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Equity in HIV/AIDS Prevention and Treatment in New York City: Public Health and Civil Society Collaboration [1]

['Dr. Sarah Braunstein', 'Assistant Commissioner For The New York City Department Of Health', 'Mental Hygiene', 'Krishna Stone', 'Director Of Community Relations At Gmhc', 'The Country S Oldest Organization Working With People Diagnosed With Hiv Or Aids']

Date: 2022-11 

NEW YORK FOREIGN PRESS CENTER, 799 UNITED NATIONS PLAZA, 10TH FLOOR

MODERATOR: Good afternoon and welcome to this New York Foreign Press Center briefing on equity in HIV/AIDS prevention and treatment in New York City. In this briefing we will learn how both the city of New York as well as civil society work to combat the spread of HIV and facilitate access to treatment options for those living with HIV, as well as other support services available in the United States’s largest city. Our briefers today are Dr. Sarah Braunstein and Krishna Stone.

My name is Ryan Matheny and I am the moderator for today’s briefing. This briefing is on the record and is being recorded. We will post a transcript and video of this event later today on our website, which is fpc.state.gov. If you haven’t already done so, we ask that you make sure your Zoom profile reflects your full name and the media outlet you represent. We also invite you to turn your camera on should you wish to. Each of our briefers will give opening remarks followed later by a period of questions and answers which I will moderate.

First, I am honored to welcome Dr. Sarah Braunstein. Dr. Braunstein is the assistant commissioner of the New York City Department of Health and Mental Hygiene’s Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, or STIs. She has been with the health department since 2010. Dr. Braunstein’s extensive background includes conducting domestic and international clinical studies and epidemiologic research on the prevention and epidemiology of HIV and other STIs for over 20 years. Welcome, Dr. Braunstein. The floor is yours.

MS BRAUNSTEIN: Thank you so much, and it’s my honor to be here today. Let me share my screen. Okay, can you see my slides? Just making sure. Okay, wonderful.

So today I’ll be talking about our efforts to end the HIV epidemic in New York City. I – here’s a brief outline of my talk for today. I’ll be talking just a little bit about the New York City Department of Health and Mental Hygiene to orient you to the context and the institutional context in which we do our work. I’ll share some data on HIV in New York City using our latest published data from 2020. I’ll describe our New York City 2020: Ending the HIV Epidemic Plan, share some information about select New York City Ending the HIV Epidemic programming and services, and then end with a discussion.

So an overview of our New York City Department of Health and Mental Hygiene. We have a very large health department. We have an annual budget of $1.6 million* [CORRECTION: $1.6 billion] and more than 6,000 staff spread across the five boroughs of New York City. The New York City Department of Health and Mental Hygiene is one of the largest public health agencies, in fact, in the world, and the mission of the health department is to work to protect and promote the health of 8 million New Yorkers.

Within the New York City Department of Health and Mental Hygiene is the bureau that I have the honor of overseeing, with an annual budget within our bureau of approximately $212 million and more than 440 staff across six programs. The Bureau of Hepatitis, HIV, and STIs oversees all of the health department’s work related to addressing viral hepatitis, HIV, and other STIs. Our vision in BHHS, the name of our bureau, is a New York City without transmission or illness related to viral hepatitis, HIV, and STIs, and we do this – we seek to achieve this vision – by improving the lives of New Yorkers by ending transmission, illness, stigma, and inequities related to viral hepatitis, HIV, and STIs.

So to orient us to the context of the HIV epidemic in New York City, I’ll share some data from our 2020 HIV surveillance system. So this slide attempts to capture in data the history of New York City’s HIV epidemic, which, of course, is a long and large one. So this is data from 1981, since we began documenting and capturing AIDS cases, up through 2020. So if you can see the line, the red line, that tracks the number of new AIDS diagnoses each year in New York City. You can see that it peaked in the mid-’90s and then declined precipitously thereafter, after the introduction of highly active antiretroviral therapy.

The green line that’s just below the red line tracks the number of HIV-related deaths, or deaths among people living with HIV that are attributed to HIV infection itself, each year in New York City. And again, you can see that that follows the same curve as the AIDS diagnosis line, insofar as there was an increase in the first years of the epidemic and then a steep drop after treatment was introduced and more New Yorkers began taking it.

The black line that starts about midway through the graph shows the number of new HIV diagnoses each year in New York City. And we began counting officially reportable HIV diagnoses in New York City in 2001. Each year since, we’ve seen a decline in the number of new HIV diagnoses, or fewer people being diagnosed with HIV.

The blue bars in the background of this graph track the growing number over time of people living with HIV in New York City, and of course as more people became diagnosed with HIV, the height of those bars increased over time. Also, though, notably, as people with HIV began surviving longer, those bars increased in height.

So in New York City in 2020, we had nearly 1,400 new HIV diagnoses representing about 17 HIV diagnoses per 100,000 population, we had 917 people newly diagnosed with AIDS that year, and we had over 1,900 deaths among people with HIV from all causes.

