HEALTH
Cuomo Declares HIV Victory, Data Says Not Yet
State determined to meet 2020 goal, but stats present confusing picture
BY DUNCAN OSBORNE
In a recent story in The New
York Times, Governor Andrew
Cuomo was quoted
declaring victory in an ambitious
plan that would reduce
the number of new HIV infections
annually in New York to the point
where the HIV epidemic in the state
would be over.
“Five years ago we launched an
aggressive, nation-leading campaign
to end the AIDS epidemic in
New York and to ensure every person
living with HIV or AIDS gets
the support they need to lead a
full and healthy life,” Cuomo said
in a statement issued on October
3, the day the Times story was
published. “This new data shows
we are on track to meet that goal
and continue our historic progress
to fi nally bend the curve on an
epidemic that has taken too many
lives for too long.”
Buried in the story was the sentence
“State health offi cials say
they believe they are on track to
lower the number of new HIV diagnoses
to a little more than 1,500
per year by 2020.”
Huh?
The Plan to End AIDS was announced
in 2014. Since then, the
state and city health departments
and a host of HIV groups have developed
a number of metrics that
are being used to assess the plan’s
progress and will be used to measure
its success. Chief among them
was that new HIV infections will be
reduced to 750 annually by 2020.
It appeared that the Cuomo administration
was moving to a new
measure of success.
Not so, said Johanne Morne, the
director of the state AIDS Institute,
a unit of the state health department.
“We will have the evidence to
show our success by 2021,” Morne
told Gay City News, adding that
750 new HIV infections annually
remains a goal of the plan.
There were just a few skeptics
who doubted the plan in 2014.
Over time, skepticism has become
a little easier.
Governor Andrew Cuomo receiving the Larry Kramer Activist Award from Gay Men’s Health Crisis at the
group’s October 2 gala.
Every year the city and state
health departments produce reports
that show how many new
HIV diagnoses were made in the
prior year and they detail the demographics
of the newly diagnosed
population.
In the Times story, the state reported
that there were 2,481 new
HIV diagnoses in 2018. Under the
plan, the target for 2020 is 1,515
new HIV diagnoses. That would
be a 39 percent decline over two
years. From 2014 through 2018,
the state reported declines in new
HIV diagnoses that ranged from
a low of three percent to a high of
nine percent. The average decline
was four percent.
“I can tell you in New York State,
we’ve never seen a decrease like
that,” Morne said. “Maybe we will
be the fi rst in the nation to see a
signifi cant decline on an annual
basis.”
New HIV infections — as distinguished
DONNA ACETO
from those infections
newly diagnosed — can only be estimated.
Those estimates are produced
annually using a methodology
that is effectively imposed on
state and local health departments
by the federal Centers for Disease
Control and Prevention (CDC).
Using one method from 2014 to
2016, the state saw eight percent
declines year over year in estimated
new HIV infections. The state
saw a 17 percent decline from 2016
over 2017, but it also used a new
method to estimate new infections
in 2017. Whatever method is used
in 2020, the state is asserting that
estimated new HIV infections will
fall from 2,269 in 2017 to 750 in
2020, a 67 percent decline. The
state has not yet estimated the
number of new HIV infections that
occurred in 2018.
The Plan to End AIDS set annual
targets for new HIV infections
and then compared those to the
new infections estimated to have
occurred. The difference is getting
smaller.
“So the gap is closing, and this is
a favorable trend,” David Holtgrave,
the dean of the School of Public
Health at the University of Albany,
which is part of the SUNY system,
wrote in an email. “We will have to
wait for the 2020 end-of-year data
to see if that gap closes entirely,
but it is moving in the right direction.”
What will also change in 2020,
state health offi cials say, is the
proportion of estimated new HIV
infections to those infections newly
diagnosed. From 2014 through
2016, the estimated new HIV infections
accounted for 97 percent to
95 percent of the new diagnoses.
In 2017, using the new method to
estimate new infections, 82 percent
of the people who were newly
diagnosed were counted as newly
infected. In 2020, only half of the
newly diagnosed people are projected
to be newly infected.
“While these two constructs
tend to correlate and move in the
same direction, they do not always
do so depending on the particular
circumstances of the local epidemic
in a given time period,” Holtgrave
wrote. “I don’t believe we can
say with certainty that 1,500 new
HIV diagnoses in 2020 necessarily
means that there will be more
than 750 new HIV infections in the
same year. That may or may not
ultimately be the case, but we will
need the data to fi nd out.”
Cuomo’s statement prompted
Gay City News to seek clarifi cation
from the state health department.
A fi rst interview occurred on October
7, but the newspaper was told
at the start that it was “on background.”
The interview was ended
abruptly after 20 minutes and Gay
City News asked if some material
could be used on the record. The
newspaper sent quotes that it proposed
to use. The newspaper was
then offered an on-the-record interview
with Morne on October 8.
The city health department did
not respond to a request for comment.
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