Ending AIDS in New York Means Finding the Most Vulnerable

Gwen Ifill: Next, we continue our series, “The End of AIDS?” Tonight, we go to New York state, where health care providers are trying innovative approaches to bring HIV infection under control. While pushing widespread use of the HIV prevention drug Truvada, they are also trying to expand care to the state’s hardest-to-reach populations. Correspondent William Brangham and producer Jason Kane continue their reporting, which is supported by the Pulitzer Center on Crisis Reporting.

William Brangham: This might not look like a breeding ground for HIV, and Tina Wolf might not look like a typical health worker. But she is. Her windblown drives across Long Island, New York, are part of a statewide effort to get out of clinics and medical centers to find hard-to-reach people. Wolf recently started a needle exchange program for injection drug users. Sharing infected needles is one of the most efficient ways to spread HIV. So, each day, she and a small staff pack up hundreds of clean syringes.

Tina Wolf, Community Action for Social Justice: I brought 200, so we need another 200 29-gauge half-CCs.

William Brangham: They load them into her hatchback, and head out. New York, like so many states, has a growing heroin problem. Wolf wants to stop HIV from piggybacking onto that crisis.

Tina Wolf: It could very well turn into a new HIV epidemic if we don’t get ahead of it in terms of syringe exchange right now.

William Brangham: In middle-class neighborhoods throughout the island, Wolf goes to meet her clients.

Jen: Hi.

Tina Wolf: Hey, how are you?

Jen: Good. How are you?

William Brangham: Today, she meets with this woman. A woman who prefers to be known only as Jen.

Jen: It’s perfect timing, because I ran out two days ago.

William Brangham: Most needle exchanges would require Jen to come to them, but Wolf makes house calls. Before these deliveries, Jen says she and her boyfriend would reuse needles until they became dull as butter knives. And even though Jen knows lots of people with HIV, she’s shared needles in the past.

Jen: You’re not going to say, “Oh, I’m going to wait until I get a new one.” You’re going to wait until the person who’s in the car with you is done. Maybe you will rinse it out with the bottle of water in the car, and you get high, and you don’t think about it.

William Brangham: That needle-sharing is what public health officials say drove the recent HIV outbreak in Austin, Indiana, which prompted a state of emergency there.

Jen: I have done things that other people have done, and they have ended up with all different diseases. So, I feel like, with Tina, I can avoid all that now.

Gov. Andrew Cuomo (D), New York: We will not stop until we add AIDS to the list of conquered killers!

William Brangham: Last year, New York Governor Andrew Cuomo pledged $200 million to ramp up efforts statewide to end the AIDS epidemic here by 2020. Their aim is to cut the rate of new HIV infections below the rate of HIV-related deaths. But New York, one of the states hardest-hit by the epidemic over the years, still has enormous challenges. Nearly one in 10 people with HIV in America lives here. That’s an estimated 154,000 HIV-positive New Yorkers. Approximately 3,000 people are diagnosed statewide every year. And, here, minorities bear the brunt of the infections. An estimated 70 percent of new cases are among blacks and Latinos. Jon Cohen has been covering HIV/AIDS for more than 25 years for “Science” magazine, and helped us report this series. He says New York’s plan is bold, but the state has a tremendous challenge ahead.

Jon Cohen, “Science” Magazine: New York has so many infected people that it has problems of scale when trying to end an epidemic. It buys more drug than anywhere else to treat HIV-infected people. It has to track, monitor more HIV-infected people. It has to address the failures that are far larger than anywhere else in a way that’s just more overwhelming than any other jurisdiction in the country faces.

William Brangham: Step one for public health workers is finding those who are infected and don’t know it. They’re the most likely drivers of new HIV cases.

Robert Gamboa: I love this outreach here.

William Brangham: An estimated 22,000 New Yorkers fit that bill. So, how do you identify them?

Jose Velez: So, what we would want to do is look for like hiding spots right now.

William Brangham: Here in Harlem, sometimes, that looks like an adult version of hide-and-seek.

Jose Velez: So, usually, like, you will see them standing up there, like along the railing.

William Brangham: Robert Gamboa and Jose Velez work for the Harlem Prevention Center. It’s part of an organization called ICAP out of Columbia University. Their job is reaching out to gay and bisexual men, encouraging HIV prevention, and inviting them to join the center’s research.

Jose Velez: Behind the tree over here, that’s clearly out of view.

Robert Gamboa: Hmm. Oh.

William Brangham: They target well-known cruising spots where men often have sex. Gamboa sees a couple having oral sex behind a tree, and he doesn’t hesitate.

Robert Gamboa: What up, man? I work with Harlem Prevention Center. We do research studies.