To put this one year of data from 2020 in the context of other recent years of data, here I’m showing the number of new diagnoses of HIV in New York City by year – for New York City – from 2016 to 2020. And you can see just looking at the height of those blue bars that each year, fewer New Yorkers have been diagnosed with HIV. Also importantly, the HIV diagnosis rate, which takes the number of new diagnoses out of the size of the population of New York City, has also decreased. That’s that number and line in the green. That has also decreased year over year. So important progress in terms of fewer people newly being affected with HIV.

However, despite this overall progress, we absolutely see persistent inequities in the ways in which HIV is distributed in the New York City population, particularly inequities by race and ethnicity. So this slide attempts to capture that and kind of put it into stark perspective for you, showing in red bars here the number of new diagnoses – the proportion, excuse me, of new diagnoses by race/ethnic group in New York City, and then the blue bars the proportion of that population in the New York City population overall. So, for example, for black New Yorkers, 47 percent of new HIV diagnoses in 2020 were among black New Yorkers compared to black New Yorkers just representing 22 percent of the New York City population.

Similarly you see the same disparity with Latino/Hispanic New Yorkers, whereby 34 percent of our diagnoses were in that community in 2020, and they represent only 29 percent of the population. So absolutely we see – and if I had the chance to show you the wealth of data that we have to describe our HIV epidemic in New York City, you would see persistent inequities by race/ethnicity in the ways in which HIV impacts the New York City population. Something we are very concerned with here at the health department.

Similarly I’m showing inequities in the distribution of HIV in New York City a different way. We look at our data tracking something called area-based poverty. It’s the percent of a New York City ZIP Code, of which we have about 200, the percent of each population in that ZIP Code that is living below the federal poverty level. And you can see here – and this is the rates of new HIV diagnoses by area-based poverty level, and you can see that persistently across this five-year period the highest rates of new HIV diagnoses were among people and ZIP Codes with the highest levels of poverty. So that’s that black line at the top, and then followed by the sort of second-highest level of poverty in the green line and onward. The lowest proportion or the lowest rates of new HIV diagnoses were experienced by the lowest-poverty-level areas. So again, inequities shown a different way here by poverty level.

Another thing we track in addition to new diagnoses of HIV in New York City and their distribution by demographic and other factors is outcomes for people living with HIV. It is critically important that people with HIV receive a diagnosis of HIV, that they receive linkage to care – to HIV care, that they initiate HIV treatment, and that they successfully are sustained on that treatment so that their virus can be controlled. And UNAIDS maintains these 90-90-90 targets for people living with HIV in a certain region or locality, and if you can look at the bars on the left of this graph, it shows New York City’s sort of scorecard, if you will, against the UNAIDS 90-90-90 goals in the year 2020. So looking at that cluster of three bars on the left of the graph, we can see that 93 percent of people with HIV in New York City were diagnosed; just 89 percent of people diagnosed with HIV were taking treatment; and then 93 percent of people diagnosed with HIV on treatment actually achieved viral control, which is important for their own health and for reducing onward transmission of HIV in the population.

So New York City as a whole missed one of those goals but achieved the other two. If we look at those goals then by race/ethnic group, which are the bars scanning to the right, you can see disparities immediately in the achievement of those 90-90-90 goals by race/ethnicity with people with HIV of color achieving them less so. So certainly, again, more work to do to ensure that all New Yorkers are receiving the benefits of the progress we’ve made toward improving HIV outcomes.

So with that in mind, I’ll talk about New York City’s 2020: Ending the HIV Epidemic Plan. In February of 2019, the U.S. Department of Health and Human Services announced a federal initiative to end the HIV epidemic in the United States, or EHE, and it really was a set of strategies sort of focused on the goal, the overarching goal, of reducing new HIV infections by 75 percent in five years and by 90 percent in 10 years.

And the strategies involve a number of pillars, or sort of strategies or key activities to achieve these goals, and they’re listed on the right there. They’re about diagnosing people with HIV; they’re about treating people with HIV; they’re about protecting people from acquiring HIV using biomedical or other interventions that can protect – that can prevent HIV infections; they’re about responding to HIV clusters to intervene and stop the growth of those clusters and serve the people involved in them. And then the sort of overarching goal here – underpinning goal – is to strengthen and invest in the HIV workforce.

This federal EHE initiative identified 48 counties, Washington, D.C., San Juan, Puerto Rico, and seven states that were identified as having a substantial rural burden of HIV to devote resources and technical expertise and assistance to, to really make overall progress in our national effort to end the HIV epidemic. And here in New York City, we have four of those 48 counties. So those include Bronx, Kings County or Brooklyn, New York County or Manhattan, and Queens.

