HEALTH
New York City Likely to Miss Goal in Plan to End AIDS
Mayor says focus on ending epidemic “strong as ever,” but numbers show warning signs
BY DUNCAN OSBORNE
W ith 1,200 new estimated
HIV infections
in New York
City in 2019, the
city will likely miss a key goal of
the Plan to End AIDS that called
on the city to reduce new estimated
HIV infections to 660 in 2020
— which would have required a
45 percent drop between 2019 and
2020.
The plan, which Mayor Bill
de Blasio and Governor Andrew
Cuomo endorsed in 2014, expands
HIV testing and treats
HIV-positive people with anti-HIV
drugs so they remain healthy and
the virus is undetectable in their
bodies so they cannot infect others.
The plan also relies on giving
HIV-positive people housing, nutrition,
transportation, and other
services to make it easier for them
to keep taking their drugs.
Truvada, an anti-HIV drug, is
given to HIV-negative people to
keep them uninfected. That drug
regimen, which is called pre-exposure
prophylaxis (PrEP), is highly
effective when used correctly. A
cocktail of anti-HIV drugs can be
given to HIV-negative people with
a recent exposure to the virus so
they remain uninfected. That second
drug regimen is called postexposure
prophylaxis (PEP). It is
also highly effective when taken
correctly.
An original goal of the plan
was to reduce new estimated HIV
infections from 2,000 in 2015 to
600 in 2020. There were 1,200
estimated new HIV infections in
the city in 2019, according to a
city health department report
that was released in December.
While that number has declined
since 2015 by about 200 new infections
per year year-over-year,
the declines have never been
close to a 45 percent change yearover
year. The largest decline was
a 14.2 percent change from 1,400
estimated new infections in 2018
to 1,200 new infections in 2019.
The plan was conceived by
Charles King, the chief executive
The de Blasio administration is on track to fall behind ambitious goals in the Plan to End AIDS.
at Housing Works, a non-profi t
serving people living with HIV/
AIDS and experiencing homelessness,
and Mark Harrington, the
head of Treatment Action Group,
an advocacy organization. It was
King who convinced the state
health department and the city to
embrace the very ambitious goal
of a substantial reduction in estimated
new HIV infections.
The state health department
originally had a goal of getting to
750 estimated new HIV infections
statewide in 2020. With most new
HIV infections occurring in New
York City, the city adopted 600
new infections for its original 2020
goal. In 2019, the state conceded
that that goal was unrealistic and
it now has a goal of 825 new HIV
infections in 2020. A state health
department website that tracks
metrics for the Plan to End AIDS
has 660 new estimated HIV infections
as the city’s new goal.
Gay City News found the new
660 metric only after questioning
city offi cials about the goal.
The plan has been successful in
getting more newly diagnosed people
into treatment and undetectable.
New HIV infections were already
declining in the city and the
plan used the classic public health
strategy of jumping on an existing
downward trend with additional
resources to accelerate a decline.
New HIV infections among injecting
OFFICE OF MAYOR BILL DE BLASIO/ED REED
drug users have nearly
been eliminated by distributing
clean needles to injectors. Thirtysix
new HIV diagnoses were attributable
to needle sharing in
2019, with another 24 attributable
to needle sharing and sex
among men who have sex with
men. Early in the epidemic, needle
sharing resulted in thousands of
new HIV diagnoses in a year. One
new HIV diagnosis was attributable
to mother-to-child transmission
in 2019. That transmission
mode used to result in hundreds
of new HIV diagnoses per year.
New HIV infections among gay
and bisexual men in the city have
declined substantially among
white gay and bisexual men, but
remain stubbornly higher among
Black and Latinx men who have
sex with men. In 2017, that disparity
was large enough to prompt
Dr. Demetre Daskalakis, then the
city health department’s deputy
commissioner for disease control,
to say “You lost the game” when
asked about the plan’s goal if new
HIV infections were not reduced
among Black and Latinx gay and
bisexual men. Daskalakis is now
the director of the Division of HIV/
AIDS Prevention at the federal
Centers for Disease Control and
Prevention.
During the mayor’s press availability
on January 6, the mayor
and city health offi cials appeared
to be unaware that the state
health department had assigned
the new metric. They remained
upbeat about further reductions
in new estimated HIV infections
despite the COVID-19 outbreak
that continues to plague New York
City and much of the world.
“It has made a world of difference,”
de Blasio said during the
press availability. “2020 was obviously
a year where many goals and
plans have been disrupted by the
coronavirus… Our focus on ending
the epidemic is a strong as ever.
It’s quite clear that when we work
closely with communities, when we
provide the right kind of resources…
that’s the way forward.”
Dr. David Chokshi, the city’s
health commissioner, praised the
mayor for his “visionary plan for
ending the epidemic” and added
that it was too soon to know what
the 2020 numbers will be.
“There have been historic reductions
in new HIV infections
year over year,” Chokshi said.
“Between 2019 and 2020, the
preliminary data that we have
does indicate that those reductions
will continue between 2019
and 2020… We’ll see what the fi -
nal numbers show with respect to
new infections in 2020.”
While achieving a 45 percent
reduction in new estimated HIV
infections in 2020 over 2019 remains
unrealistic, it is a gruesome
fact that New York City’s
COVID-19 outbreak may have reduced
sexual interactions among
men who have sex with men who
fear the coronavirus. That could
mean a larger reduction in new
HIV infections than might otherwise
have occurred. One way to
measure that is to look at changes
in the incidence of sexually
transmitted infections, such as
syphilis and gonorrhea, among
gay and bisexual men.
“There have been some declines,
but the picture is more
complicated because in many
cases care was interrupted in
March and April so people weren’t
getting tested as often for those
infections,” Chokshi said.
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