NYC HEALTH DEPARTMENT CAVES TO ACT UP’S DEMAND FOR a PEP and PrEP INFORMATION CAMPAIGN
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Media: Reed Vreeland, 917.573.6328
ACTIVISTS SAY DOHMH HAS NEGLECTED HIV PREVENTION FOR THE LGBT COMMUNITY
NEW YORK CITY – AUGUST 22, 2013 – On Thursday, August 15, pressured by a picket line of AIDS activists spotlighting the city’s failure to provide effective HIV prevention for gay men and transgender women, the New York City Department of Health and Mental Hygiene (DOHMH) immediately promised to launch a new public education campaign for the HIV prevention treatments Post-Exposure Prophylaxis and Pre-Exposure Prophylaxis, commonly referred to as PEP and PrEP, according to a DOHMH statement published by OUT.com.
PEP, an HIV prevention treatment that must be started shortly after potential HIV exposure, can dramatically reduce the chance of HIV infection for anyone who may have been exposed to HIV. And PrEP, an anti-viral treatment taken daily, has proven highly effective at reducing HIV infection among people who adhere to treatment and are at high risk of HIV exposure. Yet activists pointed out that the DOHMH has not done the necessary work to make PEP or PrEP widely accessible and affordable, and the city has so far failed to educate the general public about the existence of these treatments.
“ACT UP will not be declaring victory anytime soon,” said long-time ACT UP member Jim Eigo, one of the activists featured in the Oscar nominated documentary How to Survive a Plague, a film about the group’s use of bold direct actions to press for improved HIV drugs in the late 1980s and early ‘90s, which eventually curbed the precipitous rise in U.S. AIDS deaths.
Eigo was among the more than 30 protesters who swarmed the DOHMH building in Long Island City last Thursday, with signs and posters that reflected the activists’ demand for improved HIV prevention, including a citywide PEP and PrEP awareness campaign. The activists’ sharpest criticisms concerned DOHMH funding cuts to HIV prevention programs and misallocation of resources away from at-risk groups, which they say has contributed to the sharp rise in new HIV infections among transgender women and gay men, a crisis that ACT UP has called a “second wave” HIV epidemic, or AIDS 2.0.
More than 5% of New York City’s gay population is becoming HIV positive every year—a number roughly double the national average—according to the latest, potentially low-quality, data, released publicly by the DOHMH and its own analysis of the 2008 report on men who have sex with men (MSM) from the National HIV Behavioural Surveillance System (NHBS). Even more alarming, the DOHMH estimates that more than 11% of the city’s black gay population is becoming HIV positive every year.
Yet despite these distressing numbers, when the Federal government recently cut HIV funds dedicated for New York City, the DOHMH did not increase the amount that the city contributes to HIV prevention. “Even as federal funding decreases, the DOHMH is reducing the already absurdly small amount of money the city itself spends on HIV,” explained James Krellenstein of ACT UP. The HIV funding that the DOHMH controls consists overwhelmingly of Federal funds, and what the city contributes represents less than 2% of the overall HIV budget. However, the city has proposed to decrease the funds it reserves for HIV by 37% in the next year, from about $3.4 million in FY 2013
to $2.15 million in FY 2014, according to the DOHMH budget proposal for 2014.
Many of the AIDS groups responsible for HIV prevention programs have been operating in an environment of reduced funding and looming program cuts for years. In late 2011, the DOHMH sent letters to city AIDS service organizations, such as Gay Men’s Health Crisis (GMHC) and Gay Men of African Descent (GMAD), informing them that their HIV prevention contracts would be slashed by 50% for the second half of FY 2012. Eventually, community outrage and media attention prompted the City Council to restore most of the DOHMH cuts for 2012. However, the City Council’s intervention did not protect HIV prevention funds from being cut for the following year.