So the mandate that came with this federal initiative was for regions and localities with EHE counties to develop a local jurisdictional plan to guide their activities toward ending the HIV epidemic. So we in New York City to do so held a – or led a nearly year-long community planning process to really ensure that we were hearing from and embedding the input and needs of communities affected by HIV in New York City in our plan. So the community planning process involved nine virtual listening sessions that invoked over 300 participants. We also administered an online survey, to which almost 620 participants responded. And we used this information gathered through this community engagement to develop a draft plan, which was then reviewed and further shaped by our two primary planning bodies: our HIV Health and Human Services Planning Council of New York and our New York City HIV Planning Group. So they provided feedback on drafts of the plan, and then finally in February of 2021, both groups provided concurrence on the plan.

In March of 2021, the next month, we released our New York City 2020: Ending HIV Epidemic Plan, or our 2020 EHE Plan. And this plan really builds on efforts in the state and city over the previous years to develop jurisdictional plans to guide and organize our HIV epidemic – ending the epidemic efforts. The plan, like the New York – sorry, like the federal plan – is organized around these key strategies to diagnose, treat, prevent, and respond to HIV. And importantly, the New York City plan, in recognizing the importance of upstream drivers of our ability to respond to HIV and improve outcomes, we included these two crosscutting issues – social and structural determinants of HIV-related health inequities and HIV service delivery system, with in mind that all activities and all strategies in our local plan make headway to improving these areas as well.

Our plan also named what we call priority populations, among whom HIV is disproportionately impactful and historically and currently has had very deleterious effects, and the idea being that our efforts and resources should focus on these priority populations in order to really address HIV holistically and successfully in New York City. So these priority populations are black men who have sex with men; Latino/Hispanic men who have sex with men; black women; Latina women; all people of trans experience and people who identify as gender nonconforming, gender non-binary or gender queer; people with HIV ages 50 and older, and then youth and young adults ages 13 to 29.

Efforts to implement this plan are currently underway in New York City and at the health department. Our team is reviewing the plan strategies and key activities to identify either ongoing or planned initiatives that are responsive to each one. And we are, importantly, evaluating gaps in the planned strategies and activities to prioritize new areas for development of initiatives or expansion of current initiatives that will fill those gaps. Implementation, just like development of the plan itself, will be informed by continuous and sort of ongoing opportunities to engage community partners, solicit their feedback, identify changing needs, and include their input so that the plan is fully response to their needs.

So in the next few slides, I’ll just talk a bit about some New York City Ending the HIV Epidemic programming and services that are underway in our jurisdiction. Pardon me while I just turn my – there we go. Light just went off.

So the first one I’ll talk – I’ll mention is our routine HIV testing in clinical settings. So in March of 2022, the health department launched a new routine HIV testing in clinical settings initiative. And this was really designed to implement and scale-up universal opt-out routine HIV testing in high volume healthcare settings. We know that the – despite a legal landscape that provides for this, we know that the routine offer – universal routine offer of an HIV test is not the reality. And so this really – this set of programming was really to drive that closer to reality.

We also aim to build capacity for sustainable models of universal opt-out routine HIV testing in these high-volume healthcare settings really through systems level change to support HIV testing as a matter of routine care. And ultimately, really the goal is to make the universal offer of HIV tests available to all New Yorkers who are accessing services in these settings, without just focusing on specific priority populations, to ensure that all HIV is being detected and that all people living with HIV are appropriately connected to services.

In – the next thing I’ll talk about is our PlaySure Network. In 2017, the health department launched something called the PlaySure Network which was a citywide network of HIV testing sites, community-based organizations, or CBOs, and clinics really working together as a collaborative to promote patient-specific approaches to sexual health and HIV prevention, to increase access to prevention modalities such as pre-exposure and post-exposure prophylaxis and to link people who test positive to HIV care. The PlaySure Network, in its first iteration, ran for five years from 2017 to 2022 earlier this year, and over 50 agencies participated. There were over 44,000 client enrollments at these sites throughout the first five years of the PlaySure Network, so a really impactful public partnership sort of at multiple levels of civic society here.

And in fact, the activities were designed to really bring services to priority populations, those most affected by HIV, and that did happen. More than 65 percent of clients that received services in the PlaySure Network identified as Latino or black – black, non-Latino, and 5 to 10 percent identified as folks who were unstably housed or homeless, which we know is a major driver of HIV acquisition and poor outcomes once diagnosed with HIV. So we provided appointment support, benefits navigation, linkage to services, really impactful. And 55 percent of people newly diagnosed with HIV through their connection with the PlaySure Network providers were linked to care or immediately started treatment. These are goals of ours.

So based on that successful first iteration of the PlaySure Network, we wanted to solicit input from community members and stakeholders and partners about that first iteration. We did so through listening sessions and a survey, and we heard that partners and stakeholders were emphasizing the importance of using a human-centered approach, focusing on strengthening health systems to make these quality care more routine and service availability more routine, the importance of focusing on equity, and really the importance of rooting the work in the principle that inequities in HIV incidents and HIV outcomes are really due to structural racism, sexism, homophobia, transphobia, other systems of oppression that really persist in the United States and in New York City and affect healthcare systems, including those that provide HIV prevention and care.

