On World AIDS Day (WAD) 2020, Governor Andrew Cuomo released a statement that was misleading at best and on some points frankly dishonest. We have a right to expect clear and honest public health statements from our New York leaders, not the wishful thinking and unsupported boasts, half-truths, and falsehoods we’ve come to expect at the national level from the Trump Administration. We are saddened that the Governor tried to use World AIDS Day to mask and divert attention from deep cuts to our State’s HIV response that signal the Governor’s abandonment of his own historic plan for Ending the Epidemic (EtE) in NYS.
Pointing to just-released data from 2019, the Governor correctly describes the tremendous progress we had made by the end of that year towards our EtE goals. But what he does not acknowledge are the deep setbacks to our efforts caused by the co-occurring COVID-19 pandemic — setbacks that will require redoubled effort in the months and years ahead. And the Governor chooses not to mention his deep, devastating cuts in funding for the community health centers and HIV service providers that are the backbone of our EtE efforts in the low-income Black and Latino/Hispanic communities hard hit by both HIV and COVID-19. It is not surprising that the Governor’s release does not include a single quote from an HIV/AIDS service provider.
The reality is that HIV/AIDS providers face new and serious funding cuts that threaten to undermine and turn back our EtE progress. NYS is withholding 20% of all State contracts with non-profit organizations, while for-profit contractors are left whole. HIV/AIDS providers are left without the resources they need to provide critical HIV services during a global pandemic. Even more devastating is the proposed “carve out” of Medicaid pharmacy benefits from managed care to fee-for-service — a change that will strip Federal 340B drug discounts from all safety-net providers in the State, including those who serve our most vulnerable low-income populations living with or vulnerable to HIV/AIDS. These savings realized from drug manufacturer discounts are reinvested in the otherwise unfunded “wrap-around” services for medically vulnerable groups that have made our EtE efforts possible, and that are essential to addressing persistent and ongoing HIV health inequities based on race, ethnicity, gender identity, and other forms of oppression. Housing Works alone faces the possibility of losing $10 million in annual 340(b) rebates beginning April 1st, 2021.
Beyond these willful exclusions from the rosy picture painted by the Governor, his WAD statement demonstrates that his office and the Department of Health (DOH) either fail to understand or choose to willfully ignore key aspects of epidemiology, data collection, and harm reduction practices.
Among these gross errors in the Governor’s statement:
The Governor’s boast that 2019 data show New York State has successfully “bent the curve” on the HIV epidemic fails to acknowledge the devastating impact of the 2020 COVID crisis on our EtE efforts. HIV testing is down by 75% across the State; NYS AIDS Institute data show that people with HIV experience significantly higher COVID mortality than the general population; PrEP uptake has declined; and we are seeing increased HIV transmission among people who use drugs after years of declines. With increased COVID-related deaths among people with HIV, significantly decreased testing, 2020 data will make it appear that we have reached our target of reducing new infections to a level below all-cause deaths among PWH – or “bending the curve” – but a year later we are likely to see much worse numbers, and it will take us to at least 2022 to truly hit our 2020 goal.
Likewise, by boasting of DOH approval of “two new syringe exchange programs” upstate, which are long overdue, the Governor seeks to divert attention from the administration’s gross negligence in failing to pay existing harm reduction organizations fully, and on time, which has resulted in at least one new HIV cluster in Monroe County, affecting mainly non-Hispanic Black and Hispanic residents. Due to these cuts in funding, harm reduction programs across the State run out of clean syringes well before the end of each month, leaving syringe exchange programs no option other than urging their clients to clean their reused syringes with bleach before each use.
Perhaps most dishonest is the proclamation that the Governor’s Medicaid Redesign Team II (MRT II) has secured $100M in savings for 340B safety-net providers, when the Governor knows full well that the 340B carve-out will devastate community health centers and across the state by stripping away an estimated $240M in drug rebates. Nor is it true that the State is “working directly with stakeholders and providers” on this plan to “mitigate” the loss of 340B savings. The community advisory group formed to provide recommendations has been so ignored that it has informed DOH it refuses to make recommendations. Moreover, the $100M — just 40% of anticipated losses — is not directed to HIV services, but to all 700+ safety-net providers across the State. A recent study found that just 15 of the hundreds of HIV/AIDS providers that rely on 340B will lose over $55M annually in critical funding. Make no mistake, when combined with 20% withhold on all non-profit contracts, clinics in medically underserved neighbors will close, critical services will be eliminated, avoidable inpatient and emergency department costs will soar, and people will die.
Nor does Governor Cuomo acknowledge his refusal to date to fulfill key Ending the HIV/AIDS Epidemic (ETE) Blueprint recommendations that are essential to address the insidious health disparities that ultimately drive the AIDS epidemic. Per our November 30th World AIDS Day press release, despite repeated promises to fully implement the Blueprint recommendations of an appointed 64-person task force, the Governor is uninterested and even willfully ignorant about the necessity of housing homeless and unstably housed people HIV/AIDS living outside of NYC, expanding overdose prevention efforts to prevent new HIV and hepatitis C infections, and eliminating HIV/HCV co-infection among PWH, all of which must happen to truly end the epidemic, let alone bend the curve.
We ask the Governor, why are you abandoning PWH and your own EtE plan, and why was the Governor so distressed by yesterday’s demonstration of 12 cars demanding the safety net be protected that he had State troopers shut down State street in an attempt to hide the truth? Denying New Yorkers their freedom of speech cannot hide the fact that the Governor is not the progressive Democrat he plays on TV, but instead simply a millionaire-appeasing, bureaucrat “trying to balance the budget on the backs of the safety net system and the communities that rely on it.”
While the Governor claims to be “bending the curve” he is in actuality bending the facts to suit his heroic self-narrative. In a recent speech, he pledged to address the health disparities exposed by COVID, while at the same time devastating the safety-net system that serves our most vulnerable communities — all in the context of this current, deadly pandemic. Not only has Housing Works fought to overcome these disparities for our community for 30 years, but we’ve heard this before: the Governor made a similar pledge in the Blueprint. We’re still waiting for him to fulfill it, to recognize and fight the racism, homophobia and transphobia that drive HIV/AIDS, to implement those recommendations that provide support for those he overlooks. Maybe then he will have done something truly great, something worth writing a press release about.
To help save the New York State healthcare safety net, go here: https://www.savenysafetynet.co...