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ENDING AIDS

March 26, 2014

To the Editor:
Let’s be clear: there is no “END OF AIDS” until there’s a CURE FOR AIDS (“Do We Already Have the Tools to End AIDS?,” by Duncan Osborne, Mar. 19).

Your article begins, “Leading AIDS groups are pressing an ambitious plan…” Really?! Not if they’ve got anyone on their boards who has one foot in reality. This isn’t science. It is irresponsible statistical sleight-of-hand. If they don’t know it, they need to stop talking to each other and start talking to those newly diagnosed.

It’s very disappointing to see and hear these “experts” talk about HIV/ AIDS with such a disconnect to the populations most at-risk. Maybe they really don’t know any better and should have taken that one elective in marketing that would have taught them that branding a lie has dangerous consequences.

So far, those consequences include: a state budget that currently does not appropriate the $10 million sought for PrEP ($1.5 million), for PEP ($1.5 million), High-Impact Prevention/ Surveillance ($3 million), linkage to retention in care ($2 million), expanded partner services ($1 million), and evaluation and monitoring ($1 million). The governor has not declared the “End of AIDS” as many advocates thought he would on World AIDS Day or in his State of the State Address, we have BOTH houses of the State Legislature largely ambivalent to those with HIV/ AIDS, and the message from New York City’s health commissioner is that HIV/ AIDS is over and we should all go home.

Sure, if everybody just gets tested early and often, takes their ARVs, keeps their viral loads undetectable, and one might as well add “uses a condom,” doesn’t inject drugs, and never ever trusts anyone else’s test results… and never visits Russia or Uganda or anyplace that preaches “AIDS=HIV=gay=deserving of God’s wrath” (which could be the South Bronx), THEN we won’t have “that many statistical AIDS cases in a certain geographic area.”

William Cooke
New York City

 

March 20, 2014

To the Editor:
It is disappointing that this article focused only on the biomedical interventions. While these are critical, there are other key factors that have led us to believe that this is the time to call for a real effort to end AIDS as an epidemic in our state.

The first is that the Affordable Care Act gives us the opportunity to get health insurance coverage for people most at risk of HIV, which means we can seize the moment to get people into culturally appropriate primary care, where issues like routine HIV testing and education about PEP and PrEP as well as access to early treatment become the norm.

The second is Medicaid Redesign, which has freed up funds that can support housing, care coordination, and other services that are vital to treatment adherence.

Finally, we have both a governor and a mayor who have appointed leadership that is committed to this agenda. The first test of this was the inclusion of the 30 percent rent cap for people in New York City receiving HIV/ AIDS rental assistance in the state budget. This came about because Mayor de Blasio was willing to pick up the city share.

A second test was the state’s successful negotiation, announced yesterday by New York State Health Commissioner Shah, with Gilead to further discount ARV prices so that the state can aggressively press for more people on treatment.

To end the AIDS epidemic, we will need many non-biomedical steps going forward. Some, like rental assistance for everyone who is homeless and HIV-positive, will be costly; others, such as a ban on condoms as evidence and decriminalization of syringes, will be controversial. But a meaningful commitment to end AIDS as an epidemic is what will propel these critical agenda items forward.

Charles King
New York City
The writer is president of Housing Works, an AIDS services group.

 

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