This summer, the de Blasio administration tapped Daniel Tietz for the newly created position of Chief Special Services Officer at New York City's massive Human Resources Administration (HRA).
Tietz graduated nursing school just as the AIDS epidemic was emerging in 1982. Since that time, his work in public health, non-profit and government services and policy has cut across many of the interlocking challenges of HIV in the U.S. -- including mental health, health literacy, housing and homelessness, research, LGBT rights and most recently, aging issues.
Tasked with managing all that HRA's 14,000 staff members do to provide direct services to New Yorkers, Tietz now oversees a broad range of programs, including Adult Protective Services; the HIV/AIDS Services Administration; Domestic Violence; Shelters and Services; Disaster Assistance and Crisis Management and Customized Assistance Services for public assistance recipients.
The former executive director of the AIDS Community Research Initiative of America (ACRIA) spoke with TheBody.com about his new role as the city prepares to take on the charge of "bending the curve" of HIV to end the epidemic in New York state.
What are top items on your agenda, as far as HIV/AIDS, as you're making this transition?
Well, the most notable of these is the governor's announcement in late June with regard to an "End of AIDS" plan; I think it's referred to by the governor as bending the curve. That's good, and it's fairly descriptive.
By 2020, the goal is to have not more than 700 new infections annually in New York state -- which is a number below epidemic levels.
In calendar 2012, New York will be, for the first time in about 20 years, below 3,000 new diagnoses. So that's an ambitious goal: below 700 by 2020, which is only like five years from now.
We mostly know what to do. A plan at this point is half-developed; an outline is there with the [New York] State Department of Health, the City Department of Health and Mental Hygiene -- advocates worked on it over the last year.
What comes next is a task force that will be named by the governor, which, we understand, will happen very soon. And some number of city officials will be on it. I don't know that I'll be one of them. But certainly, folks from here will be a part of that. So I think that's the big push.
Because if you think about who's left to get to an undetectable viral load, they have much in common. There's poverty; mental health and substance use challenges; unstable housing, or homeless. So it's addressing those issues that will get us there. And unless there's coordination of not-for-profit community providers with city and state making that happen, we're not going to get there.
And by the way, New York doesn't get to "an end of AIDS," down to below epidemic levels by 2020, without full cooperation from the city -- because 80% of New York's epidemic is in the five boroughs [of New York City].
The people who are gainfully employed, whose lives are reasonably well organized, who have got housing, who have got insurance -- whether that's public, like Medicaid, or otherwise -- those folks are mostly taking their meds. They're mostly showing up for it. It's the hard ones that are left. It's the folks who are going to need more than that. They're going to need intensive case management.
We've got great models out there. Now we have to scale those up. We have some of that happening right here in the city by providers we know well. We need to expand that. In terms of HIV and HRA -- all of our anti-poverty efforts here, the employment plan that we're working on now with the state; all of the mayor's initiatives with regard to both affordable housing and addressing inequality -- all run in this direction, too. If you think about this, they run together. So I think it's building on that and the governor's announcement. We're going to be committed about that.
One of the things you worked on during your time at ACRIA was pushing for deeper understanding and engagement on HIV and aging. What is the state of HIV and aging? What has been gained or achieved, and what's left to do? And is there some crossover of what's on your plate in this role?
A lot happened with that. And I'm really pleased about that, I have to say. I've expressed frustration with UNAIDS, and less with the [New York] State Department of Health AIDS Institute, which has been pretty thoughtful on this whole issue, recognizing that people on meds are going to live, and that means they're going to get old -- which is what we all wanted! The whole idea was that you wouldn't die. You wouldn't die young. I mean, you would die in the natural course of things, if you will.
If the worldwide goal is not less than 15 million on meds by 2015, did anybody think that they're all going to live now? And then what? Then what will their needs be? What will we have to do differently than you would for a 25-year-old, or a 35-year-old, with HIV?