William Brangham: Each new HIV infection that’s prevented saves almost half-a-million dollars in lifetime treatment costs.

Dr. Wafaa El-Sadr, Director, ICAP: It would be very interesting to think of what we can do…

William Brangham: Dr. Wafaa El-Sadr oversees ICAP, which also supports global HIV prevention and treatment programs. She says testing as many people as possible, and treating them as quickly as possible, is one of the best tools for ending the epidemic.

Dr. Wafaa El-Sadr: Getting those individuals into care, on treatment, for their own benefit, as well as, of course, to prevent transmission from them to others, that’s something that we have to tackle. And that’s usually individuals who are disenfranchised, afraid, in denial, stigmatized. So it’s a hard-to-reach population that we must reach.

William Brangham: New York has also pioneered other data-driven ways to find people in need of HIV care. Using Medicaid information, the state works in tandem with specialized insurance companies like Amida Care to identify patients who’ve stopped having tests or stopped refilling prescriptions for their HIV meds.Outreach workers then try to get them back into treatment. Right now in New York, Medicaid covers half the HIV-positive people in the state, so keeping those people in care is crucial. One estimate said nearly $4 billion could be saved in New York by successfully caring for this slice of the population. So Amida Care’s staff try the phone first.

Man: No, she didn’t answer.

Man: OK.

William Brangham: If that doesn’t work, they will often head out into the city to go knock on doors, anything they can do to get people back on track. Breaking down the barriers that keep people from consistent HIV care is the next step. A few years ago, that was the issue for Joe Pannell. He’s HIV-positive, and he was given antiretroviral medications. But he was homeless then and addicted to crack and alcohol, so staying on those meds was pretty low on the list of priorities.

Joe Pannell: I would go to the doctor and he’d give me medication, and I would sell it. I didn’t take it. Finally, one of the doctors told me, he said, “That’s suicidal.” He said, “Everything you’re doing, it sounds like to me like you’re trying to kill yourself.”

William Brangham: But that all changed when he got a roof over his head. New York says this is their—quote—“greatest unmet need,” helping the estimated 10,000 to 12,000 HIV-positive New Yorkers who need housing assistance. Joe Pannell now lives in an apartment complex run by Housing Works, and not only do they provide a home, but residents here can also get their HIV treatment in the same building.

Charles King, CEO, Housing Works: Part of the idea of developing this type of facility was that a person living upstairs, the way I like to say it is, they can crawl out of bed and they will fall into the program.

William Brangham: Charles King started Housing Works. They provide 241 units for low-income HIV-positive people in New York. King was also instrumental in the creation of New York’s broader HIV plan. He says homelessness is a clear risk factor for acquiring HIV.

Charles King: It doesn’t matter what risk category you fall into, if you’re a gay man, man who has sex with men, transgender person, sex worker. Homelessness magnifies the vulnerabilities that are going to expose you to HIV.

William Brangham: Like the majority of HIV-positive residents in Housing Works, Pannell is now taking his antiretroviral drugs regularly. The virus is now undetectable in his blood. His life is back on track, he says. Long-lost family members are reaching out to him again.

Joe Pannell: Since I came here, all of these things reoccurred in my life. My daughter called me one night, and said, “Hi, Daddy.” I could not believe it.

William Brangham: Over the last 10 years, New York has been successfully bending its HIV/AIDS curve, reducing new infections by 40 percent and reducing the number of HIV-related deaths by even more. Whether these are enough to break the back of the epidemic remains to be seen.

Dr. Wafaa El-Sadr: I think we can do it. I think it can be done. I’m not saying we’re going to go to zero, but I think we can decrease the numbers substantially.

William Brangham: Public health advocates say that, absent a vaccine or a cure, the challenge ahead is maintaining, and intensifying, these efforts. They argue ending AIDS in New York means prevention has to be dialed up and more people brought into care.The state needs increased housing for the most vulnerable and sustained lifetime treatment for tens of thousands of people for many years to come. For the “PBS NewsHour,” I’m William Brangham in New York.

Gwen Ifill: Tomorrow night, our series on “The End of AIDS?” turns from the epidemic here to the one in sub-Saharan Africa, and specifically to Rwanda, a nation that’s recovered from a genocide, and has now achieved impressive results tackling HIV. Here’s a preview.

William Brangham: At this hospital in a remote northern area of Rwanda, a small medical miracle is unfolding. This district, still in the grips of an HIV epidemic, has not recorded a single case of mother-to-child HIV transmission for three years. Similar progress has been happening throughout Rwanda, outpacing many other places in the world, even many in the U.S.

Gwen Ifill: That’s tomorrow right here on the “NewsHour.”