NEW YORK CITY – August 16 – At the 16th International AIDS Conference in Toronto, Canada, the New York City Department of Health and Mental Hygiene (DOHMH) presented new HIV/AIDS data showing that one out of five New Yorkers newly diagnosed with HIV/AIDS is still not getting medical care 12 months after their diagnosis. DOHMH also presented data showing that substance abuse continues to contribute significantly to HIV/AIDS deaths in New York City.
Linkage to HIV Treatment and Care Delayed
Current data show that among people newly diagnosed with HIV/AIDS in New York City, only 65% began treatment within 3 months, 70% within 6 months, and 78% within 15 months of their diagnosis. That means one out of every three New Yorkers who tests positive for HIV still had not started treatment three months after their diagnosis. Moreover, one in five New Yorkers newly diagnosed with HIV/AIDS was still not in care more than a year after diagnosis. Data also indicate that treatment was particularly delayed for some groups, including injecting drug users (IDUs), African-Americans, and people who were diagnosed in jail or by community groups without medical care located in the same facility.
“Every New Yorker should know their HIV status,” said DOHMH’s Director of HIV/AIDS Surveillance Lucia Torian, Ph D. “But testing is only half the battle for those who are HIV-positive. For people living with HIV, HIV primary care should be started as early as possible. Additionally, 1,000 people each year are first finding out about their HIV infection when they are already sick with AIDS. All providers who offer HIV testing should have effective systems in place to ensure their patients can get the care they need to live a longer and healthier life.”
DOHMH is working to ensure that all persons newly diagnosed with HIV infection are actively linked to medical care. To address this problem, linkage to care activities are being incorporated in to all HIV testing conducted or funded by DOHMH. Testing programs are required to track and report on their success for this critical activity. Through these programs, we hope to ensure that all HIV+ New Yorkers have appropriate access to life saving HIV clinical services.
Substance Abuse Increases Risk of Death in PLWHA
DOHMH also presented data showing the effects of persistent substance abuse on people living with HIV/AIDS (PLWHA). While injecting drug users (IDUs) represent one-quarter of PLWHA, they account for more than 40% of HIV deaths in New York City each year. While deaths continue to decline in all transmission risk groups, the death rate in IDUs remains two to three times higher than in, for example, men who have sex with men (MSM).
From 1999–2003, there were approximately 5,300 deaths among IDUs and about 1,500 deaths among MSM in New York City. The most frequent cause of death in IDUs was drug abuse, including overdose (22% vs. 4% in MSM). Liver disease contributed to 16% of deaths in IDUs compared with 8% in MSM.
The disparity in deaths is largely related to substance abuse-related causes including overdose and diseases of the liver (e.g., viral hepatitis and alcoholic cirrhosis). Deaths could be reduced substantially by addressing these causes through substance abuse treatment and liver disease treatment, and through the promotion of harm reduction strategies such as syringe exchange programs and distribution of antidotes (e.g., naloxone) to treat accidental overdose. DOHMH actively supports and funds harm reduction efforts, including through recent Ryan White Request for Proposals.
HIV Partner Notification and Elicitation in New York City
Among approximately 3,600 newly diagnosed HIV cases in New York City in 2004, 6% (206) were diagnosed in Health Department clinics and 94% by other providers. However, among those diagnosed in City clinics, 50% provided one or more named partners compared with only 18% among those diagnosed by other providers. Also, more of these identified partners had adequate contact information to successfully be notified of their possible HIV exposure: 71% for partners of City clinic cases versus 48% for other providers. The rate of new HIV diagnosis among tested partners was high for both groups: 27% for City clinic cases versus 22% for partners elicited by other providers.
“Partner notification is one effective way to stop the spread of HIV – whether performed by the person who is HIV-positive or their health care provider,” said Beth Begier, Medical Director of DOHMH’s Bureau of HIV/AIDS Prevention and Control. “Telling someone you may have exposed them to HIV is not an easy task. That is why we offer free and confidential partner notification services both for people with HIV in New York City and for health care providers and are expanding services to help provider to perform this crucial, public health service. ”
Know Your HIV Status
There are more than 100,000 New Yorkers currently living with HIV/AIDS in New York City, and thousands more who are HIV positive but do not know their status. Every New Yorker should know their HIV status. In 2005, DOHMH provided 50,000 HIV tests in its clinics citywide, and more than 26,000 HIV tests in City jails. DOHMH’s clinics are located in each of the five boroughs and offer confidential or anonymous rapid HIV testing free-of-charge, on a walk-in basis. Rapid HIV tests are available, and results available within 30 minutes. For more information about free safe, fast HIV testing, call 3-1-1 or visiting nyc.gov/health. Ordering condoms online is easy: log on to nyc.gov/health/condoms.
Alcohol dependence can be effectively treated with counseling, 12-step programs, medications, and other interventions. Brief doctor interventions are effective in helping people reduce harmful drinking.
For counseling and referral services, call 1-800-LIFENET or call 311 and ask for LIFENET. LIFENET is available in English at 1-800-LIFENET (1-800-543-3638), Spanish (1-877-AYUDESE; 1-877-298-3373), and Chinese (1-877-990-8585). For other languages, New Yorkers can call LIFENET and ask for a translator.