So we took that information, and we announced in August of 2021 the next phase of the PlaySure Network – what we call PlaySure Network 2.0 – with three goals: increasing access to and provision of a comprehensive health package of HIV prevention services that really uses this equity-focused, one-stop shop, holistic, client-centered model for priority populations; that increases provision of client-centered affirming, non-stigmatizing, and anti-discriminatory services, which we know are really sorely needed; and then ultimately decreases inequities in access to and utilization of these services by priority populations.

We are in the phase of implementing this PlaySure Network 2.0 in March of this year. We launched PSN – what we call it – PlaySure Network 2.0, and it is offering these – a range of services – universal testing, PrEP, and emergency PEP, immediate antiretroviral therapy, primary care related to HIV, STI testing and treatment, mental health services, substance use services, and as many sorts of wraparound services as we can. And we are continuing to really rely on the commitment and resilience of the providers that are part of this PlaySure Network 2.0 because they are the ones who are best positioned and best experienced in really engaging and meeting the needs of community members.

I’ll also just comment that the health department has engaged to I think great impact in a range of activities related to public health detailing. So this notion of public health detailing is bringing information, tools, connection to services to different providers and different spaces to promote essential, preventive, and health promotion. And so it’s really around sharing evidence-based practices with providers who are positioned to deliver them to communities in need. So we’ve done so around PrEP and PEP in the HIV space. We’ve done so as a health department around the importance of breastfeeding, smoking cessation and prevention of smoking uptake, on the HPV vaccine, and adult vaccination as well.

And so riffing on that and building on that, the health department in our sort of capacity as conveners and engagement with providers in the HIV space, we completed 59 site visits across 101 HIV primary care sites in New York City over a period of time. And we met with representatives at those sites and presented and shared resources in the HIV space to support their HIV service provision.

One of the things that emerged as an area of high need for support by these providers was resources and support to implement immediate initiation of antiretroviral therapy. This is something that has become standard of care in New York State and City in the last few years, and it really speaks to this idea of as soon as someone is diagnosed with HIV, initiating linkage to care so that they can initiate HIV treatment and really as a health and lifesaving intervention that we know is critically important for our individual health with HIV and critically important for reducing spread of HIV at the population level.

So in response to this area of need that was serviced through these visits, the health department did formative work to understand what was challenging to these providers around implementing immediate antiretroviral therapy, developed key messages, and then we launched a detailing campaign. It was in person at first, and then had to pivot to a virtual format in 2020, but it really promoted key messages around testing clients and offering HIV testing to detect HIV, initiating antiretroviral therapy as soon as possible after diagnosis, performing genotype resistance testing for HIV to understand potential – rare but potential resistance to HIV medications, and then building clinic workflows around supporting the implementation of immediate antiretroviral therapy.

Here are just some images of our immediate antiretroviral therapy public health detailing action kit. We make them approachable and interesting, and of course informative and resource-laden.

Another suite of activities I just wanted to mention is what we call our BE InTo Health Intervention, and it is a portfolio of work through which we are funding five agencies to adopt and implement evidence-based interventions. And these are HIV interventions that – behind which there’s an evidence base showing that they work. And so these are – these agencies are implementing an evidence-based intervention of their choice, focused on bringing that intervention to clients of our EHE priority populations. So this is a very – just an example of one of the ways in which we are really ensuring that our efforts and resources are being brought to the communities most in need.

Also wanted to mention some work, really important work in the harm reduction space. Our Re-Charge Program is a – what we call an HIV-status-neutral, so it serves people living with and people not living with HIV but potentially at risk for HIV, from a sort of sex-positive, non-judgmental, harm reduction perspective. It’s for men who have sex with men, and transgender people who have sex with men, who use crystal meth. We know this is a particularly vulnerable community with high personal vulnerability to acquiring HIV and then to poor outcomes after HIV acquisition.

So the program has many components, which are listed here, but the idea is really to bring a suite of services – including those directly related to but also ancillary to HIV itself – to ensure that this population is getting what it needs to stay healthy.

We also have something called the Undetectables Viral Suppression Program, Viral and Suppression Program. It is a program designed to really support and promote this concept of becoming undetectable with HIV or having HIV viral control through the use of medications. But most – first and foremost, it really promotes an anti-stigma approach to HIV care and treatment. So it’s a sort of health marketing platform with a toolkit that includes evidence-based interventions to support adherence to medication, client-centered care planning, directly observed therapy, and also financial incentives for clients who achieve viral suppression.

The program in New York City ran from 2017 to 2022 with seven agencies and then was rebid this past summer with nine agencies. And here is an image on the right side of the screen, a really fun, impactful, powerful image from this anti-stigma health marketing campaign.

