HIV/AIDS among infants, according to Dr. Stephen W. Nicholas, director of pediatrics at Harlem Hospital in New York and associate professor of clinical pediatrics at Columbia University. 

Consistent treatment and better drugs for pregnant women have reduced mother-to-child transmission rates from 20 to 25 percent to less than 8 percent. Extensive public education, outreach and testing also have helped to reduce the number of children with HIV born at Harlem Hospital to one in the last four years, according to the Times article. 

A graduate of Casper College in Wyoming, Nicholas was instrumental in bringing the number down.

Nicholas was in medical school when AIDS first was identified. He received his pediatric training at Columbia University's Babies Hospital and at Harlem Hospital.

"I came to Harlem with a particular interest in taking care of poor children. I left Babies Hospital thinking I was sure of one thing – I didn't want to take care of dying children."

Initially, Nicholas' goal was to help put together better health systems for poor children. In 1983, he went to Harlem Hospital, a city hospital in one of the poorest neighborhoods in the country, prior to the discovery that babies could be born with HIV. Knowledge came all too soon when the hospital admitted a baby who turned out to be one of the first identified with AIDS. 

"It was probably the first time in my career that I hoped someone else would step into the breach," he said. No one did. Still not wanting to watch kids die, Nicholas began his career fighting pediatric AIDS.

What a fight it's been. 

Nicholas attacked it on all fronts. He cobbled together money to pay for clinics, treatments, drugs and research. He designed and implemented outreach programs to educate mothers on the risks of transmission and the need to be tested.  In 1988, he began housing and caring for children, who were removed from parental care, abandoned because they had AIDS or orphaned by the disease. He lobbied the state to mandate testing of newborns, which it did in 1997. 

Until 2000, Nicholas was the executive director of the Incarnation Children's Center, a 21-bed skilled nursing facility, outpatient clinic and drug-trial site that began as an alternative to endless days in hospital beds for children with AIDS who could find no place in foster homes. ICC was and still is the first residence for children with HIV/AIDS in New York and is a model that has been replicated in England, Brazil, Thailand and Russia.

During the program's first three years, two-thirds of New York City's AIDS "boarder babies" were admitted to ICC. Eventually, the foster care program began to absorb HIV-positive children, and Nicholas and ICC concentrated on convalescent care for children with AIDS who were too sick to live at home, but not sick enough to require hospitalization.

Nicholas is now an internationally recognized expert on treating and preventing AIDS in children. Many of the lessons learned about how children with AIDS improve with high-quality medical and nursing care are being exported around the world. He is working with AIDS workers, experts and officials in Russia, South Africa, Haiti and the Dominican Republic to treat and care for children with AIDS. "The model of what we've developed in terms of care and testing new life saving drugs is being replicated throughout the world," Nicholas said.

"We've gone from a time of pure apocalypse to a one of shimmering hope."

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