Healthcare

Can NY Really End the AIDS Epidemic by 2020? Five Experts Weigh In

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This past Thursday was World AIDS Day, and the city unveiled a new memorial to honor those who lost their lives due to complications from AIDS at the site of St. Vincent’s Hospital in Greenwich Village, which was once home to the city’s first and largest AIDS ward. There was also a bit of good news: the Health Department announced that for the first time in the history of the AIDS epidemic, the annual number of new HIV diagnoses had fallen below 2,500. Additionally, no babies were born with HIV across the five boroughs in 2015.

Those record lows are steps forward in what Governor Andrew Cuomo called a “blueprint” to end the AIDS epidemic by 2020, an ambitious plan he announced in June 2014. Since the epidemic emerged in the 1980s, some 35 million people are known to have died from complications due to HIV and AIDS. In the United States, more than 1.2 million people live with HIV. In New York, nearly one in 10 residents are living with HIV.

Last year, Cuomo announced plans to invest $200 million in additional state funding toward initiatives to boost treatment, prevent exposure, and expand access to services – an increase over the $2.5 billion spent annually on state programs for people with HIV and AIDS.

And on Thursday, Cuomo unveiled more new initiatives, including a proposal that requires all service providers to track viral suppression rates of people who are HIV-positive, expanding access to HIV preventative services for youth patients, and increasing access to HIV/AIDS related medical information and data for researchers. He also set an additional goal—zero deaths from AIDS and HIV transmission through injection drug use by 2020.

The Voice spoke with several AIDS activists and researchers who commented on New York’s progress and weighed in on whether Governor Cuomo is making good on his pledge to end the epidemic by 2020, and what still needs to be done.

Kelsey Louie, CEO, Gay Men’s Health Crisis non-profit and Member, Governor Cuomo’s New York State End-AIDS Task Force

What we’re up against are two things that not even the governor can address: Complacency and stigma. These are really pervasive. When there’s stigma, people are less likely to talk about HIV, ask questions, get tested, and seek treatment.

Governor Cuomo’s plan is achievable if there is attention paid to the recommendations made in the plan, to get the state to less than 750 new infections. If there are dollars attached to the new initiatives, it can be done. That is a critical piece. The dollar value has been difficult to nail down because a lot of these recommendations are in planning stages, and until they’re implemented, we won’t know the exact cost. That said, the governor had announced a recommitment at World AIDS Day last year, too, and what actually came through in funds allocated was slightly under. But then, there were dollars pulled from City Council. It’s a very complicated process. It would’ve been impossible to expect all of the funding for the initiatives would happen in year one. 

Mark Harrington, Executive Director of the Treatment Action Group (TAG)

We’re definitely making progress, but it’s not happening as deep as we need it to be in terms of accelerating the decline. That’s why the early treatment and PrEP parts are so important in the plan. My feeling is we’re probably on track to achieve the goal in NYC, Long Island, the Hudson Valley — they’re more urbanized and there are more HIV services. But I’m concerned about the rural areas and upstate New York, in a lot of counties there isn’t access to services. New York City and state are paying subsidies to ensure people with HIV get housing, but that hasn’t been applied upstate yet. They don’t have the housing because NYC is putting in the majority of the money for that. A lot of the other municipalities don’t have as much money to leverage state resources to get those housing guarantees and services. And we need a single point of access to all services—clinics for case management, treatment, and prevention. There’s probably an estimated 6,000 people that are unstably housed or homeless and living with HIV outside of NYC.

Michael Worobey, expert on virus evolution at U of A in Tucson, and co-author of a study debunking the “Patient Zero” AIDS origin story.

First, driving down transmission of HIV-1 to very low levels is absolutely an achievable goal, even without a preventive vaccine. Smart public health measures aimed, for example, at closing the gap between when people get infected and when they initiate drug treatment are extremely promising, because this makes it very difficult for the virus to find new hosts. And that is one of the major weaknesses of HIV: it is less transmissible than many other viruses, and it is not unrealistic to look toward a future where the average infected person passes the virus on to fewer than one secondary host. That’s sort of the magic number for epidemiologists since at that point an epidemic starts dying out.

Second, I gather that Governor Cuomo’s proposed plan does not fund measures to provide clean needles for injecting drug users. That is a major shortcoming. It’s like saying you plan to eliminate traffic fatalities but you’re not going to require car makers to put seat belts in cars. Providing for safe injections is the low-hanging fruit of HIV prevention and you only need to look at the profound success of such measures in places like Vancouver to see that they protect not just drug users but the rest of the community.

The Voice asked Cuomo’s office to respond to Worobey’s comments on clean needles, and will update here when they respond.

Jeremy Saunders, co-executive director of VOCAL NY

Through tremendous policy and political work the AIDS movement in New York proved to the Governor the science behind the plan to end AIDS, and showed him the opportunity to make a critical, moral commitment to end this epidemic that has taken the lives of over 100,000 people in New York City alone. But he is still a socially liberal, fiscally conservative, big D Democrat that we have had to fight for every dollar that we have needed to address the issues of poverty and homelessness that drive this disease. On World AIDS day, I want to honor what people living with AIDS have done to end this epidemic. Not Cuomo. I would hope he would agree.

Guillermo Chacón, President of the Latino Commission on AIDS & Founder of the Hispanic Health Network

I’ve lost many friends over the years to HIV and AIDS, and it’s been a long journey to reach today. It’s a sign of progress that diagnoses are down, but it’s important to address the racial disparities that still exist. Black and Latino men who have sex with men are continue to be disproportionally affected by HIV and AIDS [accounting for 75 percent of new cases in 2015] and the infection rate is high for communities of color. We have the tools, and leadership matters. We need political will from the governor and mayor, continual funds for research. Another challenge going forward is to pay more attention how we’ll do a better job to remove to the stigma attached to HIV and AIDS, especially among health care providers. I believe New York can be a good example in the fight to end AIDS if we continue to recognize diversity, and be inclusive.

Interviews have been edited and condensed.

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