Cuomo Plan Seeks to End New York's AIDS Epidemic
By ANEMONA HARTOCOLLIS
JUNE 28, 2014
Borrowing an idea from leading AIDS researchers, the Cuomo administration said on Friday [http://www.governor.ny.gov/press/06292014-end-aids-epidemic; see press release below] that it had developed a plan to aggressively identify, track and treat people with H.I.V. infection with the aim of reducing new infection to the point that by 2020, AIDS would no longer reach epidemic levels in New York State.
Gov. Andrew M. Cuomo's office plans to publicly announce the new measures - a result of months of negotiation with AIDS activists as well as several significant changes to state H.I.V. testing laws - on Sunday, aides said, on the same day as New York City's Gay Pride Parade.
The Cuomo administration described the effort as reflecting a once unimaginable sea change in thinking since the first cases of AIDS were reported among gay men, mostly in the city, by the Centers for Disease Control in July 1981. It has gone from a mysterious plague to a disease that experts can envision one day vanquishing.
"Thirty years ago, New York was the epicenter of the AIDS crisis," Mr. Cuomo said in a statement on Saturday. "We are in a position to be the first state in the nation committed to ending this epidemic."
The state's acting health commissioner, Dr. Howard Zucker, said on Friday that he believed that by 2020, New York could reduce its annual incidence of new H.I.V. infections to about 750 from the current 3,000, bringing the number of new cases below the number of annual deaths, or as he put it, "bending the curve" in the direction of ending the epidemic in the state.
This would put the number of new H.I.V. cases on a par with that of new tuberculosis cases, he said. "No one views tuberculosis as an epidemic - it's a manageable disease at this point," Dr. Zucker said.
The governor's plan builds upon "key policies already enacted," the administration said, to track those infected, identify those who do not know they are infected and make sure they all get the treatment they need.
The prospect of ending the AIDS epidemic is gaining momentum in epidemiological circles. It is based on studies showing that AIDS drugs have a double-barreled effect not just as treatment but as a means of blocking transmission. On Tuesday, Dr. Anthony S. Fauci, a leading AIDS researcher, argued at the Aspen Ideas Festival that "we can end the AIDS pandemic in the next 10 years."
Dr. Fauci praised the governor's plan in an interview on Friday, saying that it would be a national model. "If you aggressively seek out people who are infected, get them into voluntary testing, care and treatment, the mathematical model shows a sharp deflection in the curve of people ultimately getting the infection," he said. "Ultimately you can end the pandemic."
The announcement could also help solidify the governor's support among gay voters in his bid for re-election this year.
Though the advocacy community helped develop much of the plan, some AIDS experts raised concerns that it would be more easily said than done. "Having it as a goal is not really the same as accomplishing it," said Dr. Donna Futterman, director of the adolescent AIDS program at Children's Hospital at Montefiore Medical Center in the Bronx.
She said that while the goal was "fantastic," parts of the plan seemed to be simply tinkering with past policies. It also would be dependent upon having the money and will to persuade patients to be tested and treated.
Dr. Frederick P. Siegal said he had tried to institute universal treatment when he was medical director of the AIDS Center at St. Vincent's, the now-shuttered hospital in Greenwich Village, a neighborhood at the center of the AIDS epidemic. "It turned out it wasn't so simple because a lot of people were just not adherent," he said. "I think in a way that is the biggest problem, getting people to take their medications reliably."
Dr. Futterman said she would like to see more focus on reaching young people 18 to 24 years old and young black and Hispanic gay and bisexual men, who she said are most at risk and who are the least likely to know whether they are infected.
In New York, of an estimated 154,000 people infected with H.I.V., 22,000 do not know they have it, state officials said. Of the 132,000 who know they have it, 64,000 need treatment to suppress the virus.
The Cuomo administration said $5 million had been dedicated to the plan through Medicaid and the state's AIDS Institute, and the effort would be a priority in the next budget cycle.
Dr. Zucker said the state had several new tools for executing the plan, including a less cumbersome consent requirement for H.I.V. testing and a law that allows health officials to discuss patients' treatments with their doctors.
To make H.I.V. drugs more affordable, the Cuomo administration said on Friday that it had secured agreements for bulk discounts from three major pharmaceutical companies - AbbVie, Bristol-Myers Squibb and Gilead - which account for 70 percent of the H.I.V. market, and is negotiating with others as well.
Dr. Zucker said the state would also promote access to the Truvada pill, which when taken consistently can prevent people from becoming infected with H.I.V.
Charles King, chief executive of Housing Works, an advocacy group for people affected by AIDS, was among the signers of a series of letters to the governor over the past year urging action.
"We're just ecstatic that New York is going to be the first political jurisdiction in the world to publicly declare a goal of ending AIDS as an epidemic," he said.
Governor Cuomo Announces Plan to End the AIDS Epidemic in New York State
Three-pronged Plan Focuses on Improved HIV Testing, Preventing the Spread of the Disease, and Better Treatment for People Who Have It 
Albany, NY (June 29, 2014)
Governor Andrew M. Cuomo today announced a three-point plan to "bend the curve" and decrease new HIV infections to the point where the number of people living with HIV in New York State is reduced for the first time. The end of the AIDS epidemic in New York will occur when the total number of new HIV infections has fallen below the number of HIV-related deaths.
