The problem that now confronts the public health structures of New York City and State is that both have not paid for their major community AIDS prevention programs since July. Repeat: the city and state with the most HIV/AIDS cases in the nation simply stopped paying for the community-based AIDS prevention highly localized to the communities most at risk. For an epidemic whose victims are now 88% Black and Hispanic, and largely located in the ungentrified stretches of the Bronx and Brooklyn, these governments can't be bothered to undertake routine---and proven---prevention.
But, even strapped for cash, they will pay for a lot of other things; while it wasn't paying its AIDS prevention programs, for instance, the city just went on painting mostly unused bike lanes, keeping up free ferry rides and gratis activities for months of sophisticated summer pleasure at Governors Island, and escalating its miserable program of 500,000 police stops and frisks a year, at a cost of millions almost beyond calculating.
Because the problem of AIDS is so huge in New York, we tend to forget how far we have come. The infection of newborn babies in New York has been reduced almost to zero---in no small part because community-based programs constantly do outreach to place pregnant women with AIDS in the proper treatment to prevent their babies from being infected. The rate of HIV infection among drug users has been slashed from 50% a decade ago to 20% now---in no small part because of the needle exchange programs both the city and state were supporting. And when the mostly male drug-injecting population doesn't contract HIV, neither do their wives or partners or infants.
Along with the reduced male HIV infection, AIDS education with women has had such great impact that the number of new women's HIV infections declined 16% in just the past two years.
Since the Bronx and Brooklyn have the highest women's HIV infection rates---and risk---withholding prevention in the "outer boroughs" has an especially bad impact on women. This withholding of outer borough prevention comes on top of a heinous shift in AIDS care and services which has already increased women's deaths as a portion of all HIV/AIDS deaths. In 2006, the New York City Health Department shifted funding for the $110 million in special AIDS clinical care and support services funding that it receives from the federal government every year; the city selectively collapsed more than 30 care and support programs in the Bronx and Brooklyn which had been run with this federal funding and then put most support services, self-care education and similar help at large agencies in Manhattan. Next, it shifted most medical care to large hospitals. The result has been that the portion of women's deaths has risen every year since 2006; women now constitute 33.3% of deaths of New York City residents with AIDS, but 29.5% of cases. Before the city denuded poor areas of the Bronx and Brooklyn of easily accessible AIDS care, women's percentage of cases and percentage of deaths were the same.
Yes, that's correct. In a city which is a liberal icon, a city where immigrant rights and gay marriage are key causes for the political elite, the Department of Health's "redistribution" of federally funded AIDS services increased the portion of AIDS deaths of black and brown women.
But in a city which already has 107,000 residents with HIV, halting any progress is impermissible. Where there is substantial cause for hope, the city and state are willing to revive the horror of an unchecked epidemic. The many community groups who do the outreach and prevention that have brought so much progress have tried to keep going, do their work, get "bridge" loans, cut staff hours--- but at least continue some prevention despite the fiscal strangulation of having state and city contracts that aren't paid. But, after almost six months without payment, they are nearing collapse. This collapse will take away not just prevention now, but all the skill and tactics and able people---most from low-income communities, themselves---who built the state and city's ability to have successful prevention.
Have we heard from City Health Commissioner Thomas Farley about trying to protect AIDS prevention programs? No. What is particularly strange about the city's complete lack of payment is that almost half of the city's community AIDS prevention costs are paid for by the federal government. What has the Health Department done with those millions in federal dollars which are specifically assigned to these community grants?
What about City Council Speaker Christine Quinn, who's supposed to really, really care because her Chelsea district does really suffer from AIDS? We haven't heard from her. There are just other things to do. She has to focus on joining with the Health Commissioner and Mayor Bloomberg to push through new legislation making sure no one takes a puff of smoke in a park. And the Mayor has lots of other things to do, himself. Why only last week, he held a major news conference with the Rockefeller Foundation to announce a wonderful new philanthropic initiative---draping the city's construction sites with "artistic" canvases instead of the blank mesh that suffices now.
Although is no excuse for letting AIDS prevention collapse, the state is now so poorly administered that anything can happen. The same is not true for the city. We live in a city where little or nothing happens by accident. If the Bloomberg Administration wants it done, it is; and if they don't, it isn't. This should leave us to ponder most seriously the message being sent when, ostensibly because of cash flow, AIDS prevention goes first.
Note: The author has administered well-evaluated AIDS Prevention programs in New York City for 19 years.