In his State of the Union address, President Trump pledged to end new HIV transmissions in the United States by 2030. He can start by looking at what is working right here, in his home state of New York.
Thanks to Governor Andrew Cuomo, the state Department of Health, and the persistence of countless advocates and community groups, New York is the national leader in the effort to end the HIV epidemic.
How do we know New York’s policies and approaches work? The proof is in the data. At the height of the epidemic, over 10,000 new HIV/AIDS cases were diagnosed in New York every year. But in 2017, new HIV diagnoses were down to a record low of just 2,157 in New York City, with an overall state decrease of 39 percent in new cases since 2007.
To end the HIV/AIDS epidemic nationally, we need to implement policies like those in New York that address health disparities and promote access to health care. While the Trump administration has consistently and systematically rolled back protections for LGBTQ Americans, who are disproportionately impacted by HIV, New York is addressing barriers to health care like stigma and discrimination. Most recently, Governor Cuomo signed legislation that added gender identity and expression as a protected class in the state’s human rights and hate crimes law.
While the Trump administration has signaled to health care providers that they can deny treatment based on sexual orientation (see the Conscience and Religious Freedom division of HHS), New York has brought more people into care, including helping New Yorkers with HIV become virally suppressed so that they’re unable to transmit the virus. To help HIV-negative people stay negative, New York has made testing accessible statewide and expanded access to essential HIV prevention medications like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
New York also has Medicaid Special Needs Health Plans (SNPs) like Amida Care, which are specifically designed to serve New Yorkers living with or at higher risk for HIV. SNPs connect people living with HIV to care and have the expertise to help people who are HIV negative stay negative through access to PrEP and enhanced sexual health services. Transgender individuals, who are disproportionately impacted by HIV, are eligible to join SNPs regardless of HIV status. Amida Care has enrolled 230+ HIV-negative members of transgender experience since November 2017, when they became eligible to join the plan; all have been screened for HIV risk, and more than 20 percent are now on PrEP. Amida Care is working with Governor Cuomo and the NYS Department of Health to open SNP eligibility to HIV-negative individuals from all communities at higher risk for HIV, including young gay and bisexual men and women of color, which will be an important step to further reduce new infections.
New York SNPs like Amida Care also connect members to supportive services that help them access safe, secure housing and food assistance. These are social and economic challenges that have a tremendous impact on good health. The Trump administration’s proposed cuts to programs that provide lifelines to Americans battling food insecurity or struggling with housing instability threaten the foundations of the fight against HIV/AIDS. When you don’t know where you’ll sleep at night or where your next meal is coming from, you’re much less likely to seek care or take the medications needed to be virally suppressed or prevent HIV.
The Trump administration has also proposed harmful changes to Medicare Part D, which would make it difficult for older Americans living with HIV to access necessary medication. And, they are making it harder for communities at higher risk of HIV to access health care by allowing states to implement work requirements for people on Medicaid, which have already led to thousands of vulnerable Americans losing coverage.
In contrast, New Yorkers living with HIV can secure a peer certificate that empowers them to pursue voluntary employment without jeopardizing their Medicaid coverage. Thanks to New York City Council funding, Amida Care offers an employment program that allows people with HIV to get back to work in community health centers, using their lived experience to help others with HIV.
Actions speak louder than words: President Trump dismissed the entire Presidential Advisory Council on HIV/AIDS, which is responsible for advising the president and guiding the Health and Human Services response to the AIDS crisis, and did not replace them for over a year. The Trump administration also wants to cut funding for the President’s Emergency Plan for AIDS Relief, a key part of the global fight to end the epidemic.
While we are encouraged by the president’s words about paying renewed attention to the fight against HIV/AIDS, we are concerned by this administration’s track record on LGBTQ rights and protections and its general approach to addressing the health needs of individuals. If the President is serious about this commitment, he must follow New York’s lead: implement policies that address health disparities and promote access to health care.
Doug Wirth is president and CEO of Amida Care, a Medicaid Special Needs Health Plan designed for individuals living with or at higher risk for HIV/AIDS.