The "Bending the Curve" three-point program includes:
1. Identifying persons with HIV who remain undiagnosed and linking them to health care;
2. Linking and retaining persons diagnosed with HIV to health care and getting them on anti-HIV therapy to maximize HIV virus suppression so they remain healthy and prevent further transmission; and
3. Providing access to Pre-Exposure Prophylaxis (PrEP) for high-risk persons to keep them HIV negative.
"Thirty years ago, New York was the epicenter of the AIDS crisis -- today I am proud to announce that we are in a position to be the first state in the nation committed to ending this epidemic," said Governor Cuomo. "New York State has reached an important milestone in controlling the AIDS epidemic, and through this comprehensive strategy, we are decreasing new HIV infections to the point where by 2020, the number of persons living with HIV in New York State will be reduced for the first time."
The first report of AIDS occurred 33 years ago on Thursday, July 3, 1981, with some of the first AIDS cases occurring in New York. The momentum to bring the HIV/AIDS epidemic to a close already exists in New York State. New York has eliminated HIV transmission via blood products; virtually ended mother to child HIV transmission; and decreased new HIV diagnoses due to injection drug use by 96% since the mid-1990s.
While the nation as a whole has seen no decrease in the number of HIV diagnoses, over the last decade, New York State has achieved a 40 percent reduction in new HIV cases and significant decreases in HIV incidence across all categories of race, ethnicity, gender, age, and risk. Although the number of new HIV infections has been declining for a number of years, the total number of New Yorkers living with HIV/AIDS has continued to increase. This is because people with HIV can now live a normal life span and the number of HIV/AIDS deaths is also decreasing.
In 2014, there were 3,000 newly diagnosed HIV infections, down from 14,000 newly diagnosed AIDS cases in 1993. The goal is to reduce the number of new HIV infections to just 750 by 2020; about the same as the number of tuberculosis cases in New York State each year.
"Bending the Curve" will precipitate a dramatic downward trend in new HIV infections beyond the current trend. Though this effort will result in increased HIV medication expenses, it is well worth the investment given the human cost, and over time the initiative will pay for itself. Each averted HIV infection saves almost $400,000 in lifetime medical costs, and by 2020, "Bending the Curve" will save the State an additional $317 million and prevent more than 3,400 new cases of HIV.
This plan would not have been possible without the support of our legislative leaders, and several key policies in support of "Bending the Curve" have already been enacted this year in the budget, including:
· The removal of the requirement for written informed consent to get an HIV test, allowing HIV tests to be ordered through a verbal consent like any other medical test.
· Allowing data collected by the health department to be shared with health care providers to find persons with HIV who have fallen out of care.
· A 30% cap of the proportion of an HIV patient's income that can be spent on rent, keeping persons with HIV stably housed, which improves their ability to stay on their medication.
Additionally, the New York State Department of Health Medicaid Program has successfully negotiated supplemental rebates with the three pharmaceutical companies representing 70% of the HIV market, AbbVie, Bristol-Myers Squibb, and Gilead; this agreement will further decrease the costs to the state for ensuring all HIV-infected persons are on appropriate medications. Additional pharmaceutical companies may join the agreement.
Housing Works CEO Charles King said, "This step by Governor Cuomo, setting a clear goal to end the AIDS crisis in New York State, is absolutely courageous. In doing so, the Governor is reshaping the way we think about the AIDS epidemic and is setting a new standard for leaders of other jurisdictions in the United States and, indeed, around the world."
New York City Human Resources Administration Chief Special Services Officer Dan Tietz said, "On this LGBT Pride Day, I greatly applaud Governor Cuomo for boldly leading in our three decade long fight to end the AIDS epidemic. We have the science and means to bring HIV infections below epidemic levels and with the Governor's and Mayor Bill de Blasio's smart leadership, we can end AIDS in New York by 2020. HRA is now implementing the 30% rent cap, agreed to by the Mayor and Governor in February, which is another part of this effort to save lives and money. Today's game-changing action will push other leaders in the U.S. and beyond to take the necessary steps to end the HIV/AIDS epidemic for all."
Harlem United CEO Steven C. Bussey said, "While we are heartened by the progress we have made in confronting the AIDS epidemic in New York State, we know that we still face an epidemic of crisis proportions for many communities. Governor Cuomo's announcement to create a plan to end AIDS demonstrates the leadership and political will needed to end the epidemic as we know it in New York State."
Treatment Action Group Executive Director Mark Harrington said, "The goal is ambitious, but grounded in reality. NYS has always been a leader and center of innovation in the fight against HIV/AIDS. We have seen an almost 40% decrease in new HIV diagnoses in the last decade, with fewer new infections each year, while nationally there has been no decline in the number of new HIV infections diagnosed each year. With continued implementation of the Affordable Care Act and the State's successful Medicaid reform, we've gained the momentum necessary to put more people living with, and at risk for, HIV into primary care and the support services necessary to achieve success."
Gay Men's Health Crisis CEO Kelsey Louie said, "We applaud the Governor for his decisive leadership and commitment to end AIDS as an epidemic on this 45th anniversary of the Stonewall Riots, a rallying cry to fight back against social injustice. The plan to end AIDS can hopefully result in a dramatic decrease in new infections among MSMs and transgender women, especially within the low income communities of color, some of our hardest hit populations."
Acting Executive Director of AIDS Community Research Initiative of America Benjamin Bashein said, "ACRIA applauds Governor Cuomo for his bold plan to end AIDS in New York State. We now have the knowledge and the means to dramatically reduce new infections and promote optimal health for those with HIV. Governors Cuomo's leadership will make New York a model for ending AIDS across the country and around the globe."