| 2007–2008 City HIV/AIDS Agenda
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here to download a PDF of the Agenda.
Introduction
With only 3% of the nation's population, New York City has more
than 15% of AIDS cases and has the nation's highest AIDS case
rate. As many as 163,000 New Yorkers are living with HIV infection. The
HIV/AIDS epidemic is not only greater in New York City than other parts
of the United States, it is far more complex. HIV/AIDS in New York City
in intrinsically intertwined with the epidemics of substance use, homelessness,
tuberculosis, poverty and issues relating to mental health.
Gay Men's Health Crisis (GMHC) has been integral to the City's
response to HIV/AIDS since the epidemic began. Founded in 1981, GMHC
is the world's oldest and one of the largest HIV/AIDS organizations. Annually,
GMHC serves more than 15,000 New Yorkers, providing hot meals, financial
and health advocacy, legal services, case management, nutrition and treatment
information, substance use counseling, workforce-vocational training and job
placement.
In the spirit of partnership, GMHC offers this FY 0708 City HIV/AIDS
agenda to the Bloomberg administration, to the City Council and to decision
makers throughout New York. The agenda's priority issues are a reflection
of GMHC's mission and the needs of the people that we serve. The goal of
this agenda is to improve HIV/AIDS services throughout NYC and to protect
the health and quality of life for the City's most vulnerable residents.
Testing
GMHC recognizes the importance of knowing one's HIV status. Early
entry into care and treatment is critical for people who test positive.
Likewise, testing presents an opportunity for those who test negative
to get the help they need to stay that way. We have long supported efforts
to expand access to free, voluntary testing and counseling. This demands
the written informed consent of those being tested, in both medical and
non-medical settings. GMHC continues to oppose the Bloomberg administration's
aggressive campaign to change state law governing HIV testing and counseling,
specifically attempts to remove written consent and to significantly reduce
the information that one receives when getting tested for HIV.
These attempts are premised on a simplistic view whereby HIV and
AIDS are no different than any other sexually transmitted disease (STD)
or medical condition. This ignores the ongoing stigma and discrimination
leveled against people living with HIV. The administration also makes
questionable assumptions about both the health-seeking behavior of members
of at-risk communities and the likelihood that an HIV diagnosis will
automatically trigger linkage to care for these individuals.
GMHC believes testing should be expanded into medical and non-medical
settings, particularly into social venues frequented by individuals with
little contact with the healthcare system. We know that lack of access
to information about testing, and competent, consistent medical care,
not counseling or written consent, is the true barrier to reducing
concurrent diagnoses. We will oppose any legislative change that threatens
to erode the fundamental human rights of New Yorkers in the context of
HIV testing. GMHC urges the New York City Council to convene a hearing
on HIV testing and counseling. GMHC recommends that the New York City
Department of Health and Mental Hygiene develop a city-wide anti-HIV
stigma social marketing campaign including the addition of anti-stigma
messages in all HIV/AIDS educational materials. GMHC further recommends
that the NYCDOHMH institute a mandatory continuing education and in-service
training for NYC HHC medical providers to increase their capacity to
initiate and sustain discourse with patients around sexual history taking,
safer sex practice, LGBT sexuality, women's safer sex negotiation and drug
use/harm reduction.
Housing and Essential Services
No one can remain healthy without stable housing. For New Yorkers
with HIV and AIDS, permanent, adequate housing is the bedrock on which
access to care, treatment adherence, and, ultimately reentry into the
labor market are built. Unexpected, quickly progressing illness is often
the trigger for loss of employment, impoverishment, and homelessness
among people with AIDS. Conversely, homelessness or even the threat of
homelessness can lead to unnecessary illness and premature death. Yet,
inadequate housing continues to be a major problem for large numbers
of persons living with AIDS in New York City. Pure and simple: Housing
equals healthcare and health for people living with HIV/AIDS.
HASA for All
HASA provides vital services to people living with AIDS; services
designed to mitigate HIV disease progression for its clients and enable
New Yorkers to live healthier and more productive lives. HASA services — particularly
its housing services — go a long way toward delaying or preventing disease
progression for many New Yorkers living with HIV, but much more can be
done. GMHC urges the City to expand HASA eligibility criteria to include
low income, asymptomatic New Yorkers with HIV before they become seriously
ill with full-blown AIDS.
