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March 30, 2005
HW Releases NYC Commission on AIDS Draft Report To Engage Community In Dialogue
On February 28, Commissioner Frieden distributed the draft report of the NYC Commission on AIDS, "Recommendations for Making NYC a National and Global Model for HIV/AIDS Prevention, Treatment and Care" for review and comment in advance of the full Commission meeting. Sources say there was heated discussion at the Commission meeting with a number of commissioners objecting to the process and secrecy.
Secret processes are not the way to do community health planning. Housing Works is releasing a copy of this draft report to engage the larger HIV/AIDS community in dialogue about the appropriate response to this continuing epidemic.
You can download the 35-page report in a retyped, searchable version here, and the original (a 2MB file) that includes Frieden's cover letter here.
The report offers 17 specific recommendations, with an emphasis on social marketing and big changes in the City's approach to testing and case management. To justify controversial changes to Local Law 49 and public benefits case management, the report focuses heavily on what's wrong with the system today. After the introduction, under the heading "Where We Are Failing", the report goes into the problems it sees, under headings like "The case management system in NYC is fragmented and ineffective." After making its bleak case, the report then itemizes and supports its recommendations. The article following this one goes into detail about our reactions to a number of the issues raised in the report. Several key items are:
- an overhaul of the current case management system and the adoption of a single, "primary case manager" for each client to manage "all aspects" of client needs -- this is an unworkable proposal that lumps together psycho-social, medical, and public benefits assistance and then suggests that all can and should be performed by one individual.
- elimination, effectively, of the intensive case management approach under which HASA has functioned since 1985; in particular, eliminating the low case-manager-to-client ratios mandated by Local Law 49, to give the agency greater "flexibility" -- the only "flexibility" such a move would provide would be the flexibility to abandon the intensive case management and specialized assistance that has been the hallmark of HASA for twenty years; eliminating this protection would not only eviscerate Local Law 49, but would be an act of contempt under Henrietta D. v. Giuliani, and thus illegal.
- an increase in housing opportunities for persons living with AIDS, a centralized database for New York City housing programs, and (implicitly) an end to warehousing homeless HASA clients in SROs -- these are urgently-needed measures PLWAs and their advocates have been fighting for, but the report fails to acknowledge the importance of housing in prevention, fails to call for an extension of housing support to all HIV+ persons, and never draws upon the detailed findings and recommendations from that DOHMH/HOPWA-funded HIV/AIDS Housing Needs Assessment report.
- normalize HIV testing, making it a routine part of medical care, rather than offering it only based on risk factors -- we agree that HIV testing, and specifically rapid HIV testing, should become a standard part of medical care, but increasing the number of venues where individuals can be tested won't somehow increase access to quality medical care, treatment and prevention services for those most at risk, and those most at risk often don't see the benefits of testing until they become ill; their lack of access to and mistrust of the health care system lead them to assume they're better off not knowing, while restricting access to tangible benefits to those with advanced disease reinforces this apathy.
- expand culturally relevant, evidence-based social marketing, make condoms "much more widely available", and improve HIV/AIDS health education in schools -- we agree wholeheartedly with the report's prevention recommendations; for prevention to be effective, it must be not only culturally appropriate, but also sex-positive and affirming of drug users.
For much more detail on this issues and analysis of other items in the report, see the following analysis article.