Second, the State has stepped out of its role as direct payer for almost all Medicaid-fundedservices. Consequently, providers have been thrown into the role of negotiating rates withmanaged care organizations and health homes, something for which they have little experienceor expertise, much less volume that gives them bargaining strength. Having the AIDS Institute
services are not diminished in the interest of short-term savings and long-term costs to the healthof people living with HIV and AIDS.Third, part of the reason we have been so successful in addressing the HIV/AIDS epidemic in New York is that the AIDS Institute has implemented and maintains effective prevention andcare programs around the state, including comprehensive harm reduction services to people whouse illicit drugs and prevention and care targeted at other key populations, and grant-fundedservices that engage in both secondary and primary prevention that will not be replaced byMedicaid. These prevention and care systems are themselves in the middle of an evolution, buteven as some services are shifted onto Medicaid, there will still be a need for strong state grantsupport and strong guidance in program development and implementation.Fourth, we still have not addressed three of the most critical issues that allow the epidemic to persist. One is continued transmission of the virus, particularly among marginalized populationssuch young men of color who have sex with men. The second is that a large percentage of peopleinfected with HIV, particularly men and women of color do not learn their status until they havean AIDS-defining event. Third, we have not addressed the treatment cascade, in which less than40% of New Yorkers with HIV are fully virally suppressed. While it is true that we havedramatically decreased the number of HIV-related deaths in New York State over the lastdecade, we still have transmission of the virus at the level of a generalized epidemic; thoughlargely manifest in particular groups. And we still have avoidable medical costs and untimelydeaths. We cannot bring the epidemic to an end unless we address these issues, and we will not be able to address these issues without a strong and vibrant
of Health that marshals resources and maintains a clear focus on bringing HIV deaths andtransmission to zero in New York State.Fifth, biomedical advances in the prevention of HIV
a as pre-exposure prophylaxis (PrEP)
have offered new optimism in curbing the epidemic. NewYork State is poised to lead the nation in effectively implementing a comprehensive PrEPstrategy and ensuring access for those most in need in our state, an epicenter of the epidemic. Itwas recently announced that New York State Medicaid will include PrEP in its formulary. NewYork State AIDS Institute has requested funding for pilot programs for prevention contractors toconduct outreach to high-risk individuals. Now is the time to invest in these potentially powerfulstrategies.Finally, even before we have ended AIDS as an epidemic, we have other epidemics of Hepatitisand STDs surging, following the same transmission pathways as HIV. The AIDS Institute hasthe experience and expertise to provide leadership in stopping this epidemic as well. But it willnot be able to do so if it is diminished as is proposed in this budget.