Another thing that we’ve launched in 2022 was to fund – to award funding to two organizations to implement psycho-social support services for transgender, intersex, gender-noncomforming, and gender-nonbinary people with HIV. We know this is a particularly vulnerable group with multiple intersecting needs, and so this portfolio really seeks to support programs that can reach this population and offer them client-centered, trauma-informed, culturally appropriate services. So they range from supportive counseling, linkage to HIV care and treatment, referral to medical and supportive services including gender-affirming care, and then a range of education, prevention, and remediation programming to really address stigma and discrimination.

And I’ll just mention that we have a deep history and deep current practice around doing this work in the closest collaboration with community planning groups and advisory bodies. We know this is absolutely essential to the impact of our work and to how it’s received by the community, how it’s taken up by individuals, and just overall to its success. So we have a number of these community partners, including our HIV Planning Group, which helps to inform our HIV prevention activities, our HIV Health and Human Services Planning Council, which develops spending priorities and allocates Ryan White Part A resources to meet the needs of people living with HIV in New York City and our several surrounding counties which form our EMA.

The HPG, the HIV Planning Group, has a – and the Planning Council have a Joint Policy Committee which brings together members of those two planning bodies who are really committed to advancing efforts to end the HIV epidemic through strategic community-driven policy advocacy – a really important group that is informed of and responds to legislation and regulations and policies that affect our ability and the shape of our approach to addressing HIV in New York City.

We also have New York Knows, which is a partnership between the health department and community-based organizations, community health centers, hospitals, colleges, faith-based organizations, and businesses to promote and provide HIV testing to New Yorkers, identify people with HIV, link them to HIV care and services, connect people to HIV prevention services. And we in the last few years have expanded the focus of New York Knows to addressing other STIs and Hepatitis C as well.

We have our SHAG, or our Sexual Health Advisory Group, which brings together sexual health stakeholders from around New York City and it really – it works to advise, sort of go beyond just disease prevention to incorporate sexual health and wellness broadly in our work.

We have our Women’s Advisory Board, which is comprised of – it’s a diverse group of dedicated and passionate women leaders in New York City that have close connection with and experience working with and empowering their communities. And we work – that group really works to improve HIV prevention and care through sort of dialogue and action.

And then I’ll just end by sharing some exciting news that New York City recently received a 2022 Circle of Excellence Award. So in October at the 2022 Fast Track Cities Conference, the International Association of Providers of HIV Care, or IAPAC, in partnership with its Fast Track Cities Institute, awarded New York City a 2022 Circle of Excellence Award, really in recognition of our local efforts to end the HIV epidemic. There were other Circle of Excellence Award recipients this year, including Amsterdam, Johannesburg, Kingston, Lagos, and Quezon City. You can see here an image of these awards, including New York City’s, and our mayor was there to accept the award on the behalf of the city.

Also excitingly during the Fast Track Cities 2022 Conference, New York City signed on to the Sevilla Declaration. So this really builds on the Paris Declaration, which New York City signed onto in 2016, and the Sevilla Declaration commits to placing effective communities really at the center of urban responses to HIV, and it has 10 commitments to which we’ve signed on ranging from safeguarding the dignity and rights of communities affected by HIV to meeting UN goals for community-led HIV responses. So a really exciting both recognition of our work and commitment to deepening and expanding it going forward.

And I will stop there and look forward to the question-and-answer session soon.

MODERATOR: Thank you so much for that presentation, Dr. Braunstein. Next it’s my pleasure to welcome Krishna Stone, who is the Director of Community Relations at GMHC. Founded as Gay Men’s Health Crisis in 1982, GMHC is the world’s first HIV and AIDS service organization. Krishna has been involved with GMHC since 1986, originally as a walker in the first Annual AIDS Walk New York, later volunteering at GMHC, and since 1993 as a member of their staff. Krishna has received awards from the New York City Department of Health and Mental Hygiene amongst others for her outstanding dedication to combatting the spread of HIV, and in 2021 she was spotlighted by POZ Magazine as one of the top Black advocates who are making a difference in the fight against HIV and AIDS in the United States.

Welcome, Krishna. Thank you for sharing a little bit from the perspective of a community organization such as yours. The floor is yours.

MS STONE: Thank you, Ryan. Thank you, Sarah, for your presentation. And hello everyone, I thank you for the opportunity to talk briefly about GMHC which was, as you just heard, founded as Gay Men’s Health Crisis in 1982 and it is the world’s first HIV and AIDS service organization.

So I’m going to talk a little bit about how and why GMHC started and move through the 40 years as quickly as possible about how the programs and services expanded and working to meet the needs of the people who needed our services, and then also where we are now in terms of the parallels between HIV and AIDS, the HIV and AIDS epidemic, the COVID-19 pandemic, and the monkeypox also known as MPV outbreak, and how we are balancing all of the issues faced by the epidemic, pandemic, and the outbreak and parallel – parallel patterns that we have learned form the HIV and AIDS epidemic.