So we're pleased to have gotten that on the agenda, and ever-increasing responsiveness from providers and people with HIV themselves who have the comorbidities, have needs that are, if you will, beyond their years. When you're a 58-year-old and you've got three comorbid conditions, and you're not yet eligible for Medicare, and you're not yet eligible for a host of senior services (which turn on chronological age), but you're not so disabled that you can get disability, what do you do?
A number of providers across the country, and beyond the U.S., are thinking it through: How should we reconfigure our services to actually meet this growing need that is, by the way, mostly good news? It's also true that about one in six new diagnoses are in people above age 50. And I'm careful to note diagnoses as opposed to new infections. We don't have as good data on new infections above age 50 -- at least not in this country.
So we're pleased to have gotten it on the agenda. And having just come back from Melbourne, from the International AIDS Conference, more than ever before this was on the big agenda. There was more talk about this. There were more sessions that were devoted to this topic, and thinking through what happens when you keep people alive, and how would their needs change.
So, shifting to our context here: there are 32,000 New Yorkers with clinical, symptomatic HIV (because, of course, that's the definition for HASA [the city's HIV/AIDS Service Administration], as it stands now). If we do our jobs right, they're all going to get old. It's very much thought of here. There's a lot of focus at HASA about what would we need to do differently to better meet that need. It's definitely on the agenda.
You're stepping into this gig as the "30% rent cap" has finally been put in place. So can you describe what that is, and what the landscape looks like now that things are changing?
New York is an expensive place to live. Housing here is tight and expensive. Essentially, the state budget that got passed in March included a 30% rent cap. For folks who are being served by HASA -- again, people who have mostly clinical, symptomatic HIV disease, or AIDS -- who meet public assistance eligibility requirements for enhanced rental assistance, will get their rent capped at 30% of their income. And the city and state, in a deal, will pay the difference.
That comes to some 7,000 of the 32,000 or so HASA recipients. So it's a big impact.
We have people who have been residing in supportive housing who arguably today don't need it, and don't want it, and are only there because they had no way to move out, because they didn't have enough income to rent an apartment. We have other folks who are living in emergency housing, often SROs [single room occupancy housing] that are not desirable, that are not good places for anyone, much less somebody with HIV. And they're living there for some of the same reasons. They would otherwise be just homeless.
So we're glad for it. We've just made retroactive payments to a chunk of folks, for the period of April to July, who were in the same apartment from April 1 to July 1, at the same rent.
In terms of going forward and actually getting some folks moved out, we have two priority populations. One is those folks in supportive housing who are ready, willing and able to go, who want to live on their own. And then a chunk of folks who are in emergency housing who also are ready, willing and able.
It's a tough housing market. But we're very committed to making this work.
There's certainly a long history in the HIV community of advocates and activists being very deeply involved. Now that you've got this particularly broad scope, how are you engaging with advocates within and across aging, adult services, and so on, as well as those from the HIV community?
What have you learned from HIV/AIDS as far as being, and working with, advocates? What do you hope to learn from other folks who you haven't been working with as much the last couple of years?
Well, I've figured out that some are more polite than others! You know, what I think I really like about HIV advocates is, you don't have to beat around the bush. The people are just going to tell you what's what. So it's interesting to have been on one side of that.
I wasn't brought here just to idle. The commissioner and I have a long history together. I was a trusted aide for him in the past. And we're very much on the same page, in terms of our politics and how we think about these issues, the kinds of things that HRA is here to address, and how that fits with the mayor's vision. Otherwise, hence, we wouldn't be here.
No bigger advocate than he, than the commissioner in the past, before coming here. It's an administration that signed up to have people like me and him on the payroll. I think they knew what they were getting.
I worked at a former job where part of my job was to supervise. It wasn't my immediate last job; I'll just say that!
Part of my job was to supervise policy and advocacy. And I used to have a line at times, when they would get on my nerves, about, "Can we do some advocacy outside the building? Why are you bothering me?" So I sometimes wonder if City Hall thinks the same thing: Please, can you go bother somebody else with all your schemes?
Some advocates -- mostly HIV advocates, but not only -- have said that they hadn't been on the mayor's side in City Hall in 20 years, for a meeting; or that they had never been in a conference room for a meeting at HRA, much less in that same conference room several times over three months, where somebody actually asked their opinion and wanted to hear it, and then invited them back even after they gave it! That feels gratifying.
