May 24, 2005
NYCityWatch: THE SECOND TIME AROUND
You may remember that in AIDS Issues Update's March 30 issue, Housing Works did something mischievous: It published a confidential draft version of a report by the New York City Commission on HIV/AIDS with its "Recommendations for Making New York City a National and Global Model for HIV/AIDS Prevention, Treatment and Care." (To access the draft report, plus Housing Works' commentary on it, click here for our March 30 issue.). We took our licks for going public with this "classified" version of the report, but it was our way of protesting the behind-closed-doors manner in which the report was hashed out and produced by the commission, which includes a roster of A-list names like health commish Dr. Tom Frieden, Aaron Diamond's Dr. David Ho, amfAR's Mathilde Krim and GMHC's Ana Oliveira. Housing Works commended some of the report's recommendations but warned that it also "overlooks huge gaps in the system of care, assuring perpetuation of the epidemic."
Yesterday, the commission finally released the draft of the report it actually intends for public comment beginning today through Monday, June 13. (Comments can be e-mailed to the commission at comments@health.nyc.gov). The bulk of the public report is much the same as the confidential one we released in late March, even if the former's blunt assertions that the city had "failed" on many accounts has been softened with such language as "future challenges we face." Also, in many instances, recommendations in the original draft that drew sharp criticism in the community have been recategorized as "areas requiring additional study"—or the language of the recommendations has been mellowed.
Section by section, compared to Housing Works' critique of the classified March draft, this public version stacks up like so:
PREVENTION
Unlike the March report, this one includes an excellent write-up on the expansion of harm reduction services, with clear-cut recommendations to encourage the New York State legislature to make permanent Expanded Syringe Access Program (ESAP) legislation and to expand and/or establish syringe exchange programs (SEPs) at HHC facilities, Article 28 (licensed medical) facilities and CBOs. The report also urges that law enforcement personnel stop arresting citizens for syringe possession and recommends that law-enforcement training programs incorporate the proper treatment of participants in ESAP and SEP programs.
However, the new report issues no call to lift the federal ban on syringe exchange, nor does it challenge New York State to expand and simplify its SEP waiver process so that more CBOs and Article 28 facilities can petition to become SEPs.
DRUG TREATMENT
On the plus side, the new report moves this issue from the Treatment, Care and Coordination category to that of Prevention. It also urges drug-treatment programs to add a harm-reduction approach to their total-abstinence model (one of Housing Works' direct recommendations!). And it clearly recommends increasing the number of patients receiving buprenorphine by increasing the number of doctors licensed to prescribe it.
REDUCING STIGMA
On the plus side, the new report removes this issue from a sub-set of Testing and lets it stand alone, both in the introduction and as a recommendation under Prevention. But disturbingly, transgenders are not once mentioned, not among the usual "clump" of HIV high-risk groups, nor in the Prevention section under groups that should be targeted with social marketing.
TESTING
On the plus side, this section is now titled Testing and Linkage to Care. Also, the former direct recommendation for the city to "advocate for revising the current state laws and regulations [i.e. Article 27F] has now been moved to Areas Requiring Additional Study, with new language seeking "possible legislative changes to facilitate normalization of testing and counseling to make it a regular part of medical care." Note: since the March report, New York State has since proposed streamlined regulations for HIV testing and counseling.
The rest of Housing Works' previous commentary on this section still stands for this version of the report.
TREATMENT, CARE & COORDINATION
The original recommendations, and our original commentary, stands—although the new report has reclassified its original proposal for the privatization of case management to an Area for Further Study.
HOUSING
Again, the original recommendations, and our commentary, remain the same. Unlike the March report, however, this one briefly mentions the DOHMH/HOPWA-funded AIDS Housing Needs Assessment report (which detailed the gap between what the city needs to do for AIDS housing and what it is actually doing). But it doesn't detail any of the report's recommendations.