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Ending the Epidemic: What Will It Take?

January 5, 2017

During a routine physical exam 12 years ago, I received news that changed my life forever: I was HIV positive. I was young, scared, and unsure of what my options were and what my future would hold.

Only in my early 20s at the time, I was forced to navigate our complicated health care system both at times when I had insurance and when I was uninsured. Like so many New Yorkers, I had to manage my health care proactively while working full time and trying to keep up with our city's rising cost of living.

The road has not been easy, but I am extremely fortunate that, because of extraordinary medical breakthroughs, an HIV diagnosis is no longer considered the death sentence that it once was. Today, with proper treatment, people with HIV can live long, healthy lives. New prevention options like PrEP promise to reduce the number of new infections dramatically. And as the search for a cure continues, research advances are bringing us tantalizingly close to a breakthrough.

New York State will end the epidemic here by the end of 2020, but we've got a long way to go before we do.

Medical advancements need to be matched with progressive, compassionate housing and health care policies that ensure that all low-income HIV-positive New Yorkers are in a position to manage their care.

The bottom line is this: Housing is health care.

I can safely say that if I did not have stable housing while seeking treatment, particularly in the earliest days of my diagnosis, I would not be where I am today.

When HIV-positive people have adequate housing, we see that they end up with increased rates of viral suppression and reduced mortality rates. Importantly, their communities see lower HIV infection rates as well.

On the other side of that coin, we have seen that homelessness has a direct and staggering impact on people's health. A large body of research demonstrates that homelessness and unstable housing are strongly associated with a greater risk of HIV, inadequate HIV health care, poor health outcomes, and early death.

At the City Council, I'm proud to have sponsored "HASA for All" legislation that would expand lifesaving benefits to all low-income New Yorkers with HIV. HASA (the HIV/AIDS Services Administration) is a program that currently provides critical shelter, food, and transportation assistance to people in the direst health circumstances -- those who have an AIDS diagnosis, a CD4 count of 200 or less, or two opportunistic infections.

Certainly these individuals need this assistance, but when we wait for people to become sicker before we lend a helping hand, we do them, and ourselves, a great disservice.

Homeless people with asymptomatic HIV are often forced into the Hobson's choice of initiating treatment and remaining homeless or delaying treatment until they qualify for rental assistance or supportive housing.

Currently, thousands upon thousands of people with HIV -- including the 800 or more who reside in NYC shelters on any given night -- remain medically ineligible for the publicly funded HIV-specific non-shelter housing assistance, case management, and transportation allowances that HASA provides for people with symptomatic HIV. Homeless people with asymptomatic HIV are often forced into the Hobson's choice of initiating treatment and remaining homeless or delaying treatment until they qualify for rental assistance or supportive housing.

It's time to reach these people while we have a chance to change the course of their illness. It's time to usher in HASA for All. I look forward to working with my fellow elected officials and so many incredible advocates to make this goal a reality. Indeed, I've been greatly encouraged by my colleagues in the City Council, who have joined in the effort to end the epidemic in a number of crucial ways.

Together we're working to channel modern scientific breakthroughs in ways that have a profound impact on HIV-positive New Yorkers. Last year, City Council Speaker Melissa Mark-Viverito and I announced a new $6.6 million City Council initiative that will fund new prevention and support services, as well as the largest PrEP and PEP access program in the nation.

This funding will allow us to make sure our health care professionals are fully trained on these treatments so they can offer their clients the most effective care possible. It will support education and training for those who work with high-risk clients, and it will support expanded PrEP and PEP access for young people of color. This initiative will help us reach out to those who exhibit the highest risk for HIV, and it will allow us to get them the education, testing, and medical assistance they need to stay HIV-free.

Governor Cuomo has provided game-changing leadership on this front as well. With his announcement last year that he will seek an additional $200 million for supportive housing and health care programs for people with HIV, he is solidifying New York State's place as a national leader on this issue.

Similarly, Mayor de Blasio's commitment of $23 million toward new prevention and health care programs will have a tremendous impact on the lives of thousands of New Yorkers. Every dollar of this funding will bring us closer to reaching our goal of ending the epidemic.

We're on track to prevail against HIV, but we cannot let up. We need to continue with unabated determination, using every tool at our disposal. If we stay focused and keep fighting, I have no doubt whatsoever that we can and will end the epidemic once and for all.

Corey Johnson represents the 3rd District in the New York City Council, covering neighborhoods on the West Side of Manhattan, including Hell's Kitchen, Chelsea, Greenwich Village, Hudson Square, and parts of SoHo and the Upper West Side. He also serves as Chair of the Committee on Health.

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This article was provided by AIDS Community Research Initiative of America. It is a part of the publication Achieve. Visit ACRIA's website to find out more about their activities, publications and services.


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