Plan Needs Better Effort Among Gay, Bi Men of Color
Infections curve “bending,” but Housing Works’ Charles King notes unfi nished work
BY DUNCAN OSBORNE
The longtime HIV activist
who has been the public
face of the Plan to
End AIDS is saying that
while the plan has achieved some
of its most important measures of
success, it will not reduce the new
HIV infections in New York annually
to the ambitious numbers
that were proposed when the plan
launched fi ve years ago.
“I know that they were quite aggressive,”
Charles King, the chief
executive of Housing Works, an
HIV services organization, said of
the original HIV infection targets.
“Ultimately, I would have loved to
achieve every goal to make sure we
got to every population. What we
really need to do is spend the coming
year and two years after that
to reach the key populations for
whom those goals have not been
realized.”
King and Mark Harrington,
the chief executive of the Treatment
Action Group, conceived of
the plan while in jail following an
arrest during a protest. The plan
involves quickly moving HIV-positive
people into treatment so they
remain healthy and reduce the
amount of the virus in their bodies
so they cannot infect others. It also
gives them services, such as housing,
nutrition, and transportation,
that make it easier for them to stay
on their anti-HIV medication.
For people who are HIV-negative,
the plan supplies pre-exposure prophylaxis
(PrEP) and post-exposure
prophylaxis (PEP). PrEP and PEP
are anti-HIV drugs used by HIVnegative
people to keep them uninfected.
Both regimens are highly
effective when used correctly.
Key measures of the success of
the plan’s HIV prevention component
were the number of people on
PrEP and PEP, which has increased
signifi cantly, and the estimated
number of new HIV infections in
the state every year. There were
roughly 3,000 new HIV infections
in New York State in 2014. The
plan proposed to get to an annual
750 new HIV infections statewide
Charles King, CEO of Housing Works and one of two principal architect of the Plan to End AIDS, at a
2018 World AIDS Day event.
in 2020, with no more than 600 of
those occurring in New York City.
“It is an incidence estimate that
has a wide confi dence margin,”
King said. “We always knew that it
was a range, not a number.”
Incident infections are cases
that occur in a given time period
— a calendar year in the case of
the plan — and incidence is the
rate at which those cases occur,
though it is typically expressed as
an estimate.
New HIV diagnoses, a different
measure, result from infections
that occurred in the year they are
reported and those from any earlier
year that were not previously
diagnosed.
New York State appeared to be
backing off of the 750 goal in October,
and the city appeared to be
doing the same when it released
its annual HIV surveillance report
on November 22. Both the city and
DONNA ACETO
state were touting signifi cant reductions
in new HIV diagnoses in
2018, though Johanne Morne, the
director of the AIDS Institute, a unit
of the state health department, told
Gay City News in October that the
state remained committed to reducing
new HIV infections to 750
annually by 2020.
The state did not release data
on estimated new HIV infections
in 2018 in its October report. The
complete 2018 data was released
on December 1, World AIDS Day,
and the state health department
reported that there were 2,019 new
HIV infections in New York in 2018.
To get to 750 new HIV infections in
2020 would require a 63 percent
reduction in new infections. While
the 2019 data shows a 40 percent
decrease in new infections since
the start of the plan, it took four or
fi ve years to achieve that depending
on when the plan is counted as
HEALTH
having begun.
The city reported on November
22 that there were an estimated
1,600 new HIV infections in New
York City in 2018. To get to 600 infections
in 2020, it would also have
to reduce new HIV infections by
63 percent in two years. It is unlikely
that such a reduction can be
achieved, given that in recent years
the rate of decline has never been
greater than 17 percent per year.
Morne is scheduled to speak at
the Ending the Epidemic Summit
in Albany on December 3 and
4. Morne will appear at one event
with Dr. Oni Blackstock, the assistant
commissioner for the Bureau
of HIV/ AIDS Prevention and
Control at the New York City health
department. They could announce
new targets for annual HIV infections
that might be in the range of
1,000 to 1,300, King said.
New infections in some risk
groups, such as drug injectors and
mother-to-child transmission, had
been substantially reduced before
the plan was implemented. In other
groups, such as white gay men,
the plan has accelerated existing
declining trends.
“All of these numbers were going
down,” King said. “What the plan
did is it accelerated everything we
had done before 2014.”
Where the efforts are falling
short is primarily among African-
American and Latino men who
have sex with men.
“I’m not ready to say we have
achieved every threshold for every
group,” King said adding that in
2020 “I’m not going to be saying,
‘Victory, it’s over and done.’”
What the data is showing is that
as some HIV-positive people are
dying — largely from causes unrelated
to HIV — their numbers are
not being offset by people who are
newly infected. In New York City
in 2018, 1,683 HIV-positive people
passed away as opposed to the
estimated 1,600 people who were
newly infected.
“That is a legitimate defi nition
of ending an epidemic,” King said.
“That bending the curve measure
has always been there.”
GayCityNews.com | December 5 - December 18, 2019 5
/GayCityNews.com
