PREP

GMHC Scores Several Wins in Legislature, Looks Ahead to Bills to Expand PrEP and PEP Access

GMHC worked with broad coalitions to achieve several key wins–notably, the passage of the landmark Gender Recognition Act–in New York’s legislative session that ended in June. Three bills that would expand access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), medications to prevent HIV infection, await the next legislative session in January.

Overall, GMHC prioritized an ambitious slate of 10 bills–and saw four pass, with six more teed up for the forthcoming legislative session.

“This year we made a concerted effort to focus on bills that were HIV-specific or directly related to the needs of the population we serve who are at highest risk,” said Jason Cianciotto, who oversees GMHC’s public policy department.

In addition to the Gender Recognition Act, which simplifies changing gender identity on a host of state-issued documents, lawmakers passed two key bills affecting access to medication and vaccines. One delays the 340B Medicaid Carve Out Plan, which would strip federal 340B drug discounts from all health care providers, including those who serve vulnerable populations living with or at high risk for HIV/AIDS. The other increases the ability of pharmacists to administer vaccines approved by the CDC’s Advisory Committee on Immunization Practices (ACIP).

“It makes it a lot easier for our community to get vaccinated,” Cianciotto said, noting that while there’s still no vaccine for HIV/AIDS, the communities that GMHC serves face a higher risk of more serious and life-threatening illness from other viruses.

GMHC also backed a new law allowing sex or labor trafficking victims to get convictions related to their trafficking, including forced prostitution, vacated through judicial review. The bill was a priority for GMHC, because trafficking victims are more likely to be exposed to HIV and lack access to medical care, Cianciotto said. A conviction makes it more difficult to secure stable housing and employment–and without those supports, these survivors are at higher risk for HIV and other sexually transmitted infections (STIs).

Gender Recognition Act

New York Governor Andrew M. Cuomo signed the Gender Recognition Act into law June 24, on the 10th anniversary of the state Marriage Equality Act, thanks to years of advocacy from GMHC and 20 other transgender, LGBTQ+, legal and civil rights groups.

The landmark law creates a new X gender marker for driver’s licenses, along with a new “parent” category for birth certificates. It also protects the privacy of people making name changes by ending a requirement to publish their new and previous names in a designated newspaper, along with their address, birth date and place.

“It’s a huge victory for transgender and nonbinary people throughout New York State,” Cianciotto said, because accurate ID documents protect people from discrimination for employment, travel, housing, health care and education.

“The bill addresses a wide variety of needs that cis-gendered people might not think about,” he added. Previously, for instance, the only way for a transgender New Yorker to change their gender on a marriage certificate was to get divorced and remarried.

340B Medicaid Carve Out

By removing a significant source of revenue, the 340B Medicaid Carve Out Plan could shut down at least 30 community health centers statewide and force others to curtail services, Cianciotto said, heavily impacting low-income Black and Brown New Yorkers, who are already the hardest hit by both the HIV/AIDS and COVID-19 pandemics.

After vigorous opposition from GMHC and a broad coalition of HIV/AIDS clinics and community health providers, lawmakers delayed the carve out from taking effect until April 2023, as part of the fiscal 2021 New York state budget that passed in April.

Currently, the federal 340B program affords Medicaid providers significant savings on prescription drugs, which they can use for other health services. But under an impending law passed last year, New York Medicaid would instead capture the estimated $250 million in savings.

Cianciotto said GMHC opposed the cuts because community clinics provide essential health services, including HIV/AIDS prevention and treatment, for low-income New Yorkers statewide. He added that GMHC plans to open a 340B pharmacy by the end of the year, so clients can easily obtain medications when visiting its 307 West 38th Street headquarters for a meal, counseling, employment assistance or other services.

Universal PrEP, PEP

For the legislature’s resumption in January, GMHC is backing three bills sponsored by state Sen. Brad Hoylman for expanded access to PrEP and PEP, medications that can prevent infection from HIV exposure.

Hoylman is sponsoring a bill with Assemblymember Danny O’Donnell to require insurers to cover the cost of PrEP and PEP, and another with Assemblymember Richard Gottfried barring insurers from requiring prior authorization for PrEP. (No prior authorization is needed for PEP, because it’s for a medical emergency.)

Cuomo has issued executive orders requiring PrEP and PEP insurance coverage and prohibiting prior authorization for PrEP–but codifying these protections into law helps to make them permanent and more strongly enforceable, Cianciotto said.

Hoylman is sponsoring another bill with Assemblymember Didi Barrett that would allow pharmacists to dispense PrEP in limited quantities without a prescription. “Why require people already at high risk to make a doctor’s appointment for what they need, instead of just going to a pharmacy?” Cianciotto asked.

Equitable Health Care

Three other bills that GMHC supports would expand healthcare access and treatment for people at highest risk for HIV. One would amend the current public health law so that medical providers can treat minors under 18 for HIV and other STIs without a parent or guardian’s consent. “To us, it’s a no-brainer, since plenty of LGBTQ+ youth don’t feel safe telling their parents that they’re sexually active,” Cianciotto said.

Another requires medical professionals to complete training on HIV and STI testing, and sexual health related to sexual orientation and gender identity, so that all New Yorkers can receive informed and respectful care.

GMHC also supports a bill that would extend affordable health insurance coverage equivalent to New York’s Essential Plan to undocumented immigrants. That is a key way to stop the spread of HIV because the highest growth rates for new HIV infections in New York are for undocumented immigrants, people of color and transgender people–all groups facing greater barriers to health care, Cianciotto said.

Compared with whites, the rate of new HIV diagnoses was 9.7 times higher for Black and 6.3 times higher for Latino New Yorkers in 2019. That same year, transgender people accounted for nearly 3.5 percent of all new HIV infections in New York, a rate disproportionately higher than their representation in the general population.

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