Gov. Cuomo Introduces Plan to End AIDS in New York State

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Category: HIV Policy & Advocacy
Published on Thursday, 10 July 2014 00:00
Written by Liz Highleyman
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New York Governor Andrew Cuomo announced a plan late last month that aims to end the AIDS epidemic in the state by reducing the number of new HIV infections and AIDS-related deaths. Key elements of the plan include identification of people who remain undiagnosed, linking people who test HIV positive to care and treatment, and expanding access to pre-exposure prophylaxis (PrEP).

"Thirty years ago, New York was the epicenter of the AIDS crisis -- today I am proud to announce that we are in a position to be the first state in the nation committed to ending this epidemic," Cuomo said in a press release issued to coincide with the city's Heritage of Pride parade on June 29.

The 3-prong program to "bend the curve" of the epidemic includes:

"If you aggressively seek out people who are infected, get them into voluntary testing, care and treatment, the mathematical model shows a sharp deflection in the curve of people ultimately getting the infection," National Institutes of Allergy and Infectious Diseases director Anthony Fauci told the New York Times. "Ultimately you can end the pandemic."

The New York State plan was developed with input from medical and public health experts and spurred by pressure from activists such as ACT UP/New York, which has demanded better access to PrEP and post-exposure prophylaxis (PEP).

While the nation as a whole has not seen a decrease in the number of new HIV diagnoses over the past decade, New York State has achieved a 40% reduction, according to the press release. However, because people with HIV are now living longer thanks to effective treatment, the total number of New Yorkers living with HIV/AIDS has continued to increase. In 2014 there were 3000 people newly diagnosed with HIV, which the plan aims to reduce to just 750 by 2020, putting it on a par with TB.

Cuomo acknowledged that the plan will be expensive to implement but should prove cost-effective in the long run. "Though this effort will result in increased HIV medication expenses, it is well worth the investment given the human cost, and over time the initiative will pay for itself," he stated in the release. Each HIV infection averted saves nearly $400,000 in lifetime medical costs, so the plan could potentially preventing more than 3400 new infections and save $317 million, according to administration estimates.

To hold down costs, the New York State Department of Health Medicaid Program has negotiated supplemental rebates with AbbVie, Bristol-Myers Squibb, and Gilead Sciences, which together account for 70% of the HIV drug market.

"The goal is ambitious, but grounded in reality," said Treatment Action Group (TAG) executive director Mark Harrington. "With continued implementation of the Affordable Care Act and the state’s successful Medicaid reform, we’ve gained the momentum necessary to put more people living with, and at risk for, HIV into primary care and the support services necessary to achieve success." TAG called on the governor to quickly appoint a high-level task force to develop a detailed blueprint for the plan.

The governor's plan is also supported by legislative changes including removal of the requirement for written informed consent for HIV testing -- allowing verbal consent for HIV tests, as is the practice for other medical tests -- allowing the health department to share data with care providers, and capping the proportion of income HIV positive people must spend on rent at 30%.

"This step by Governor Cuomo, setting a clear goal to end the AIDS crisis in New York State, is absolutely courageous," said Housing Works CEO Charles King. "In doing so, the governor is reshaping the way we think about the AIDS epidemic and is setting a new standard for leaders of other jurisdictions in the United States and, indeed, around the world."

New York is not the only jurisdiction out front in the effort to bend the curve of HIV, however. In 2010 the San Francisco Department of Public Health adopted a policy of providing antiretroviral therapy to all people diagnosed with HIV, rather than waiting for CD4 T-cell counts to fall below a specified threshold -- a recommendation later adopted in U.S. Department of Health and Human Services treatment guidelines. Studies have shown that the policy led to higher average CD4 counts at the time of treatment initiation and lower community viral load. San Francisco also implemented one of the first PrEP demonstration projects. However, that city has taken little action to ensure housing for people with HIV/AIDS, despite high and rapidly rising housing costs.

"We have the science, and now we have the partnerships and political commitment to end AIDS in New York State," said TAG's U.S. and global health policy director Kenyon Farrow. "If we’ve learned anything over the past three decades of the epidemic, it's that a shared commitment -- by government, state, and city health agencies, activists, health care and support service providers, and people affected by HIV -- is required to replicate the tremendous breakthroughs in research in our communities, which not only help ensure a life without HIV-related illnesses for those living with the virus, but also help protect those at greatest risk of infection with HIV, particularly people of color, men who have sex with men, and transgender women."

7/10/14

Sources

Governor's Press Office. Governor Cuomo Announces Plan to End the AIDS Epidemic in New York State. Press release. June 29, 2014.

Treatment Action Group. TAG Calls on Governor to Expeditiously Appoint a High-Level Task Force to Develop Blueprint to End AIDS Deaths and Halt New HIV Infections. Press release. June 29, 2014.

A Hartocollis. Cuomo Plan Seeks to End New York’s AIDS Epidemic. New York Times. June 28, 2014.

C King. Governor Cuomo Makes History by Committing New York State to Ending AIDS. Treatment Action Group blog. June 29, 2014.