So if you google June 5th, 1981, most likely the CDC report, the morbidity and mortality report will come up, and in that report there is an article written by a number of physicians about their patients, all of whom were gay men, who were presenting with rare infections and ultimately dying very quickly. And that was the first government report even though prior to June 5th, 1981 one of our founders, Larry Mass, Dr. Larry Mass – he’s still alive and wonderful – he wrote an article for a newspaper called the New York Native, which has since closed, asking like what’s going on here, this is what I’m hearing.

And then in August 11th – on August 11th, 1981 – our six founders, all of whom were gay men, gathered in the late Larry Kramer’s living room. He died. He’s one of our founders and he died in May of 2020. And they brought their supporters there and they brought a doctor who basically was sharing what he was seeing. And as with many disasters, people do gather together to try to figure out what to do, and so between August 1981 and January 1982 this organization was founded. And also, as well as grassroots organizations, the programs and services developed based on who was coming through the doors, who was calling, what did people need. And the term “urgent care” meant something very different versus the urgent care centers that you see today.

So urgent care meant let’s get this person connected to care before they die. So we were trying our best to help, in the early years, people die with dignity. And as we – as I talk further, we were – with the advent of medications in the mid-’90s, we were helping people to live with dignity.

So one of the first programs was the hotline, and for some of you, you may be too young to know what an answering machine was, but a telephone was connected to an answering machine in one of our volunteers’ living room. He later became the first paid executive director. And it was basically a message on that machine saying: Please leave your name and number and we’ll call you back with whatever information that we have. And there wasn’t a lot of information in 1982.

Another signature program was the Buddy Program, which is still around, which is – consists of volunteers who then ultimately went through trainings to do this work, to visit our clients who were living and dying with AIDS during the early ’80s, and just to provide emotional support. Because what was happening was that our clients at that time were being disowned by family members and friends because there wasn’t enough information. And so the volunteers were able to step in and be supportive and connect them to lawyers if they needed to work on a will, or a therapist who could help them with the impact of the diagnosis of AIDS.

And I remember a really fabulous psychologist once saying that when people would hear their diagnosis, whether it was HIV or AIDS, it was like being given a sentence with post-traumatic stress disorder, and I never forgot that. And that still can be the case today when people are diagnosed with HIV.

So what we were also seeing as the programs began to develop, as funding started to trickle in, we were developing a legal department. We were having a meals program because people with AIDS were shunned in restaurants – they weren’t welcome – and setting up individual counseling sessions and support groups for people living with HIV and AIDS. And so the programs began to expand, again, based on the needs of the people coming through our doors. And so we moved in – a couple of times in the last 40 years as our programs began to expand.

One of the things that is – was very much connected in the early years of the epidemic, and tragically still is, is stigma, which for some folks – which is a word that people are like, “What does that mean?” One of the definitions that I think really says what stigma is, is a mark of disgrace. And so as long as people were and continue to be shamed about who they are and who they have sex with, the shame will continue and affect their health and well-being. And we still continue to see that in – and shame and stigma manifests in many ways. It creates barriers for people to access care, whether it’s HIV testing or care services or HIV prevention programming. So that is still an epidemic in its own right in terms of shame that’s connected to HIV and AIDS.

So in the mid-’90s – we’re moving to the mid-’90s now – we – that was the beginning – well, AZT came in at ’88, ’89, and then more medication started to be rolled out in the mid-’90s. So our clients began to live longer and they wanted to address more issues on a long-term basis versus a short-term basis.

So again, our programming expanded to include workforce development. People wanted – they started to feel better, so they wanted to go back to work or start work. They wanted to work on their relationships or their family challenges. And so the programming continued. And the populations that Sarah – Dr. Sarah – showed you mirror the clients that we serve, whether they are living with or affected by HIV and AIDS.

And so our programming around prevention expanded. Our community outreach continued to expand. You can’t just sit in an office building and expect people to come here. We have to go out into the communities. We have worked in coalition with the health department and our community member – community partner organizations and faith communities and corporations, and so you can’t do this work in isolation.

And so here we are. So we are now dealing with – so HIV and AIDS, COVID-19 pandemic, and the monkeypox/MPV outbreak.

So what’s happening is that people who are long-term survivors who are living with – who have been living with HIV and AIDS for 15, 20-plus years, 30-plus years, they are being retraumatized because they’re seeing people die of COVID-19, they’re seeing people – or with infections that connect to MPV, and they’re being shamed. Shamed for having COVID-19. Shamed for having monkeypox. So it’s triggering people who have been living with HIV and AIDS for a very long time and it’s causing increases in requests for counseling for mental health and substance use issues, and it’s a lot to balance. And it’s a lot to balance for those who are newly diagnosed with HIV of, like, how do I deal with all of these diseases and illnesses and all the health disparities that are connected to these – the epidemic, pandemic, and the outbreak. Sarah – Dr. Sarah mentioned some of them: homophobia, transphobia, poverty, racism, violence, immigration status, mental health and substance use issues, shame and discrimination.

