One year ago, after two years of organizing by civil society, New York State’s Governor Andrew Cuomo committed to end AIDS as an epidemic in the State of New York by 2020. If achieved, this would make New York the first high HIV incidence jurisdiction in the world to end the epidemic.
The Governor based his announcement on a three-pronged plan that includes identifying every person who is infected but unaware of his or her status, getting everyone who is positive engaged and retained in care, on ARV’s and consistently viral suppressed, and finally, scaling up use of PrEP (pre-exposure prophylaxis) for people who are at highest risk of HIV.
Governor Cuomo followed his June announcement by appointing a task force of over 60 experts and community leaders to develop a blueprint for implementing these goals. That task force developed a Blue Print with three components, including strategies around the three-pronged plan announced by the Governor, additional actions necessary to create an enabling environment for these strategies to be successful, and a set of additional far more ambitious recommendations that would ensure, not just a state-wide end to the epidemic, but an end to the epidemic in every community and population in the state.
New York State already has a good track record in the AIDS response. At the peak of the epidemic, there were some 15,000 new infections every year, including some 500 perinatal infections and some 7,500 infections among people who inject drugs. The estimated incidence for 2013, the last period for which reporting is complete, there were slightly over 3,300 new diagnoses, with an estimated incidence of 2,700. Perinatal transmission was reduced to 3 cases out of scores of live births, and transmission among people who inject drugs was reduced to less than an estimated 100 new cases.
To achieve the technical definition of an epidemic, New York would have to achieve an incidence of less than 750 by 2020. But the Governor’s Task Force set a goal of achieving the three zeros: zero new infections, zero AIDS mortality, and zero discrimination. Even getting below 750 new infections is a challenge. However, the community is committed to the larger goal and recognizes the strategies to achieve that objective will make an incidence of less than 750 inevitable.
While the plan has several important metrics, the key to viral suppression is a combination of the rigorous use of technology to track progress, along with ensuring stable housing, transportation, food security, and vocational opportunities for every person living with HIV. The key to prevention among people at risk is changes in the law that improve the environment for people who use drugs and transgender people, even more, robust harm reduction services that reach every person who uses drugs in the State, expanded sex education for young people, and linking young gay, bisexual and transgender youth, racial and ethnic minorities to health insurance, culturally competent primary care, and an introduction to PrEP as just one more means to holistic health care.
Last April, Governor Cuomo accepted the blueprint from the Task Force and promised its full implementation. He went further and committed to making New York State the example to set the path to end AIDS in the United States. Already, implementation of the blueprint is well underway. The community expects many challenges, particularly with more controversial changes in State law. There is much hard work ahead to achieve the goals now set, but just the act of making the commitment and developing a plan to achieve the end of the epidemic has galvanized the community and brought it together around a common purpose more than at any time since the introduction of ARV’s.