Healthy Homes Act
No New Yorker, especially one with serious health needs, should
have to live in substandard housing or experience the debilitating
stress of fighting with recalcitrant landlords. The Healthy Homes
Act will give the Department of Housing Preservation and Development
the ability to repair serious housing code violations and charge
landlords for the repairs. This will enable the City to stop the practice
of landlords neglecting rent-stabilized apartments in hopes of turning
them into market rate units once they are vacated. Current tenants will
have some measure of protection against intolerable living conditions,
and some affordable housing in New York City will be preserved. This
is an extremely cost-effective prevention and care tool in the fight
against AIDS. Proper housing allows people living with HIV and AIDS
to make healthier decisions for their own lives and gives them the
ability to better manage their disease and prevent the further spread
of HIV. GMHC urges the City Council to pass the Healthy Homes Act and
calls on Mayor Bloomberg to sign it.
Prevention
Crystal Methamphetamine
The methamphetamine epidemic is exploding in this country and in
this city. Between 1993-2000, the number of people seeking treatment
for crystal, as the drug is also known, doubled nationally. The epidemic
of methamphetamine use has moved east, from the West Coast and the Midwest,
and it has now put down roots in Philadelphia, Washington, Atlanta, Miami
and New York, particularly among gay men, where it is estimated that
10–20% of gay men are using the drug. According to the New York
City Department of Health, "while NYC-specific data is limited, it does
show that crystal methamphetamine use among gay men in NYC is growing
and that it is correlated to higher rates of HIV." Research with gay
and bisexual men indicates that methamphetamine use is strongly associated
with risky sexual behaviors that may transmit HIV." GMHC urges the
continuation of citywide campaigns against crystal methamphetamine. In
addition, the City should develop comprehensive counseling services for
those interested in addressing their crystal usage. It is essential that
testing and counseling services be provided in an environment where
individuals using substances such as crystal methamphetamine can discuss
the risks engendered by their substance use and sexual behavior, learn
their HIV status and address next steps, including referrals to services
that can help keep them HIV-negative and address their substance use or,
if they test positive, to services that can help them not infect others
while also addressing their substance use.
Microbicides
AIDS is now the number one cause of death in the United States among
African American women aged 25–34. In New York, women and girls
constitute 48% of newly infected individuals between the ages of 13 and
19. Biologically, women are two to four times more susceptible than men
to sexually-transmitted HIV infection. Their susceptibility increases due
to their lack of economic and social power, especially in situations where
women cannot control sexual encounters or insist on protective measures
such as condoms.
There is a formidable prevention tool on the horizon called
microbicides. Hailed as one of the world's most promising new
HIV-prevention technologies at the 2004 International AIDS Conference
in Bangkok, microbicides are a class of products currently under development
that women could apply topically to prevent transmission of HIV and other
infections. Many scientists believe that, with an increase in funding and
coordination, a safe and effective microbicide could be available in five
to ten years. Even a partially effective microbicide could avert an estimated
2.5 million HIV infections over three years. GMHC urges the City Council to
pass a resolution supporting the Microbicides Development Act introduced
in both the House (H.R. 1420) and Senate (S. 823). GMHC further urges the
New York City Department of Health and Mental Hygiene to work with community-based
organizations to raise public awareness of microbicides.
Black and Latino MSM
Data from the Centers for Disease Control and Prevention (CDC) on HIV
infection rates has shown that 46% of Black men who have sex with men
(MSM) are HIV positive. Five cities, including New York, were sampled
for this study. Similar research has likewise demonstrated alarming HIV
infection rates for Latino MSM. GMHC calls for an expansion of a campaign
to address the staggering rates of HIV infection among MSM of color. Such
an initiative must address factors that drive their risk of HIV infection,
including homophobia, racism, violence, depression, and drug use. The
Campaign for Black Gay Men's Lives, spearheaded by the NYS Black Gay Network,
is a coalition of various NYS HIV/AIDS organizations that are working to
address the multiple issues driving HIV risk for Black MSM. This needs to
be a part of a comprehensive citywide approach to health and wellness for
MSM of color. GMHC urges the City to increase funding for the Campaign for
Black Gay Men's Lives. GMHC also recommends that the City Council hold
hearings on the results and implications of the CDC study.
