Blueprint To Action: Brooklyn Works to End AIDS

Community leaders, policy makers and health care providers came together at Brooklyn's Borough Hall on September 24 for "From Blueprint to Action: Ending the Epidemic Regional Discussion," to discuss ways to advance the recommendations outlined in New York State's Blueprint to End the AIDS Epidemic.

"We have looked at evidence that shows that we can hit our goal, and what that means is that we must take the necessary actions toward ending AIDS by 2020," said moderator Johanne Morne of the AIDS Institute.

An important part of this, she said, is to make sure community partners have a voice. These sessions -- part of more than a dozen planned throughout the state - are not intended to be one-time events, but part of a continued dialogue.

Dr. Sarah L. Braunstein, PhD, MPH, Director of the HIV Epidemiology & Field Services Program for the NYC Department of Health and Mental Hygiene, joined Dr. Charles King, President and CEO of Housing Works and NYS Ending the Epidemic Task Force Co-Chair, to further this dialogue.

She noted that in 2013, there were 1,800 deaths from HIV in New York State. There were 150,000 people living with HIV/AIDS, and the total number of New Yorkers living with AIDS is increasing -- primarily because new regimens allow them to live longer with HIV.

"Sixty-four percent of New Yorkers are virally suppressed, which just shows us where we have to go," said Braunstein.

Of the boroughs, Brooklyn is third, with 63 percent of PLWHAs virally suppressed. Ending new infections relies on us identifying people who are not virally suppressed and linking them to high-quality care that promotes viral load suppression, as well as finding people at risk and getting them care via PrEP so that they stay HIV-negative. The New York Knows: Be HIV Sure campaign has recruited almost 70 local organizations to be part of this effort.

The organizations are working on targeting these populations with at-risk, anti-stigma data, not dogma, to teach what it means to be undetectable. This comes with an increasing focus around transgender health.

"I gave up 22 years wearing a bulletproof vest to lead Brooklyn, the center of the universe," said former police officer Eric Adams, Brooklyn Borough President. "We need to have an emotional GPS on where we are at all times. Those who are pursuing the battle to rid the city and country of HIV must embody that GPS, to be present in moments of extreme difficulties, but... also be having real dialogues looking at all partners. The numbers are not the only way we gauge this blueprint. It's not just about HIV, but about being mindful and compassionate."

As part of this mission, King has ben touring the state doing these regional discussions. He has done eight, and has five to go.

"Today is a great day to end HIV," said King. "All over the state, local officials want to be part of ending the epidemic in their community. I have seen a unification between the New York City Health Department and the New York State AIDS Institute that is absolutely remarkable, and has never happened before. Many times, in fact, we have been at odds with one another. But the fact that we are coming together in lockstep to end AIDS is testament to this."

In June 2014, Gov. Andrew Cuomo committed to making New York State the first jurisdiction in the world to end AIDS, and charged service providers and clinicians to end HIV. In 93 days, they distilled this concept into a blueprint that would allow for only 750 new HIV infections, maximum, by 2030. But they set a goal for zero new infections instead, said King. Getting rid of new infections, stigma and AIDS mortality was paramount, they decided by consensus.

"On April 29, 2015 outside the Center, Cuomo accepted the blueprint and called for full implementation," said King. "People say we can't get to zero, but take a quick look at our history. In the mid-'90s, we had 15,000 new infections a year in the city, but last year, we only had 3,000 in the whole state. In 2015, we had zero infants born with HIV. It's proof that when we try, we can get to zero."

And this history can be replicated. King noted that in 2013, less than 100 people in the state were infected by injection drug use. Women were 30 percent of PLWHAs, but now are only 22 percent of new infections.

"That's not to say that we can let up on the gas," warned King. "If anything, we need to push harder on the accelerator to get rid of HIV."

Today, men who have sex with men (MSM) and transgenders make up 72 percent of all new infections. The vast majority are black, Latino and poor. Until we frame them as people with needs to address, we will never end the infections.

The governor's three-prong plan relies upon us to first figure out how to get those who are HIV-positive but unaware tested and into care. There are 3,425 people living with HIV who don't know their status living in Brooklyn. To reach them, we need to change the paradigm of testing and results.

"When you tell people they are HIV-positive, you are saving their life," said King. "The law says you should offer everyone an HIV test every time they go to the doctor, but we have to make this regular. We have to test everyone without making judgments about what kind of risk they might be. Test everyone, and make it routine."

We also need to do target testing of the high-risk group of MSM, because that is where new infections are, and if they are HIV-negative, to keep them that way through health insurance, care, and PrEP.

The second goal is viral suppression. Brooklyn is almost even with Manhattan in PLWHAs and new infections, but only third place in viral suppression; 8.626 PLWHA are not virally suppressed.

"We know who these people are," said King. "We need to find these folks and get them virally suppressed. We need integrated care, to cooperate and share info so that everyone is working toward the same goal."

The third goal is preventing new infections. We need to get rid of the stigma of taking PrEP; as King noted, "you are no more a slut or whore for taking this than for taking birth control."

It's clear who needs PrEP: anybody who is at risk, from women in domestic violence situations to those who suspect their partner of infidelity, to those who have regular unprotected sexual encounters. But PrEP can't just be about the pill. Data shows that Black MSM 18-25 are not taking their pills.

"Success has to be about their whole health and well-being," said King. "Jobs, housing and healthcare. We have to care about LGBT health. We can't end this epidemic by ourselves."

We also can't end the epidemic without money, said King, adding, "there is an opportunity in November when Mayor Bill DeBlasio announces his budget for New Yorkers to demand that $75-80 million be allocated to end HIV, to be matched by the state.

"Let the Mayor know that you want him to change this, and to put his money where his mouth is," said King.

What needs to happen is for every school child to get age-appropriate sex education. We must have syringe decriminalization. We must pass GENDA, and pass housing, transportation and nutrition through HASA. We must expand surveillance so care coordination has access to HASA, and give minors the right to consent to their own health care, without having their parents informed of their HIV testing or treatment. We need to cover undocumented immigrants with health insurance.

"We need to strong-arm the Senate, have the Assembly sit on the things the Senate wants unless they do this," said King. "This is only gonna happen if you go up to Albany and make it happen. At the end of the day, it's up to you."