State must step up in fight to end the HIV/AIDS epidemic

On World AIDS Day last Dec. 1, state and city officials gathered at the Apollo Theater and announced plans to prevent new HIV infections and eliminate HIV/AIDS deaths in four years. It was an inspiring day, with a massive commitment to end the HIV/AIDS epidemic in New York.

As legislators finalize the state budget plan, we have the opportunity to significantly advance this critical agenda. We need Albany to ensure that this year’s housing investments include the necessary funding to provide stable housing to between 3,000 and 7,000 New York City residents with HIV/AIDS who are homeless or unstably housed, including 700 to 1,000 who are forced to use homeless shelters each night.

Stable housing is critical to the city's plan toward achieving the statewide goal of fewer than 750 new HIV infections per year by 2020. About 80 percent of all New Yorkers living with HIV/AIDS reside in the five boroughs, and most of them live in low-income communities of color.

HIV/AIDS is a health condition that’s very difficult to address if the patient does not have a stable place to live, and access to transportation and groceries. Meeting these basic needs is necessary to manage any chronic illness, and has proven to improve rates of viral suppression, reduce HIV/AIDS-related deaths, and prevent new infections in our city.

The argument for housing as an effective public health intervention for treating people living with HIV/AIDS is hardly new. Thirty years ago, near the start of this epidemic, New York City was the first municipality to acknowledge the significant role that safe and appropriate housing plays in providing care for people with HIV/AIDS and reducing ongoing transmission.

The city HIV/AIDS Services Administration program – which provides access to safe, affordable housing and a range of services and support to low-income New Yorkers with advanced HIV/AIDS – is one of the key reasons New York City has seen a 40 percent reduction in the number of annual new HIV infections over the last decade, even as national rates remain steady. We know what works and must continue these efforts.

Mayor Bill de Blasio’s End the Epidemic plan includes a $23 million investment to increase HIV/AIDS prevention and health care programming for nearly 200,000 New Yorkers every year when fully implemented. The funding is allowing us to expand testing, use targeted HIV/AIDS prevention strategies, including newer tools to prevent infections, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and maintain universal access to condoms.

Recognizing that New Yorkers living with HIV/AIDS need more than health care to live healthy and productive lives, the mayor’s plan also includes a commitment to cover 50 percent of the cost to expand the services administration program to reach all homeless and unstably housed New Yorkers with HIV, as well as more supportive housing units for this population. We need the state to commit the funds to pay for the other half of the HASA expansion, as it has done in the past as a public health investment. With the 2020 goal in sight, this is not the time for the state to weaken its commitment.

New York has long fought to get to this day when we can realistically say that ending the HIV/AIDS epidemic is within our reach. We urge the state to help us cross the finish line and to earmark funds this year to ensure that low-income New Yorkers living with HIV/AIDS are able to meet basic needs and make their health a priority.

Peter Gordon, MD, is the medical director of the Comprehensive Health Program and an assistant professor of clinical medicine at Columbia University Medical Center. Judith Aberg, MD, FIDSA, FACP is a professor of infectious diseases at Mt. Sinai Hospital. Joseph P. McGowan, MD, FACP, FIDSA is the chair of the American Academy of HIV Medicine’s New York/New Jersey Steering Committee. Barry Zingman, M.D. is the medical director at the AIDS Center at Montefiore Medical Center.