Older Adults Initiative
Older adults account for one of the largest and least recognized segments
of the HIV/AIDS community. As many as 15% of all adults infected with HIV
nationwide are over the age of 50. In New York City, that number nearly
doubles. Prevention messages and trainings that resonate with older adults
must be developed. Furthermore, older adults need to be educated on the
variety of drug interactions associated with HIV and regular symptoms of
aging (diabetes, hypertension, heart disease, and depression). This population
receives the least amount of targeted HIV education. At the same time, stigma
around HIV and AIDS is at its most virulent among this demographic. Goals moving
forward should include: reducing the stigma surrounding HIV/AIDS, expanding
the availability of HIV/AIDS services to HIV-positive older adults, and
addressing issues related to various intersecting aspects of HIV and aging. GMHC
recommends the City develop a new initiative for older adults living with
HIV/AIDS. Funding must be dedicated to develop curricula, training, and
evaluation materials for advocates, healthcare and service providers, senior
center workers, families, and all those who interact with and care for older
adults if we are to prevent the spread of HIV among this population.
Advocating in Washington and Albany for Legislation
and Adequate HIV/AIDS Funding
Perhaps now more than ever, it is apparent that one cannot speak of the
"City AIDS Agenda" without discussing the importance of federal and state
policies to the City's continuum of HIV care. Decisions made in the next
few months in Washington and Albany will determine in large measure whether
New York City will have the support it needs to mount an effective response
to HIV/AIDS epidemic. GMHC calls on the Mayor and the City Council to prioritize
federal and state advocacy in FY200708.
Highlights of GMHC's 2007–2008 Federal Legislative Agenda (PDF)
- Passage of the Microbicides Development Act
- End to the federal ban on syringe exchange
- Support of the Protection Against Transmission of HIV for Women and Youth (PATHWAY) Act
- Passage of the Responsible Education About Life (REAL) Act
- Endorse the Justice for the Unprotected against Sexually Transmitted Infections
among the Confined and Exposed (JUSTICE) Act
- Passage of the Early Treatment for HIV Act (ETHA)
- Protect Medicaid and Medicare, the nation's first and second largest public
payer of HIV/AIDS care and treatment
- Amend the Immigration Naturalization Act to eliminate HIV/AIDS as
grounds for inadmissibility and pass legislation granting permanent residence
to immigrants facing extreme medical hardship in their counties of origin
- End the ban on MSM blood donation
- Passage of the Employment Non-Discrimination Act (ENDA)
- Appropriation of the Ryan White CARE Act and the Housing Opportunities for
People living with HIV/AIDS (HOPWA) Act at full funding levels
Highlights of GMHC's 2007–2008 State Legislative Agenda
- Oppose mandatory HIV testing legislation
- Passage of the Health Teens Act
- Support the Unintended Pregnancy Prevention Act
- Passage of the Gender Expression Non-Discrimination Act (GENDA)
- Passage of the Family Health Care Decision Act
- Support the Dignity for All Students Act (DAS)
- Change the oversight of health care in prisons to the Department of Health
- Urge a renegotiation of the Federal-State Heath Reform Partnership
(F-SHRP) waiver which bars the state from reinvesting recovered Medicaid dollars into
the Medicaid program
- Repeal the Rockefeller Drug Laws
- Support marriage equality
Summary of GMHC's FY 07–08
City Agenda Recommendations:
xImprove HIV testing by developing a city-wide anti- HIV stigma
social marketing campaign and training for NYC medical providers to
increase their capacity to initiate discussions with patients around
sexual history taking, safer sex practice, LGBT sexuality, women's
safer sex negotiation and drug use/harm reduction.
Expand HASA eligibility criteria to include low income, asymptomatic
New Yorkers with HIV before they become seriously ill with full-blown AIDS.
Pass the Health Homes Act which will give the Department of Housing
Preservation and Development the ability to repair serious housing code
violations and charge landlords for the repairs.
Continue citywide campaigns against crystal methamphetamine
and develop comprehensive counseling services for those interested
in addressing their crystal usage.
Pass a city resolution supporting the Microbicides Development
Act introduced in both the House (H.R. 1420) and Senate (S. 823) and
work with community-based organizations to raise public awareness of
microbicides.
Increase funding for the Campaign for Black Gay Men's Lives. GMHC
also recommends that the City Council hold hearings on the results and
implications of the CDC study.
Develop a new initiative for older adults living with HIV/AIDS. Funding
must be dedicated to develop curricula, training, and evaluation materials
for advocates, healthcare and service providers, senior center workers,
families, and all those who interact with and care for older adults if we
are to prevent the spread of HIV among this population.
Advocate in Washington and Albany for adequate HIV/AIDS Funding
and legislation that will improve HIV/AIDS services throughout NYC
and protect the health and quality of life for New Yorkers living
with HIV/AIDS.
© 2007 Gay Men's Health Crisis |
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