Cuomo Task Force Pushes Him On AIDS Goal

A task force set up by Governor Andrew Cuomo to recommend ways the state can eliminate AIDS as an epidemic in New York within five years is hoping it can convince the governor and the Legislature to go even further.

The task force is planning a series of recommendations that its members say will reduce the number of new infections statewide almost to zero, while ending the stigma that goes along with the disease.

Cuomo announced in June 2014 that he would seek to end AIDS as an epidemic statewide, reducing the number of new HIV/AIDS infections each year below the number of annual deaths from the disease.

That plan would mean the state's new infection rate would have to drop from about 3,000 new cases each year to roughly 750.

After Cuomo announced the plan last summer, he said he would empanel a task force to develop a blueprint for how the goal could be achieved within five years. That panel is scheduled to deliver a final report sometime over the coming weeks.

But while advocates say that everyone agrees an end to AIDS is a worthwhile achievement, some of the ideas contained in the yet-to-be-released report from the task force may be a hard sell in Albany, where new dollars for health initiatives can be scarce.

And the task force, made up of 63 different people representing all areas of the state, is trying to go beyond its mandate, not just reducing the number of new infections below the threshold necessary to qualify as an epidemic, but virtually eradicating the disease, as well as the stigma that goes along with it.

That is easier said than done, said Charles King, the president and C.E.O. of Housing Works and a co-chair of the Ending AIDS task force.

One of the central pieces of the report the task force will release in the coming weeks is a call to pass GENDA, the Gender Expression Non-Discrimination Act. This bill, which would prohibit discrimination against transgender New Yorkers, has passed multiple times in the state Assembly, but has yet to be brought for a vote in the Republican-held State Senate.

Transgender New Yorkers, along with poor, young Latinos and Black men who have sex with other men, are among the populations most at risk for contracting HIV/AIDS, King said. Infection rates among all other populations of New Yorkers have been steadily decreasing over at least the past two decades. In 1993, 15,000 New Yorkers were infected with HIV each year, and by 2013, the number of new annual infections had decreased to 3,200.

The introduction of drugs like Truvada, the pre-exposure prophylactic drug that can be taken to ward off infection, is expected to help curb new infection rates. But new infection rates have held steady among black and Latino men who have sex with men and transgender people.

"We've seen the curve of new infections go down among every population, with the exception of younger Black and Hispanic gay and bisexual men, where it's still continuing at more or less the same rate of new infections as before," King said. "We also know there's a huge issue among transgender people, we just don't have the data."

Passing GENDA would help transgender people feel more comfortable disclosing their sexual practices, and seeking health care, King said.

"For transgender folk you've got to have an enabling environment, and if it's still legal to discriminate against transgender people, it's very hard to create an environment that's good for them to avoid infection," King said.

Ending the epidemic would be much more difficult without GENDA, said Kimberleigh Smith, the vice president of policy advocacy and communications at Harlem United, a nonprofit human service organization providing community based health care and supportive housing.

"I'm sure we can get closer without GENDA, but I think passing GENDA is a big part of these recommendations," Smith said.

Two other task force recommendations affect teenage sexual practices, a political landmine in Albany, especially among more conservative lawmakers loath to appear to be condoning permissive sexual behavior.

A bill called the Healthy Teens Act would "require every school across the state, every high school and middle school to teach age-appropriate public health informed sexuality courses," King said.

As of now, the state does mandate every public school provide comprehensive sex education, and decisions on what to teach are made at the district level.

Education about lesbian, gay bisexual and transgender sexual practices is key to helping young people at risk of infection understand how to avoid the disease, King said. And some of the state's most at-risk populations in school have no sexual education. High schools for nontraditional students, over the age of 18, aren't required to provide sexual education classes, and neither are schools for developmentally disabled students.

Another policy change would allow minors, who are already allowed to consent to HIV testing, to consent to receiving treatment or one of the new prophylactic drug regimens if they become infected.

The most difficult proposal to pass among the task force's recommendations might be a new measure that would provide housing support for homeless and unstably housed HIV/AIDS patients outside of New York City. Health officials have long noted the correlation between how stable a person's housing is and their ability to adhere to a drug treatment regimen. But providing housing for the estimated 4,000 to 6,000 New Yorkers outside of New York City who are HIV infected would cost the state an estimated $100 to $120 million a year, said Mark Harrington executive director of Treatment Action Group (TAG).

The AIDS advocates know that anything costly or controversial can be a hard sell in Albany, especially while the Legislature is preoccupied with ethics reforms and looming fights over education and rent regulations. But the task force members say they are encouraged by the governor's public commitment to the idea of being the first state in the country to end its epidemic, a move being closely watched by other states like Washington and Minnesota, where similar plans to lower new AIDS infections have recently been announced.

Cuomo endorsed GENDA in his written budget book this year, the first time he has done so, advocates noted.

"I think [Cuomo]'s being looked at, as is New York State across the country, as really at the forefront of this," said Kimberleigh Smith, of Harlem United.

The Cuomo administration released amendments to the state budget last week that added an additional $5 million of funding for AIDS treatment programs, on top of money already committed in the original budget.

"What we really want more than anything is we want the governor's face, on TV, in a room announcing that he's endorsing this and he's doing this," Harrington said. "Because yeah, he said it, but people's attention spans are very short and you know, we want this to be a personal initiative of his."

Housing Works, which has often rallied and fought for budget initiatives through protest action in New York City and Albany, is closer to the levers of power on the ending AIDS initiative than it has been on other issues in recent memory. King was named by Cuomo as the task force's co-chair, and Housing Works retained Metropolitan Public Strategies, the consulting firm headed by Neal Kwatra, which was also involved in Cuomo's re-election campaign, to provide help with their efforts to rally support for the task force recommendations in Albany.

The task force members said reluctant lawmakers might be persuaded by the economic arguments of a possible end to AIDS in New York.

"Other than appealing to their basic underlying humanity... beyond that, let's say we prevent 10,000 new infections in the next five years and the lifetime cost of care for an HIV-infected person is about $388,000 dollars," Harrington said. "Overall we'll save the state over $4 billion dollars by averting those 10,000 infections."

The task force estimated the state would save a total of $5.1 billion by 2020 in averted housing costs and combined savings from not having to treat newly infected patients.

"It's pretty hard not to look at those numbers and think that that's a pretty substantial gain to the state taxpayers, not to mention all the lives that you've saved," Harrington said.

King said the advocates understood the biggest pressure on reluctant lawmakers could be the governor, who can be remarkably persuasive for the right cause.

"It's more a question of, is the governor, who has very complicated and weighty issues on his plate -- he wants to get ethics reform through, he's driving a school agenda that he wants to get through, you know -- in the middle of driving all those things, is he going to be willing to put the political capital behind issues like transgender rights, like sex ed in the schools and children having the right to consent?" King asked.

"It's a question of bandwidth, and it's a question of investing political capital. And so I'm hopeful that the governor with a lot of encouragement from activists and from the task force is going to do the right thing on all of these things, but I think it's really incumbent that we continue to encourage him," King said.

The goal of ending the epidemic seemed remarkably within reach, Harrington noted.

"Having worked with New Yorkers fighting AIDS for the last 35 years, this is one of the most exciting periods in our work together because we're finally beginning to see the pieces come together for an endgame. And if we can do it here, we can try to scale it and adapt it to any other part of the world," he said. "Going from something that was once considered to be a universal death sentence and people didn't even want to talk about it to thinking about the endgame, it's a really exciting period to be doing this work in. We're really hoping the governor is going to help us cross the finish line."