These cuts have been sharply felt. “If city officials don't put more resources behind effective HIV prevention programs, we can't think about an ‘AIDS-free generation,’" said Johnny Guaylupo, a program coordinator at Housing Works. His reference to the “AIDS-free generation” slogan, used regularly by the U.S. State Department in the global fight against AIDS, shows the stark contrast between global aspirations and local realities.
Guaylupo explained the funding cuts and on-the-ground realities facing the current generation of young people, including a lack of shelters and assistance for LGBT youth—which in turn can increase the likelihood of an acute AIDS diagnosis. "At this time the number young MSM getting infected with HIV is rising,” he added, “and the cuts to prevention are decreasing the number of prevention services for this population in desperate need of help.”
Activists also say that the DOHMH needs to be held accountable for not improving its HIV data. In a DOHMH surveillance slide set on HIV/AIDS Among MSM in New York City, 2011, the city’s health department estimated that only 14% of MSM, were living with HIV but were unaware of their HIVpositive status—another presentation provided the same percentage of females. However, upon further inspection, the health department was relying on one study conducted over a two-month period at a single Jacobi Medical Center emergency department in 2009—and the study did not collect sexual orientation or transmission category data.
The DOHMH advertisement of the relatively low 14% figure for MSM living with HIV and unawareof their positive status has serious implications, since this figure is usually used to determine funding for targeted HIV testing for at-risk groups. For comparison, the Centers for Disease Control and Prevention (CDC) NHBS data for New York City—which recruited MSM from all over the city—stated that for 2011, approximately 40% of HIV-positive MSM in New York City were unaware of their status. The same standardized protocol was implemented in San Francisco in the same year, and showed that only 7.5% of HIV-positive MSM in San Francisco were unaware of their status.
“It seems that DOHMH is cherry-picking the data,” explained Krellenstein. “When higher quality data indicates a worse epidemic, it goes with lower quality data that makes them look better,” he said. Krellenstein emphasized the need for more targeted HIV testing for MSM and transgender women. In 2009, the two groups received less than 6% of DOHMH funded HIV tests offered in non-clinical settings and through social-network recruitment, even though MSM and transgender women represent over 60 percent of new HIV infections, according to the health department’s Enhanced Comprehensive HIV Prevention Plan from 2011.
With a long list of demands, and accusations of negligence that remain unanswered, it is no surprise that Jim Eigo and other ACT UP members are sceptical of what the DOHMH plans for its PEP and PrEP informational campaign. “ACT UP wants DOHMH to work with communities at-risk to devise comprehensive, sex-positive, queer-friendly HIV prevention programs that build on the early success of safer sex programs, but recognize new prevention strategies and tools for a different epidemic and a different world,” Eigo said, implying that accessible and affordable PEP and PrEP for at-risk groups would only be two of many components of prevention programs in this new era.
Despite the fact that hospitals nationwide have been able to quickly provide PEP to medical workers for more than a decade, even major NYC hospitals have recently failed to adequately train medical staff on PEP for non-medical patients, as evidenced by a recent incident at Mt. Sinai Hospital when a man was initially turned away from the emergency room after asking for PEP, eventually prompting an ACT UP protest at the hospital in July. ACT UP has observed that poor and underfunded PEP programs are often symptomatic of inadequate HIV prevention plans.
“Unless the city begins dealing with this HIV prevention emergency today, the HIV caseload tomorrow will be enormous,” Eigo concluded. Once again, ACT UP is mobilizing to address an HIV epidemic that is disproportionately hitting the LGBT community: More than half of transgender women and young MSM may become HIV positive by age 50, unless action is taken now. Last week’s demonstration sent a clear message to the DOHMH and other city and state health departments allocating HIV prevention funding: “ACT UP, and allies, are watching!”
About ACT UP: Founded in 1987, ACT UP (AIDS Coalition to Unleash Power), is a diverse, nonpartisan group of individuals united in anger and committed to direct action to end the AIDS crisis. ACT UP meets every Monday night in New York City at the LGBT Community Center, 208 West 13th Street off 7th Ave.