Are there any key things that have really opened your eyes so far? Things that you just hadn't known about before coming into these meetings and sitting at these new tables? Or are you still in a gathering and assessing place?
Well, it's generally both. There are a bunch of things that are happening here that, as I said earlier, are like a little bit of news to me.
You've got different folks who are in charge. But there are also a lot of people -- good and decent people -- who have been here a long time -- 20 years and more, 25 years -- who care about these issues, who try to do the best they can to help New Yorkers in need.
And in the past, they have maybe felt constrained, where the messaging may have been, "Find a way to say no." Some of the reporting, for example, in the past, was about diverting cases, tracking "What have you done to limit additional caseload today?"
That's not our message.
Our message is not about, "What did you do to grow the caseload today?" but, rather, "What have we done to help New Yorkers today benefit from the services that we actually have on offer?" Do they have some need that we can actually help with? And what have we done to make that work? What have we done to help folks move from needing that today to self-sufficiency, in a way that actually would make a difference?
It's an effort to be responsive to those needs, and to help folks make the transitions they need to make, in an effective, thoughtful way. And so I'm really pleased that there are a lot of people here who are completely into that. It's what they came here for.
I'm grateful for some people who I'm getting the chance to work with now who are really committed, who are all on board with this mayor's agenda, this commissioner's agenda, with what we want to be doing here to alleviate poverty and inequality, to get folks to the place they need, and want, to be.
And now we know that Dr. Demetre Daskalakis will be heading up the HIV/AIDS effort over at the city's health department --
We just met this week.
He told TheBody.com that he's coming in with a vision of de-siloing prevention and treatment. As you're talking, I'm thinking the nature of your special service-ship is also a de-siloing of the consequences of poverty and inequality that affects the epidemic.
It's a big goal here of this administration to get folks to better communicate across services and programs.
Maybe it's just a matter of human nature, "I have all this to do, right here, in this little place I work in, that I'm swimming in it. I don't know what you do. I wouldn't mind knowing, but I don't have time." So I get how you get there [in the silos].
But our big goal at the chief level and on down, is this: We each need to know better. And we've seen where lawyers representing HRA with an eviction case are asked by judges, "Why didn't you refer them to this or that service at HRA?" And the poor lawyer has actually had to admit, "I didn't know that we had that."
We'd like to fix that so that there's a better sense of what everyone does and so internal referral happens better.
The commissioner is an ambitious guy, with lots of ideas. We have right now a list that runs to five dozen initiatives, a re-engineering of what we're doing and how we're doing it, to better meet HRA's overall mission as the city's Department of Social Service, to alleviate poverty and equality, to help folks transition from the need for public benefits to self-sufficiency in ways that work for them, that make sense for them. That really does mean thinking across program areas. It's not just that someone fits in one tidy box.
The HASA crowd has mental health and substance use needs. Folks who are subject to domestic violence have mental health and maybe also HIV education needs. So there's a lot of thinking about that.
Part of that 60 items on that list includes cross-agency training initiatives. Right now is LGBTQ training. And that's for everybody -- I'm attending on Monday.
There's a whole bunch of stuff about substantive and cultural competency. How do we speak to people? How does our staff behave in serving the public? How do we change the tenor and culture of our centers?
We're looking to put staff in there to essentially serve as navigators, so when people hit the front door the first person they're seeing is not the security guard. Instead, it's somebody who can actually answer questions and steer them in the right way, make the visit not only better for them, but more efficient for us. Less churning, less waiting.
So there's all of that, and thinking about how do we do business that actually will better serve people and, frankly, is better for our staff. It was a lot of work in the past to tell people no, just to tell them no, when they're going to be back. Their need didn't disappear. So if there's a way to address those needs, then let's figure that out on the first visit.
Thank you so much for taking the time to talk, and good luck with your work!
Julie "JD" Davids is the managing editor for TheBody.com and TheBodyPRO.com.