So essentially what I’m trying to say – and then I’ll close – which is that HIV and AIDS today is a multilayered experience. It requires multilayered services and programs and different strategies. You can’t just talk to somebody in one way and say, well, that’s going to fix everything. Here’s a condom. No, it doesn’t work. And so prevention work is multilayered. Services – care services, public policy advocacy. And so it requires all of us trying to understand how this connects to the populations that we serve, and that’s how we’re going to continue to move forward in our work on a daily basis and also with our partnerships. So I’ll stop there. Thank you.

MODERATOR: Thank you for sharing your experiences with us, Krishna. And now it’s time for the Q&A portion of this event. If you’d like to ask a question, you can raise your digital hand to be called on, or you can type the question in the chat function and I will read it for you.

So I see that Alejandro Rincon from NTN24 has a question. Alejandro, please introduce yourself and ask your question.

QUESTION: Yeah, hello, everyone. I’m Alejandro Rincon with NTN24. We report for Latinos in the U.S. and also throughout Latin America. Thank you so much for conducting this briefing. It’s really important to our audience to get a little bit more of the insights.

I have two specific questions on – they’re follow-up – they’re follow-ups on what I’ve been hearing on your briefing. First of all, throughout the COVID-19 pandemic we have been discussing it so little how access to care, treatment, and overall services for HIV folks has become more difficult, and this is a pressing issue towards this community. So first I’d like to know if in 2022, as we are in a way getting better in controlling the COVID-19 pandemic, do you see any evidence in Latinos and communities of people of color – has it improved their access in any way or are we still lagging from the COVID-19 epidemic?

And then my second question would be related to the – it’s kind of on monkeypox and HIV situation. When we had the first outbreak of the monkey – of the monkeypox, there was a little debate on whether or not we learned the lessons from HIV and how the federal response was simply not up to par to what was expected, meaning we did not learn the lessons. So that said, how do you see overall are the things that we should be doing better? What would you like to see just to be better prepared for a new crisis, and how should we be dealing with this? So whoever wants to take that, I’ll be happy to hear.

MS STONE: Sarah, I defer to you on the first question. I can talk about our expansion of work in terms of community outreach for the monkeypox outbreak, and if there’s anything in between. Or – yeah.

MS BRAUNSTEIN: Sure. Well, go ahead, Krishna. You —

MS STONE: Which one? Which question?

MS BRAUNSTEIN: Oh, because you’re speaking to the second question, you want me to speak to the first?

MS STONE: I just through we would split it up. I mean, we —

MS BRAUNSTEIN: Yeah.

MS STONE: So, okay, I’ll say one thing about the first question – and these are great questions; thank you, Alejandro – and then one thing about the outbreak.

So what happened for us is that, at GMHC, we had to work remotely. We could not close. That was not an option. And we did continue to reach out to our clients by phone, by email, by the Zoom meetings that began. We did shift out to instead of having congregate meals on site to grocery bag distribution. What we did see and what we were very concerned about was that our testing center had to close and we mailed out at-home test kits, but we were concerned about the fact that people were still struggling to access medical care, HIV testing, and that we might see a rise in new infections a year or two years later. So we’re monitoring that along with our colleagues at the health department.

For the monkeypox outbreak, MPV outbreak – I hope they change it to an acronym because that word is crazy – that we had to expand our work to ensure that our clients living with and affected by HIV and AIDS who met the criteria for vaccines, we helped them to navigate what began as a very complicated system, and we advocated for improvements for the system in setting up appointments. We received a grant from the health department – yay – and we have expanded our community outreach in specific boroughs to alert people around vaccines and treatment and care, and we will continue to do social media posts, create discussions, and looking forward to a social media campaign that I’m working on. So that’s where we are – while balancing all the other health disparities that are brought on by the pandemic and epidemic.

MS BRAUNSTEIN: Yeah, and I’ll just quickly add, I mean, we – I would say we know and we are seeing even in our data a sort of rebounding of folks accessing HIV testing services, HIV care services, laboratory monitoring for HIV. The things that Krishna spoke about were really very much interrupted by COVID, especially in 2020, and even to some extent persistently through 2021. But we’re seeing at the sort of bird’s eye view here – at the population level, we are seeing and we know that our partners have reopened services and that the sort of telehealth services that a lot of organizations and institutions pivoted to are now being complemented by in-person services again.

So I think we are hopeful. I mean, I think we acknowledge that there are still challenges. There have always been challenges in accessing care and services. Those were exacerbated by COVID and there’s still work to be done to return them to where they were but improve them way beyond that.

