Some of the barriers to HIV prevention and care are historical. But the obstacles go beyond history.
“Many of the current barriers to treatment and prevention are purely structural, such as the lack of sufficient HIV centers of excellence in Black and Hispanic neighborhoods,” said Doug Wirth, CEO of Amida Care, a health care plan for individuals. with special needs in Midtown. people living with HIV.
The ability to access testing, pre-exposure prophylaxis and treatment is driven by a situation not unique to HIV, but rather driven by the social determinants of health problems, and the state has recognized this, said Joanna Morne, director of the AIDS Institute.
Even if referred for treatment, Morne says patients with social determinants of health need support such as transportation, stable housing and food so they can work and receive treatment.
Ofole Mgbako, director of infectious diseases at NYC Health + Hospitals/Bellevue, said stigma can also lead patients of color to seek care from providers outside their area, and lack of access can also prevent access to care. “Black and Hispanic communities tend to face these barriers more seriously than other ethnic groups,” he added.
This year, the State Department of Health and the AIDS Institute are prioritizing funding for initiatives to close these HIV disparities, such as programs for the elderly and people born with the disease, and labor partnerships to ensure a living wage, access to food and nutrition, and housing support.
Governor Kathy Hochul in November reaffirmed the state’s commitment to achieving the goals set out in the End the Epidemic Initiative by 2024. Since its inception in 2015, the state has committed $20 million to the initiative. In his speech at the Sixth Annual End Epidemic Summit, Hochul acknowledged that communities of color and people of lower socioeconomic status are overrepresented due to the risk of contracting HIV.
“These facts point to the persistence of structural and other forms of racism and inequality as important contributors to disparate health outcomes despite overall progress,” she said.
In addition to initiatives to address the social determinants of health, Hochul and the state can make structural changes to make HIV care more accessible, Wirth said.
“For far too long under the previous administration, Medicaid has been undermined,” Wirth said, referring to former Gov. Andrew Cuomo, who proposed cutting Medicaid reimbursement rates by 1.5% across the board in fiscal 2021. 2023 will restore those cuts.
“You can’t fight racism in healthcare without investing in Medicaid,” Wirth said, adding that communities of color most likely need government support.
The reinvestment in Medicaid benefits community health centers that provide a full range of services that address the social determinants of health, not just HIV, Mgbako said.
Currently, providers contracting Medicaid for the lowest level of value-based care do not have to consider the social determinants of patients’ medical needs. The state health department, however, may require providers to address social determinants of health even with a Tier 1 contract as it reviews its Medicaid waiver program.
“The Cuomo administration ignored many of the recommendations made by us and others in the industry,” Wirth said. “I’m extremely encouraged that Hochul understands that Medicaid is the primary vehicle for addressing health inequities, especially around HIV.”
At the city level, a renewed focus on health equity is promising. Mgbako said the City Health Department’s appointment of Dr. Michelle Morse as its first chief medical officer, who will also head the agency’s Center for Health Equity and Community Welfare, means initiatives to improve HIV disparities among communities of color are on the way.
The road ahead will be rocky COVID continues to threaten progress. In 2020, the number of HIV tests has declined, and the use of pre-exposure prophylaxis medications and the number of people who achieve viral suppression have declined, according to Tesoriero of the AIDS Institute.
“It will get a little worse before we can get to where we need to be,” he said.