HEALTH
What Does 90 90 90 Say About Ending AIDS?
City touts success in diagnosing, treating HIV, but demographic disparities persist
BY DUNCAN OSBORNE
While the de Blasio
administration said
that 93 percent of
the people newly
infected with HIV in 2018 were diagnosed,
90 percent of the people
diagnosed were in treatment, and
92 percent of people in treatment
had achieved viral suppression, it
used different data and reported
different results in a city health
department report that was issued
in November.
“They have a different denominator
than we do,” Dr. Demetre
Daskalakis, the deputy commissioner
in the Division of Disease
Control in the city health department,
said of the discrepancies
outside a City Council hearing on
December 9.
Getting to 90 percent of people
with HIV diagnosed with 90 percent
of people diagnosed in treatment
and 90 percent of people
in treatment with the virus suppressed
to the point they cannot
infect others are goals developed
by the Joint United Nations Programme
on HIV/ AIDS (UNAIDS).
Jurisdictions, such as New York
City, can register with Fast-Track
Cities, a website administered by
the International Association of
Providers of AIDS Care (IAPAC),
where their progress on the goals
is tracked.
In a 3,000-word, December 2
press release, the de Blasio administration
trumpeted hitting the
90 90 90 goals and 23 HIV activists
and local, state, and federal
elected offi cials were quoted in the
press release celebrating the city’s
achievement.
“Years of hard work and determination
have put New York
front and center in the global fi ght
against HIV/ AIDS,” Mayor Bill de
Blasio said in the press release.
“With more New Yorkers receiving
treatment than ever, the day
of zero diagnoses is closer than
ever, something many believed unthinkable
not so long ago. We will
not rest until we end the epidemic
once and for all.”
Dr. Demetre Daskalakis, the deputy commissioner in the Division of Disease Control in the city health
department.
City Councilmember Mark Levine, chair of the Committee on Health.
But when the city presented
similar estimates for 2018 in its
annual HIV surveillance report,
which was released on November
22, it calculated that 93 percent of
the 90,800 people living with HIV
in New York City had been diagnosed
in 2018 or earlier, 87 percent
of the 90,800 were “retained
in care,” 83 percent of the 90,800
were taking anti-HIV drugs, and
77 percent of the 90,800 were virally
suppressed.
Different denominators, different
results.
“We have a lot of ways to assess
our performance,” Daskalakis
said.
In 2014, de Blasio and Governor
Andrew Cuomo endorsed the
DONNA ACETO
ED REED/ OFFICE OF THE MAYO
Plan to End AIDS. That ambitious
undertaking sought to end
the HIV epidemic in New York and
proposed to measure its success
using a number of metrics. The
plan used a classic public health
strategy of jumping on an existing
decline in disease incidence
with new interventions to accelerate
that decline. By any measure,
the plan has racked up a number
of successes.
The already substantial declines
in estimated new HIV infections
among drug injectors, which were
once at thousands annually, were
at 24 in 2018. There were zero
mother-to-child transmissions last
year. For the fi rst time since 2001,
new HIV diagnoses fell below 2,000
in 2018 at 1,917.
But the question becomes how
will the end of AIDS be measured?
Originally, the goal was to get to
an estimated 750 new HIV infections
in New York in 2020, with
600 of those occurring in New
York City. But the federal Centers
for Disease Control and Prevention,
which funds a great deal of
the state and local HIV prevention
efforts, effectively imposed
a new method of estimating new
HV infections on state and local
health departments in 2017. Those
original goals, which were already
very ambitious, were placed out of
reach.
“I don’t have a number for you yet
because we rely on the state to lead
the way,” Daskalakis said during
testimony at the City Council.
Charles King, the chief executive
at Housing Works and the plan’s
lead proponent, told Gay City News
that the new goal was likely to be
in the range of 1,000 to 1,300 estimated
new HIV infections annually
by 2020. But achieving that
might not end the epidemic. Using
one number for estimated new
HIV infections suggests that those
infections are distributed evenly
among different demographic
groups. They are not.
Among the 1,917 new HIV diagnoses
in 2018, 1,487, or 77 percent,
occurred among men. Forty-one
percent of the new HIV diagnoses
among men were among African-
American men, 39 percent were
among Latino men, and 67 percent
of the new HIV diagnoses among
men were attributable to men who
have sex with men (though 25 percent
of the total diagnoses among
men had an unknown transmission
risk). Insofar as new diagnoses
are a surrogate for new HIV
infections, the new HIV infections
are occurring disproportionately
among African-American and Latino
men who have sex with men.
While the number of new HIV diagnoses
attributable to sexual
contact among transgender people
was small in 2018 at 56, the recent
➤ MEANING OF 90 90 90, continued on p.5
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