CUOMO BUDGET A MIXED BAG FOR NY AIDS COMMUNITY, By Mikola De Roo
For the past nine months, New York’s HIV/AIDS community has been calling for Governor Cuomo to convene a task force of community and government dedicated to creating a concrete plan to end the AIDS epidemic in New York State by 2020. Indeed, during the past year, AIDS service organizations, researchers, activists, and government officials—mobilized by AIDS Community Research Initiative of America (ACRIA), Housing Works, and Treatment Action Group (TAG) and in conjunction with the New York Department of Health’s AIDS Institute—have been meeting regularly to formulate a plan that would drive down the rate of new HIV diagnoses. The plan will utilize advanced treatment strategies to suppress viral loads—thereby reducing HIV transmission rates—and will also need to address the known social drivers and structural determinants that provide the deadly breeding ground for the HIV epidemic. These meetings are also in sync with the priorities of state health leaders, as evidenced by NYS Commissioner of Health Nirav Shah’s pronouncement following the January 9–10, 2014, World Bank/UNAIDS Social Drivers to End AIDS and Extreme Poverty Summit, “New York State can commit to an end of the AIDS epidemic by 2020. This is an achievable goal. It is a stretch goal. But the Empire State can lead the way so that this can be a reality for the rest of the country.”
Last week, New York’s HIV/AIDS community waited with anticipation as Governor Cuomo released the details of his fourth Executive Budget, hoping he would indeed “lead the way” and that an End of AIDS Task Force would feature among his priorities for the year (see January 21, 2014, City Limits article). There was no announcement, a silence that the community is responding to with disappointment and concern.
The actual details of the Executive Budget that were highlighted last Tuesday revealed a mixed bag for the New York HIV/AIDS community: some good news and some possible bad news by way of glaring omissions.
NYS EXECUTIVE BUDGET: THE GOOD NEWS
Unlike past years, New York State is not in a deficit. This year, the State budget has a whopping $2 billion surplus. Additionally, Governor Cuomo announced no resounding cuts to health and human services; therefore, the programs and services delivered through the AIDS Institute were held harmless and flat-funded. New York State kept intact funding for capital and program services and rent subsidies for many homeless programs that support the health and well-being of New Yorkers living with HIV, including the Homeless Housing Prevention program, New York/New York III, and Medicaid Redesign Team (MRT) Supportive Housing Fund.
NYS EXECUTIVE BUDGET: THE OMISSIONS
What was omitted from Governor Cuomo’s budget for this year were many of the financial and legislative building blocks on which any effective plan to end AIDS will rest:
• The long-awaited 30% rent cap was not in the budget. This rent cap would ensure that poor individuals and families living with AIDS and HIV would have their rents capped at no more than 30% of their income, thereby providing them with affordable and stable housing.
• A $10-million placeholder in the AIDS Institute’s budget was also missing from the budget. That placeholder would serve as seed money to help fund those initiatives that would be part of the plan to include: fourth-generation HIV testing, which reduces detection time, potentially allowing earlier diagnosis; linkage to care; nPEP (non-occupational post-exposure prophylaxis), in which individuals go on HIV meds for a month immediately after possible HIV exposure to prevent infection; and PrEP (pre-exposure prophylaxis) the scientifically-proven, FDA-approved practice of HIV-negative individuals taking HIV medication daily to reduce the risk of getting HIV up to 99%, among others.
• Anticipated changes to legislative language that would end the current police practice of confiscating condoms to use as evidence of prostitution was also not in the budget. The thinking behind the changes is that whether or not prostitution is involved, carrying and using condoms promotes safe sex and public health, and their confiscation, even for law-enforcement-related ends, promotes the opposite; safe sex becomes far less likely if carrying the tools to practice it may be used as evidence for criminal prosecution.
• Likewise, legislative language that decriminalizes syringe possession was missing. These legislative changes remove the limit on the number of syringes that an individual can have in his or her possession.
We should also note that the NYS Legislative Retrieval System did post the original budget language put forward by the AIDS Institute to address the last two bulleted items above, but subsequent to the official budget release, that language was removed from its website The original posting was as follows, and the portion that was excised is the highlighted text below:
Enacts into law major components of legislation necessary to implement the state health mental hygiene budget for the 2014–2015 state fiscal year; relates to state aid to counties and New York City for provision of prenatal health care services to uninsured women; relates to simplifying consent for HIV testing; to amend the public health law, in relation to authorization for data sharing with providers for purposes of patient linkage and retention in care; to repeal section 220.45 of the penal law, in relation to criminal possession of a hypodermic instrument; to amend the penal law, in relation to criminal possession of a controlled substance; to amend the general business law, in relation to the definition of drug-related paraphernalia; to amend the public health law, in relation to decriminalizing the sale and furnishing of hypodermic needles and syringes; to amend the civil practice law, the criminal procedure law, and the executive law, in relation to condoms or contraceptive devices as trial evidence of prostitution; to amend the public health law, in relation to the board member composition for the health research science board; to amend the public health law, in relation to the health research science board meeting requirements; to amend the state finance law, in relation to the New York state prostate cancer research, detection and education fund…
The combined effects of these Administration priority omissions and the lack of a public commitment to end AIDS are seeding the groundswell of public discontent. New York State has a window of opportunity during which it can lead the nation and make epic changes in the lives of those living with and at-risk for HIV, and it seems that the state and its leadership are failing to step up and take advantage of this moment of tremendous possibility.
A NYS Task Force to End AIDS: WHAT IS THE HOLD UP?
The creation of a NYS Task Force to End AIDS is currently caught up in the vortex of drug-pricing negotiations that the Administration is engaging in with a pharmaceutical company that makes HIV treatment medications. According to the Administration, these dealings have forestalled an End of AIDS announcement by Governor Cuomo despite widespread support for the initiative across all stakeholders.
WHAT CAN YOU DO?
You can do a number of things to move the End of AIDS initiative forward in New York State:
• Attend the NYS Health Committee Budget Hearing. On Monday, February 3, 2014, the NYS Senate and Assembly will be holding a joint Health Committee Budget Hearing in Albany in the Legislative Office Building, Hearing Room B, beginning at 9:30AM. If you would like to sign your organization up to give testimony about the need for Governor Cuomo to create an End of AIDS Task Force, call Dottie Pohlid at 518-455-3511.
• Give testimony to be delivered to NYS legislators. You can also draft testimony and email it to terri smith-caronia at smith-caronia@housingworks.org, and we will make sure to hand-deliver it to all of the NYS legislators.
• Meet with legislators in Albany. If you or members of your organization would like to join us on our weekly van trips to Albany to meet with legislators, we would be happy to set up appointments and get you and your folks to Albany. Again, email terri at smith-caronia@housingworks.org to make these arrangements.
