By Jeremiah Johnson
The December 2017 release of the New York State (NYS) 2016 HIV/AIDS surveillance data shows that the efforts to End the Epidemic (EtE) in New York are having an impact.
In 2014, Governor Andrew Cuomo backed a community-developed plan to aggressively scale up testing, linkage to care and treatment, and pre-exposure prophylaxis access to dramatically reduce new infections below epidemic levels by the year 2020. Numerically speaking, the number of new infections would decrease from approximately 3,000 annually to fewer than 750 a year, effectively “bending the curve” on prevalence for the first time while simultaneously improving the quality and longevity of life for people living with HIV. A mobilized coalition of advocates, in partnership with NYS and New York City (NYC) health department leadership, has since been deeply engaged in implementing the recommendations of the state EtE Blueprint, a 2015 guiding document drafted with input from multiple key stakeholders.
Leaders in the NYS EtE initiative have been eager to see 2016 surveillance data for the state, which are considered by many to be a key indication of the real value of the EtE process.
The 2016 surveillance report definitively showed dramatic progress on many of the key EtE indicators monitored by the state. New diagnoses dropped from 3,443 in 2014 to 2,881 in 2016. Notably, new diagnoses among gay and bisexual men overall dropped by 12 percent from 2015. Much of the decrease in diagnoses in men who have sex with men (MSM) was driven by a dramatic 18 percent reduction in new diagnoses among Latino gay and bisexual men, giving hope that the state is simultaneously addressing racial and ethnic disparities. This trend was also reflected in aggregate statistics in which Black and Latino communities both saw 11 percent decreases compared with a 7 percent increase in whites.
Estimated incidence, overall, declined from 2,436 new infections in 2015 to 2,115 in 2016. Although impressive, this drop did not quite reach the intended 2016 target of 2,050 estimated new infections. Efforts will need to be accelerated to meet next year’s targets, but the gap of 65 infections is a modest failure in the context of ambitious targets.
Not all of the findings are necessarily rosy, however. When we look at the data for parts of the state outside of NYC, much of the progress seen in the aggregate statistics diminishes considerably. Although the decrease in diagnoses between 2015 and 2016 was 12 percent in NYC, the rest of the state saw only a 1 percent decrease, with an increasing number of infections in Albany. Incidence estimates back this up, showing only a modest decline outside of NYC between 2014 and 2016. In addition, although there has been an overall drop in new diagnoses for people who inject drugs, for the first time ever the number of diagnosed infections related to injection drug use was higher for areas outside of NYC.
Indicators looking at linkage to care for people living with HIV have stalled or even gone slightly in the wrong direction throughout the state, highlighting a weak spot in statewide EtE efforts.
Much of the success in NYC is undoubtedly a result of a number of progressive policy victories, including increased funding for the city sexual health and wellness clinics, policy changes that facilitate screenings for HIV testing, coverage of transgender health services under Medicaid, and significant increases in housing assistance for people living with and vulnerable to HIV infection, just to name some of the highlights. Even more successful, evidence-based policy changes will be needed to accelerate progress in the city and ensure that the rest of the state is not left behind.
The blueprint created by New York State’s Ending the Epidemic Task Force can be accessed at: health.ny.gov/diseases/aids/ending_the_ epidemic/. Progress toward the 2020 goals of the NYS EtE initiative can be tracked via the NYS EtE Dashboard: etedashboardny.org/