As New York observed the 22nd annual World AIDS Day, hundreds of advocates turned out at Gracie Mansion to hear Mayor Michael R. Bloomberg and his new health commissioner, Dr. Thomas A. Farley, present a guardedly optimistic assessment of progress in battling the epidemic.
Meanwhile outside, several dozen other activists gathered in protest, ten of them arrested after trying to chain themselves to the mansion’s front gate, as the demonstrators called attention to ways the city is falling short in providing support to low-income New Yorkers living with HIV.
The mayor opened the December 1 breakfast by noting statistics that few in the room were not already painfully aware of –– AIDS has claimed the lives of 25 million people, including 97,000 in New York City, while more than 100,000 here and 33 million worldwide are living with the disease today.
But Bloomberg was quick to remind the audience of metrics he has noted on numerous other occasions –– the massive number of condoms the city has distributed, the opening of new syringe exchange programs that have had remarkable success in reducing HIV transmission, the doubling in the number of supportive housing units for those living with AIDS, and the decline by more than a third in annual deaths from AIDS in the past seven years.
The mayor declared that “the vast majority” of New Yorkers living with HIV survive at least a decade beyond their initial diagnosis, many of them leading “healthy and active lives.”
Bloomberg, however, was more forthcoming than usual in acknowledging one critical measure by which city efforts have failed –– new infections, he said, “among gay men under 30 continue to rise.” The mayor suggested that many young men, not having lived through the experience of seeing their friends die in large numbers, were complacent about risk, particularly in light of therapeutic advances over the past dozen years, but said, of the prospect of facing lifelong AIDS medications, “You don’t want to do this.”
In a speech in early 2003, Bloomberg pledged to cut the rate of infections in half over the next several years –– a goal that is far from reality six years later.
Introducing Farley, who came to the city earlier this year from his post as head of Tulane University’s Department of Community Health Sciences and Prevention Research Center, Bloomberg said that when his highly touted predecessor, Dr. Thomas R. Frieden, told him he planned to leave to head up the federal Centers for Disease Control and Prevention, the mayor told him he could only go if Frieden first “found someone who was better than him.”
Like Bloomberg, Farley mixed warnings in with some positive highlights in the city’s record. From a rate of new infections of 13,000 annually during the 1980s, New York has cut its transmission rate by 75 percent to less than 4,000. Transmission of HIV from an infected mother to a fetus she is carrying has been reduced by 98 percent, with the use of prenatal antiretroviral treatment. Transmission through injection drug use has declined by 94 percent, from a level of 2,600 new infections in 1993.
But the transmission rate among men who have sex with men has remained resistant to reduction, with increases seen in recent years among the youngest gay and bisexual men, as the mayor noted. When the city was first able to measure which infections occurred within the previous year, 58 of the original 70 they identified, or 80 percent, were among men who have sex with men.
“In some ways, this epidemic is reverting to its roots,” Farley said. “That is something we particularly need to prevent.”
Disparities also exist along racial lines. African-American New Yorkers have infection rates four times that of whites.
Until a vaccine is found, Farley said, prevention needs to focus on four key elements. More people need to be tested. Among those who test positive, “we need to make sure that they reduce their risky sexual behavior,” he said. Farley termed that “prevention for positives,” an idea that in the past has antagonized some, but is in line with the mayor’s insistence that “it’s not about being politically correct, it’s about saving lives.”
The health commissioner also said that condoms need to be made “routine and expected,” adding, “We need to be open about promoting condoms in all populations.”
And, arguing, “We know that condom use will never be 100 percent,” Farley raised perhaps the most unpalatable component of his message: “We need to focus on partner reduction.”
Clearly, if New Yorkers are having less sex, there will be less HIV transmission; whether sexually active young people will agree to use condoms consistently and to reduce their number of partners is another question.
While many of the city’s leading AIDS service providers listened with respectful interest and at times enthusiasm to presentations by the mayor and health commissioner, advocates affiliated with the New York City AIDS Housing Coalition (NYCAHN) and Housing Works staged both a picket and civil disobedience to voice their impatience with what they view as critical failures in city policy.
The key issue they focused on was the mayor’s resistance to a measure pending in Albany that would cap the rents for roughly 11,000 low-income New Yorkers living with AIDS and receiving public housing assistance to 30 percent of their monthly income. That is the standard for other rental assistance programs in the city and the requirement under federal housing subsidy programs, but current state guidelines allow New Yorkers receiving housing assistance from the city’s HIV/ AIDS Services Administration to keep only $330 above what their rent is pegged at — or a mere $11 a day to cover other expenses.
The rent cap measure passed the Senate in July by a lopsided margin after an impassioned late night floor speech by Thomas K. Duane, the out gay Chelsea Democrat who is the only openly HIV-positive legislator in Albany. The bill is stalled in the Assembly, and the Bloomberg administration has circulated an analysis, which advocates dispute, showing that it would impose a severe fiscal burden on the city.
NYCAHN highlighted their differences with the mayor with a picket along East End Avenue in front of Gracie Mansion.
Ten activists affiliated with Housing Works, including its president, Charles King, approached the gate immediately outside the mansion just moments before the 8 a.m. start of the breakfast, with several attempting to chain themselves there. Police immediately stepped in and began removing the activists, who let their bodies go limp as they were carried into a van that quickly arrived.
According to Housing Works, the ten were charged with disorderly conduct and disrupting government affairs, and were being held in jail overnight.