Accessibility, Affordability Key to Ending Epidemic
Recent declarations of victory in New York come with key caveats
BY MATT TRACY
The fi ght to eradicate
HIV/ AIDS in New York
has progressed in recent
years, but health
experts and elected offi cials are
highlighting areas that must be
addressed in order for the state to
end the epidemic.
The state, the city, and a broad
array of HIV groups embarked several
years ago on a campaign to end
the AIDS epidemic, which was defi
ned as lowering new infections in
the state to 750 annually by 2020
(and to 600 in the city). Questions
have surfaced about the viability of
the goal, however: While Governor
Andrew Cuomo recently appeared
to declare victory in the state’s
campaign, offi cials told The New
York Times that new diagnoses —
a fi gure that is different than new
infections, since not all HIV transmissions
are detected promptly —
were only on pace to be lowered to
“a little more than 1,500 per year by
2020.” Health department spokespeople
still voiced confi dence that
new infections would drop to 750
by next year, but the state has not
yet released new infection data for
calendar year 2018.
According to out gay Bronx
Councilmember Ritchie Torres
and Amida Care CEO Doug Wirth,
the remaining challenges largely
boil down to accessibility and affordability.
“To an extent not seen before,
HIV has become a disease of poverty
disproportionately affecting
communities of color,” Torres told
Gay City News. “The Bronx alone is
home to 24 percent of New Yorkers
living with HIV. The focus of public
policy should be on breaking down
the barriers to accessing PrEP that
continue to plague communities of
color.”
While the use of PrEP — which
when used consistently is effective
at preventing infection in HIV-negative
people — is on the rise, it is
not reaching men of color the way
it is reaching white men. C DC data
from 2014 to 2017 showed that
PrEP awareness and use were lower
Amida Care CEO Doug Wirth said there must be a massive boost in Medicaid recipients who use PrEP
by next year and cited the importance of getting tested for HIV.
Out gay Councilmember Ritchie Torres said “HIV has become a disease of poverty disproportionately
affecting communities of color.”
among both Latinx and Black
men compared to their white counterparts.
“Part of the challenge around
PrEP is that 80 percent of new HIV
diagnoses are among people of
color, but 80 percent of PrEP uptake
among Medicaid recipients
has been among white men,” said
Wirth, whose organization provides
services to Medicaid-eligible
HIV-positive individuals and those
at risk for acquiring HIV. “We’ve got
to increase conversations within
social networks, healthcare providers,
churches, faith communities,
and bodegas.”
Wirth stressed that it also remains
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NEW YORK CITY COUNCIL/ JEFF REED
important for folks to continue
getting tested for HIV. Knowing
one’s status and staying virally
suppressed if HIV-positive are crucial
to the emerging U=U (undetectable
= untransmittable) campaign
to spread awareness that a
person whose viral load is undetectable
cannot transmit the virus
to others. That campaign gained
mainstream exposure when CNN’s
Anderson Cooper explained U=U to
viewers during an LGBTQ-focused
Democratic presidential town hall
in October.
Many of the remaining hurdles
toward ending the epidemic in New
York pertain to healthcare quality.
WORLD AIDS DAY
Torres cited a lack of cultural competency
among too many providers.
There are providers, he said,
who are not even aware of how to
properly advise on the use of PrEP.
“There needs to be proactive
outreach to men who have sex with
men and who might face an elevated
risk of HIV,” he said.
The absence of culturally competent
providers also adds extra
hurdles to the existing challenge of
erasing stigma around healthcare
services for men who have sex with
men. Torres said an overall lack of
access to preventative care in the
Bronx and the persistence of homophobia
among providers makes
accessing healthcare even more of
an obstacle.
A prime example of the intersection
of cultural competency,
access, and affordability is PrEP
on Demand, an approach approved
by the city’s Department
of Health and Mental Hygiene that
involves taking PrEP only around
the time when a person is having
sex. That approach eases the
burden for those who are unable
to afford PrEP, but comes with a
regimen that is far more complex
than a once-a-day pill, meaning
those with incompetent doctors
would lose out on the opportunity
to learn properly about it.
PrEP costs are not a new concern.
Congressmember Alexandria
Ocasio-Cortez of the Bronx and
Queens famously highlighted the
price of PrEP during a hearing in
May when she confronted Gilead
CEO Daniel O’Day and demanded
answers as to why PrEP costs $8
per month in Australia, but nearly
$2,000 per month in the US. Two
months later, PrEP affordability
was also addressed by Cuomo
when his administration rolled out
a package of initiatives that eliminated
out-of-pocket PrEP costs for
health insurance plans that cover
millions of New Yorkers. Still, not
every New Yorker is covered under
that initiative.
Wirth explained that Amida
Care’s PrEP program, available to
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