1. The State of HIV/AIDS National Conference for LGBT Center Executive Directors and Board Members

2. National HIV/AIDS Strategy (NHAS) In July 2010, the White House released NHAS, a comprehensive roadmap for reducing the impact of HIV. The Strategy sets clear priorities and targets for HIV prevention and care in the United States, and calls on government agencies and their public and private partners to align efforts toward a common purpose. NHAS lays out clear priorities for increasing the impact of HIV prevention efforts: Intensify HIV prevention in the communities where HIV is most heavily concentrated Expand targeted use of effective combinations of evidence-based HIV prevention approaches Educate all Americans about the threat of HIV and how to prevent it NHAS Vision The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.

3. Estimated New HIV Infections: 2007-2010 A declining trend in NY versus a stable trend in US 04/03/2013 NYSDOH AI BHAE NYS Incidence EstimatesUS Incidence EstimatesNYS as a % of US Inc. Estimate 20075,30053,20010.0% 20084,56047,5009.6% 20094,16045,0009.2% 20103,40047,5007.2% -Between 2007 and 2010, the estimated new HIV infections for NYS decreased by 36%, compared to a relatively stable trend for US. - In 2007, 10% of the estimated US new HIV infections were in NYS; by 2010, the percentage decreased to 7.2%, indicating NYS had achieved a better than average reduction in new HIV infections.

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6. Cascade of HIV Care New York State, 2011 6 * Any VL or CD4 test during the year ** At least 2 tests, at least 3 months apart 85% of infected 55% of infected 65% of PLWDHI 48% of infected 57% of PLWDHI 39% of infected 46% of PLWDHI 71% of cases w/any care

8. Achieving viral suppression As many as 23,000 New Yorkers are not aware that they are living with HIV and thus potentially damaging their own health as well as risking transmission of HIV to others. A key approach to preventing more infections is to identify people living with HIV as soon as possible and link them to care. Early initiation of antiretroviral medication is recommended and reduces through viral suppression the chances that HIV- positive persons will infect others. Action: Expand efforts to facilitate linkage and retention in HIV care to those who have not entered care or are no longer retained in care. Institute quality of care methods to identify and remove barriers to access and retention in care. Action: Integrate HIV health care, prevention and surveillance activities to support and monitor linkage and retention in care. 8

9. Effective Implementation of the HIV Testing Law Makes a Difference A System Dynamics Modeling project shows that robust implementation will lead to fewer new infections. Recommendations for further adjustments to the testing law, Streamline and fully routinize the offer for HIV testing. Consider adoption of CDC’s 2006 recommendation for HIV testing to be routine, without specific consent, but with an option for patients to decline to be tested. Advise health insurance carriers cover HIV testing in the same manner as the state Medicaid program. Allow physicians to notify source patients who test HIV positive of their test results through the anonymous occupational exposure process. 9

10. Affordable Care Act and USPSTF on HIV Testing The United States Preventative Task Force (USPSTF) is an independent group of national experts in prevention and evidence based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medicines. Under the ACA, Medicare, Medicaid, and private insurance are either required or incentivized to cover “A” and “B” graded services. Grade A recommendation made for HIV screening When the Task Force recommends (Grade A) a screening test, it is because there is strong evidence that the test has large potential benefits and small potential harms. The Task Force recommends that (1) clinicians screen adolescents and adults ages 15 to 65 years for HIV infection, younger adolescents and older adults who are at increased risk should also be screened (Grade A); (2) clinicians screen all pregnant women for HIV, including those who present in labor whose HIV status is unknown (Grade A). 10

11. Advances in the HIV Diagnostic Testing Algorithm The HIV Diagnostic Testing Algorithm offers several advantages over the conventional strategy of HIV antibody screening followed by Western blot confirmation of preliminary positive results. A multi-test algorithm and the final interpretation is based on a combination of results from two or more tests. The tests that may be used must be approved with the stated intended use for aiding in the diagnosis of HIV infection by the Food and Drug Administration (FDA) or by the NYSDOH Clinical Laboratory Evaluation Program (CLEP) and must meet additional criteria specific to each step of the algorithm. 11

12. Community Mobilization AI Advisory Groups Education materials and training Social Network Housing HIV, STD and Hep C Treatment MSM as target for RFA consideration MSM Viral Suppression Guidelines on treatment for MSM for HIV, STD and Hep C MSM Anti stigma Test and link to care Managed Care Medicaid PrEP Rest of State NYC LGBT Health Care Initiative MSM & Substance Use Health care and adherence in care Interagency collaborations Surveillance HIV, STD and Hep C Best track and document cases Employment Support Services Faith based Institutions MSM and mental health Cultural and ethnic competencies ADAP Insurance Third party Health Exchange Criminal Justice Partner Services External Stakeholders Community based Organizations Immigrant populations Digital technology Social Media Cephalosporin- resistant gonorrhea

13. Pre-Exposure Prophylaxis (PrEP)* PrEP is a new bio-medical prevention method in which high risk HIV- negative persons take a daily pill to reduce their risk of becoming HIV infected. The U.S. Food and Drug Administration approved combination ARV medication for use as PrEP among HIV- negative sexually active adults at risk for HIV infection. Studies show a significant reduction in HIV acquisition among HIV-negative persons who use PrEP consistently and receive supportive prevention services.

14. Ryan White Will Remain Essential It is difficult to predict accurately the full impact of the implementation of the ACA on PLWH/A. The ACA may increase the number of people who access medical care, but gaps will remain in what is covered and who is covered. The End of AIDS is not the end of persons living with HIV/AIDS. Ryan White will continue to be essential and will continue to: address gaps in services, such as support services that enable persons living with HIV/AIDS to access and remain in care (e.g., housing, nutrition, transportation, treatment adherence support, etc.); address gaps in covered populations ; facilitate entry into newly established insurance systems. 14

15. End of AIDS It is within our reach to end the AIDS epidemic in New York State. Scientifically proven biomedical interventions use medical, clinical, and public health approaches to prevent HIV infection, reduce susceptibility to HIV, and decrease HIV infectiousness. Research demonstrates the effectiveness of antiretroviral treatment (ART) for HIV-infected patients in both improving health outcomes and reducing risk of HIV transmission. Focused, coordinated, effective prevention efforts include finding people who are infected with HIV, linking them to and retaining them in care, and achieving viral suppression by prescribing and ensuring adherence to ART. 15

16. End of AIDS New York State policies and programming have already achieved, 40% reduction in newly diagnosed HIV cases in the last decade; the near elimination of mother-to-child transmission (MTCT), with a drop in the rate of MTCT from 25% to 40% in 1990 to 0.8% -- just three cases -- in 2012; a reduction in the proportion of injection drug users among newly diagnosed cases from 54% in the 1990s to just 4%; universal access to HIV medications and care for New York’s persons living with HIV/AIDS through grant- funded HIV Uninsured Care Programs - which bridge the gap between Medicaid coverage and private insurance. 16

17. End of AIDS Emphasis on effective implementation of the HIV testing law. Emphasis on linkage, retention and adherence in care to achieve viral suppression. Continued community/government partnerships. Coordinated planning, policy and program efforts. Support of advancing bio medical technologies 4 th generation testing Pre- Exposure Prophylaxis (PrEP)* nPEP 17

18. Dan O’Connell Acting Director New York State Department of Health AIDS Institute dao03@health.state.ny.us 518.474.6399 18