New York City’s City Hall and municipal buildings were lit up in bright red to honor the 35th anniversary of World AIDS Day and the countless lives lost to the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic. City stats this year indicate new HIV cases are down as the global movement has united people in a common goal to beat back the disease, especially in heavily affected and marginalized communities.
“New York City stands in support of those living with HIV/AIDS and honors the New Yorkers we have lost to this tragic epidemic,” said Mayor Eric Adams as he hosted a ceremonial reading and vigil for HIV/AIDS victims at City Hall on Friday, Dec. 1. “While New York City has been hit by this crisis harder than any other city in the country, we are also the birthplace of the national movement to help those living with HIV/AIDS; make treatment more accessible; and reduce disparities to prevention and care, especially in communities of color.”
According to the Department of Health and Mental Hygiene (DOHMH) 2022 HIV Surveillance Annual Report, there were 1,624 newly diagnosed people with HIV in the city last year, which is down 2% from 2021 and 17% from 2018. DOHMH Commissioner Dr. Ashwin Vasan said new HIV diagnoses continue to fall and there’s been a “rebound in HIV testing and care-seeking” that had dropped during the onslaught of the COVID-19 pandemic, when HIV testing services were less accessible. The year after COVID hit, the city had a huge increase in new infections, and the Bronx is the only borough that continues to have an increasing number of new diagnoses.
“Every step in the HIV movement was underscored by tragedy and loss, but its successes radically transformed the field of public health and changed the hearts and minds of generations that followed,” said Vasan. “The people who worked in this movement changed history, and World AIDS Day is an important moment to reflect on what’s been achieved and recommit to doing whatever it takes to end the epidemic once and for all.”
The DOHMH numbers indicate that inequities persist across many communities: Of all women newly diagnosed with HIV in 2022, 84% were Black or Hispanic; of all men newly diagnosed, 83% were Black or Hispanic; at least 62% of all men newly diagnosed were identified as LGBTQ; and 41% of all newly diagnosed New Yorkers lived in neighborhoods of high or very high poverty.
“I’m old enough to remember, as a young member of ACT UP, the first World AIDS Day 35 years ago,” said PrEP4All Board Member Peter Staley in a statement. PrEP4All, founded in 2018, is an organization that sprang up to increase equitable access to HIV medication. “Much has been accomplished since then, but we won’t end AIDS until the health inequities that today’s statistics highlight become the primary focus of our fight.”
Last year, 79% of all people with HIV in the city were “virally suppressed,” meaning if they were on treatment and their virus was “undetectable,” they couldn’t transmit HIV through sex, said DOHMH. This is thanks in large part to widespread sexual education and medicines, such as PrEP and ART.
PrEP (pre-exposure prophylaxis) is a highly effective pill or shot that can reduce a person’s chances of getting HIV from sex or a contaminated needle. ART (antiretroviral therapy) is HIV medicine that reduces a person’s viral load so chances of transmitting HIV to a sexual partner drop to zero.
“There are gaps. We aren’t always able to get the tools to people who need them most at the right time and they were exacerbated during the pandemic. We saw a reduced number of people starting PrEP,” said Dr. Denis Nash, a professor and executive director of Institute for Implementation Science in Population Health at the City University of New York (CUNY) Graduate School of Public Health & Health Policy, about people with HIV during the COVID pandemic in 2020. He runs a dashboard called Ending the AIDS Epidemic in New York State that tracks the rollout of HIV/AIDS care.
Nash concurred that New York City, in particular, has been a leader in its response to the local HIV/AIDS epidemic, achieving great strides in ending the disease as a public health threat, but said there have been significant setbacks and inequities in treatments.
When the HIV/AIDS pandemic began in the 1980s, it only peaked in the mid-1990s because some people were able to access treatment, said Nash, but the death statistics did not drop to zero. Now HIV drugs and medications in the city are fairly easily available and covered by the state through Medicare and Medicaid. Vulnerable communities still do not always have access, though. For instance, said Nash, among the impoverished, homeless communities, or those with severe mental illness, a diagnosis may not happen soon enough to prevent death and it’s harder to adhere to a regimented schedule for medication with a transient lifestyle.
According to Dr. Jessica Justman, associate professor of medicine in Epidemiology at Columbia University School of Public Health and senior technical director at ICAP, there are disparities in access to medications along racial lines. In 2021, 78% of white people who were eligible in the U.S. to access PrEP did so, while only 21% of Hispanic/Latinos and 11% of Black/African Americans did.
Furthermore, she said PrEP can only be effective if taken correctly. “PrEP definitely helps to prevent HIV. It works if you take it [but the] oral pills are a challenge for some people. Women need to take them every day, but men who have anal sex with men can use PrEP before and after sex,” said Justman via email.
Nash said the main focus in the medical industry now is to eliminate the “public health threat” as opposed to eradication of the virus, and to reach the most affected communities through effective programs and policies.
“As we see nationwide threats to reproductive and sexual health care, we renew our commitment to our communities and call for action and compassion in the face of HIV/AIDS. At the core of our mission is the needed work toward a world where HIV/AIDS care is as accessible to all, and where those living with these conditions can thrive and live with dignity and opportunity. HIV care is reproductive health care,” said Tamika Howell, vice president of Planned Parenthood of Greater New York’s Project Street Beat (PSB) in a statement.
Howell said that concentrating on places where HIV/AIDS care is most needed is essential. The PSB clientele includes people who use drugs and other substances, are homeless, are sex workers, or have other circumstances that place them at increased risk for HIV. She said PSB also provides people with wraparound services like legal support, substance use counseling, opioid overdose prevention, birth control, wellness visits, health insurance enrollment, initiation of ART treatment, emergency PEP (post-exposure prophylaxis) and PrEP, clean syringes, and syringe disposal.
“We use an innovative, targeted approach to outreach, concentrating on the places where people hang out,” said Howell. “Our teams engage clients and provide services that help them make the transition from day-to-day survival to a safer, healthier lifestyle.”
New Yorkers can text CARE for information about HIV treatment or TESTNYC for HIV testing info to 55676. There is also a new Sexual Health web page at nyc.gov/sexualhealth for sexual and reproductive health information and how to get low- to no-cost sexual and reproductive healthcare services in New York City.
Ariama C. Long is a Report for America corps member who writes about politics for the Amsterdam News. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by visiting https://bit.ly/amnews1.