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CORE Center working on HIV/AIDS healthcare
by Erica Demarest, Windy City Times
2012-05-02

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In the mid-1990s, HIV/AIDS treatment in Cook County could best be described as disjointed.

Medical, mental health, pharmaceutical and case management services were housed in different locations; and Chicago's thousands of HIV-positive residents were bounced among city hospitals with limited to no HIV-dedicated space. Privacy concerns were common in cramped corridors, and long walks between services left patients exhausted.

Doctors, city officials and patients began kicking around ideas for an AIDS-specific facility, and concept for the CORE Center was born.

"The goal was to provide comprehensive medical and support services in a single location," said Associate Director Chet Kelly, who joined CORE in 2000 after a long stint with the Illinois Dept. of Public Health ( and prior to that with the Chicago Dept. of Public Health ) .

Operated by the Cook County Health and Hospitals System ( HHS ) and founded by the Cook County Bureau of Health Services and Rush-Presbyterian-St. Luke's Medical Center, the CORE Center was the first comprehensive outpatient facility in the Midwest for people living with AIDS.

It provides a one-stop shop, where clients have access to dental care, medical care, a pharmacy, research trials and case managers. All payments are made on a sliding-scale basis.

In 1994, the fledgling health center set a $25 million fundraising goal and enlisted former Playboy Enterprises CEO Christie Hefner as a project director.

"In the early '80s, [ Playboy ] started to write about AIDS with the goal of countering the scare tactics that were out there about transmission," Hefner told TimeOut Chicago in 2005. " [ Playboy ] historically has been an important force as far as issues related to health and particularly issues that also touch on human sexuality."

Under Hefner's guidance, the CORE Center far surpassed its goal, raising more than $30 million by 1998.

"I'd never really been that involved in a capital campaign, and I think I said yes because I didn't really know how hard it was going to be," Hefner told TimeOut.

"But I did say yes," she continued, "and I was able to put together a board representing people in the business community, the arts community, the public sector and the medical sector. Also, we did something quite innovative, which is put together a community action council … the idea was that the people who were actually going to be the patients ought to have input into how the facility was designed and the kind of programs it would run."

The CORE Center, later renamed the Ruth M. Rothstein CORE Center, opened its doors to the public in October 1998. The four-story, 60,000-square-foot building proved to be as innovative as the facility's programming.

Designed by Ralph Johnson and health architect Jocelyn Lum Frederick, the building was largely a collaborative effort. Members of the community, including doctors and HIV-positive patients, contributed complaints and suggestions.

The result was a sunny, welcoming facility devoid of the meandering hallways and dreary colors often associated with medical centers. Clients had complained about navigation difficulties and privacy concerns; color-coded departments and private enclaves were worked into the design.

"The concept was to provide a light, airy and positive environment," Kelly said.

That environment has changed over the years, constantly adapting to meet the needs of an evolving virus.

When construction on the CORE Center began, Executive Director Kathi Braswell said, bronchoscopies were such a common treatment that an entire room was devoted to the procedure. But by the time CORE opened its doors in 1998, highly active antiretroviral therapies had all but eliminated the need for bronchoscopies. The space was repurposed.

"Over the years, we've done extensive renovations to the building," Kelly said.

These renovations have offered new facilities, greater privacy and additional programming. Recent structural and organizational additions have included a Hepatitis clinic, bilingual clinic and dental center.

One of the most innovative programs the CORE Center has developed is the Continuity Clinic, which targets recently released detainees and prisoners. Clinic physicians work at both the CORE Center and in facilities operated by the Cook County Dept. of Corrections, so that people who are incarcerated can see the same doctors once they've been released from jail.

The transitional assistance makes it easier for patients to adhere to medications and remain in treatment, which could reduce the community viral load.

Today, the CORE Center provides counseling and support services to more than 15,000 people annually. Clients are charged on a sliding-scale basis, and the majority of patients are un- or underinsured.

"We're a safety net facility," Kelly explained.

In 2010, according to HHS data, about 60 percent of patients had no insurance and 37 percent were covered by Medicaid or Medicare.

That same year, 62 percent of clients were Black, 17 percent were Latino and 15 percent were white. The overwhelming majority ( more than 70 percent ) was male. All clients have access to medical care, a pharmacy, peer support, research trials and case managers.

Aurora Pineda, a longtime LGBT activist and CORE Center employee, said case managers provide a necessary link for an often complex web of services.

"We're somewhere in between a mental health provider and an advocate for the client," Pineda said. "The client tells you the truth. He tells you [ in regard to medication ] , 'I'm not taking that crap.' Or, 'Oh I forgot to take this pill.' Or, 'I don't get sick with this pill, so I'll only take this one.' We're like: No, you can't be doing that. Talk to the pharmacist. We tell them where to go … , [ Do you need ] food stamps? Then go talk to this caseworker. We point them to the right direction."

For clients who face homelessness, poverty, transportation issues and language barriers, staying on top of healthcare can be especially challenging.

"I have a lot of clients who can't read well," said the bilingual Pineda, who regularly works with native Spanish speakers. "They'll maybe have a third- or fourth-grade reading level, and then they get those papers from SSI [ Supplemental Security Income ] that are very intimidating."

Helping clients stay connected to care is a chief priority for the CORE Center. It participates in Project IN-CARE, which links men of color to care, and is one of 12 sites across the country to participate in a federally funded project that links, engages and retains HIV-positive women of color to care.

In addition to regular programming for those who are already HIV-positive, the CORE Center offers a weekday walk-in clinic for free HIV testing. Roughly 7,000 to 8,000 people are tested on-site annually.

"Because we do rapid tests," Kelly said, "we're able to directly link people who test positive into follow-up care at the time they get their results."

Clients are able to set up appointments with case managers and doctors.

"We also have peers and mental health professionals available to provide psychological and emotional support," Kelly said, noting that few people request such services. "It doesn't come up a lot, actually. People take bad news quite well, usually."

Moving forward, the CORE Center will continue to focus on meeting clients' needs and participating in research trials.

The medical center participates in the Chicago D-CFAR, a collaboration between Rush University Medical Center, the University of Illinois at Chicago and Cook County Health & Hospitals System.

"It's designed to support early research and various research projects that can then be expanded," Kelly explained. "We support researchers with small grants, so they can start research that they can then use to apply for larger and broader grants [ including those from the National Institutes of Health ] ."

An important push for 2012 will be to further develop the center's state-of-the-art dental facility, which was renovated in mid-2011.

"Access to dental care is very important for persons with HIV," Kelly said. "We recently renovated our dental facility to have the physical space to be able to provide those health services on-site … . Now, we're in the process of securing resources to adequately staff the facility."

To learn more about the CORE Center, visit www.cookcountyhhs.org or www.corecenter.org .


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