And I will just say absolutely the health department’s – and with our community partners – response to the MPV outbreak 100 percent – I don’t know about 100 percent – to such a large degree relied on and drew and built on experiences from our decades of addressing HIV. The community partnerships that were already well-established in that space were critical to what the health department did during the MPV and is doing during the MPV outbreak. Our relationships with providers and our ability to convene providers and engage them and ensure they were getting access to MPV vaccination for their clients and patients, ensure they were getting access to tecovirimat for MPV treatment, we really – I just – the centering of equity with – in the health department’s response to MPV absolutely came from our, again, many lessons learned and very much an ongoing work to really center equity in our response to addressing HIV in the city. So, really critical, that HIV infrastructure.

MODERATOR: Thank you so much, Alejandro. While I look to see if we have additional questions – if we do have an additional question, please do raise your virtual hand or type in the chat box. But while I wait, I wonder briefly, how similar is New York City’s model of both public and nongovernmental support to other comparable U.S. cities? And can you talk a little bit about to what extent and how you collaborate with others around the country, either one of you?

MS BRAUNSTEIN: Should I jump in, Krishna?

MS STONE: Yeah, before you do, Dr. Sarah, I just wanted to mention that we did – when the MPV outbreak started, we did see that there were some similar patterns that occurred in the early years of the epidemic and COVID-19, which was, again, the one health disparity, which is racism. We were worried that vaccines were primarily going to white gay men. We understood that that was data that was being followed; however, we understood that – from GMHC’s perspective that we knew that the health department and – we had to work – we wanted to work with them to make sure that black and brown communities would receive the same equitable care and support and access to vaccines. So – because we’ve been doing this work for years, so – and we understood that the health inequities that were there then, many are here now, so – but our partnerships are key to decreasing or addressing the health disparities.

There you go, Sarah. Go for it.

MS BRAUNSTEIN: Sure. So I can address – in New York City we really have enjoyed and benefited from strong local support from local leaders, including our mayoral administration, city council. It actually, in 2015 the sort of predecessor to our current Ending the HIV Epidemic Plan was announced by Mayor Bill de Blasio at the time, was the New York City Plan to End the Epidemic, and this really was a multimillion-dollar investment to expand HIV and sexual health programming and services citywide, to push our ending-the-HIV-epidemic efforts farther and farther.

This – that certainly remains a priority of the current administration with Mayor Adams and our city council, who actually have provided over $56 million in local funding to support the health department in this current fiscal year, to support us, our administration of HIV and sexual health programming and services – in partnership with clinical institutions, CBOs across the city. So there’s a lot of engagement and ongoing engagement by local officials with the city health department and the HIV community on how they can support, through resources and otherwise, citywide efforts to end the epidemic. So, we are fortunate in New York City to have that support.

I think you also —

MS STONE: And sharing best practices —

MS BRAUNSTEIN: Or – go ahead.

MS STONE: Oh, I’m so sorry. I was just saying that sharing best practices on a local, state, and national level, and even global when we can or international level, is so important. What are you doing? How is this working? How can I be of help? We need to share that information and also the challenges, the successes. Otherwise, we don’t grow in our work. So I appreciate our coalition work.

MS BRAUNSTEIN: Yeah. I couldn’t agree more. I mean, we, at the health department, I will say that we sort of really rely on relationships and collaborations and coalition involvement to really support and enhance the work – I think certainly with our community partners here, but also – really also with other health departments around the country.

So for example, we are members in NASTAD or the National Association for State and Territorial AIDS Directors. We have membership in that organization, which really works to address HIV and viral hepatitis at the national level through working with other federal partners, through policy advocacy, through resource generation, et cetera. We are also – I was also just recently elected to the board of NASTAD, so it puts us in a better position – thanks, Krishna – in an even better position to collaborate with other jurisdictions who are represented on the board. And it really is – it’s that. It’s that sharing of best practices, lessons learned, common struggles, problem solving toward those common struggles. So I personally – and I think just we professionally – really do rely and benefit from lots of collaborations at those multiple levels that Krishna described.

MODERATOR: Well, thank you. I see that we’re coming up on our hour mark, and so I did want to give a final opportunity for any additional questions, if there are any. And if not, I’d like to thank both of our briefers for generously sharing their expertise and time with us, and to everyone who joined us today.

As a reminder, a transcript of this briefing will be shared later and available on our website. I’d also like to preview an anticipated Washington Foreign Press Center briefing on December 1st with the U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy Dr. John Nkengasong.

The following day, December 2nd, Secretary of State Antony Blinken will speak along with Ambassador Nkengasong and representatives of the Elizabeth Glaser Pediatric AIDS Foundation at a reception in Washington honoring Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the NIH. A link to further information on registering for that event is in the chat, and portions will be streamed – portions of that event will be streamed that day on state.gov.

This concludes today’s briefing. I want to give special thanks to Dr. Sarah Braunstein and to Krishna Stone for joining us today, and for those of you who participated. Have a good day. Goodbye.

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