Free HIV Testing in New York

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New York was the most badly impacted state in the United States when the HIV/AIDS epidemic hit the country back in the 1980s. The first HIV case in the state was reported in 1981, and the diagnosis rate kept increasing through the 1990s and early 2000s. However, from 2014 onwards, the state government has introduced several new measures to reduce the HIV rate in New York.

According to the recent data, the state now ranks number 10 in the list of US states with the highest HIV rate. By 2018, the state recorded a considerable decline in the number of new cases compared to 1981 statistics with less than 2,500 new cases compared to over 140,000 cases back then. This marks an 11% drop in the number of cases from 2017 and around a 28% decrease from 28%. The reason New York has observed such a reduction in HIV rates is because the state has directed its efforts towards ensuring early testing and enhanced access to treatment across all groups of people.

Why Testing Matters

HIV testing is fundamental for slowing down the spread of HIV infection. However, a majority of people remain unaware of their health status. That's why they are least likely to take precautionary measures that would help prevent virus transmission to others, and the rate of HIV cases keeps inclining.

The Centers for Disease Control and Prevention (CDC) reported that 85% of over 1 million US citizens living with HIV are aware of their condition. About 40% of the new infections are transmitted by individuals who aren't aware that they are the virus's carriers. People who remain undiagnosed are at a higher risk of developing several life-threatening ailments, including cancer, organ failure, and AIDS.

CDC suggests that testing is the most significant first step towards preventing HIV transmission. According to the agency's revised HIV prevention guidelines, everyone aged between 13 and 64 must undergo testing and make it a part of their regular health care. Those at a higher risk must get tested annually.

For people with undiagnosed HIV, testing is the first step in maintaining a healthy life and preventing HIV transmission. The National Institutes of Health clinical trial revealed that early HIV diagnosis and treatment could prove to be immensely beneficial for those infected with the virus. They are at an increased personal health advantage than those who are diagnosed late or remain undiagnosed.

HIV tests are usually quite accurate. However, no test is efficient enough to detect HIV immediately after a person gets infected. That's why the sooner it is detected, the better chances of the person enjoying a healthy life again would be.

There are currently three types of HIV diagnostic tests available, including NAT (nucleic acid tests), Antibody Tests, and Antigen/Antibody Tests. The initial HIV test would be either an antibody or an antigen/antibody test.

In case the initial test is a self-test or a rapid test, and its result is positive, the individual must immediately visit a health care provider for follow-up testing. Conversely, if the initial test is conducted at a laboratory, and its result is positive, the lab will carry out the follow-up testing using the same blood samples.

New York has been able to reduce the number of HIV cases per year due to its dedicated efforts to expand the network of treatment. It typically begins with an effective citywide testing program. So far, the state has expanded the testing web to community health centers, businesses, colleges, hospitals, and churches.

By the end of 2017, the state dropped to number four in the number of new diagnoses with 2769/100,000 people and ranked 9th in the rate of new HIV diagnoses with 12.7/100,000 people. This shows the effectiveness of early testing addressing the HIV epidemic across the state.

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State Initiatives to Reduce HIV

New York was the first jurisdiction that launched a statewide initiative to eliminate HIV/AIDS. The state launched the Ending the Epidemic Initiative (ETE) in 2014, which has been very effective and yielded historic gains. Through this program, the government aims to end AIDS by decreasing the number of people living with HIV and offer effective treatment options. New York City is the country's first city to achieve the initial goal of reaching a 90% threshold in the diagnosis treatment and suppression as indicated in the Fast-Track Cities initiative.

Since 2014, over 300 metropolises have signed the 2020 challenge in New York, 90% of people living with HIV are aware of their status, 90% of diagnosed HIV infected individuals are receiving proper therapy, and 90% of those receiving treatment have achieved viral suppression.

New York once used to be the epicenter for HIV transmission in the US. As per the recent data, New York City has over 90% of HIV-positive residents already diagnosed and receiving treatment. The state has recorded a downward trend in the number of new HIV cases within the past three years.

This reduction could be partly attributed to New Yorkers as around 32,000 took PrEP (pre-exposure prophylaxis) in 2018, which was 32% more than in 2015. That's how the state managed to reduce the number of new HIV cases from 2400 to less than 2000 in 2019-2020. City surveillance report suggests that despite 17% more New Yorkers living with HIV (approx. 125,000) in comparison to 2001, new diagnoses have reduced in almost every demographic group.

An integral part of the government's plan to curb HIV transmission is increasing medication availability. The government has allocated $20m in state funding for the ETE plan in this regard. According to the latest guidelines from the state government, New York health insurers will start covering PrEP drugs with co-pay. When someone tests positive, the individual is assigned a physician and a case manager. Sometimes the medication is covered under Medicaid, private insurance, or the state's AIDS Drug Assistance Program.

In 2010, the state amended its HIV testing law, and providers must offer tests to individuals aged 13 or above as a part of their routine health care. In 2014, the New York lawmakers also eliminated the need to obtain written consent to carry out an HIV test.

Through ETE, the government hopes to achieve zero HIV transmission via injection drug use and zero AIDS mortality rate. The initiative encompasses three key goals- identifying and linking undiagnosed people with HIV, retaining infected individuals in care, and facilitating improvement in access to PrEP to people at higher risk of contracting the virus.

HIV in New York

For decades, New York State has remained the HIV epidemic's epicenter in the USA. However, there has been a considerable reduction in the number of new cases within the past few years. In 2018, around 127,162 people were living with HIV in New York. The same year, 2,456 people were diagnosed with HIV. However, the state still has more persons living with HIV than any other US state.

In the state, New York City is home to the largest HIV population, apart from being the largest city in the country. In 2018, around 100,644 people in the city were infected with HIV, while 1,812 individuals were diagnosed with the virus. On the other hand, Brooklyn has the greatest number of cases than any other borough, despite that the virus has reached a historic decline across New York City.

About one-third of all the cases in 1917 were diagnosed in Brooklyn with 558 new cases. This number was approx—100 more than other boroughs. The Bronx reported 440 cases, Queens had 358, Manhattan had 375, and Staten Island had 31 cases in 2018. The highest HIV diagnosis rates in 2018 were reported in Crown Heights and Lower Manhattan.

Research suggests that there is a strong link between high HIV rates and low-income areas in New York. Such as northern Brooklyn and upper Manhattan, both recorded higher rates of HIV infected people, and the patients had high levels of poverty. Similarly, African-Americans and Latinos are the highly impacted demography group as 8 out of 10 HIV carriers living in varying poverty levels were either black or Latino. Out of the 1917 diagnoses, 1761 lived in poverty. Eight hundred seventy-nine of them were African-Americas, 697 were Latinas, and 219 were White.

On the whole, New York City has observed an incredible 67% reduction in the number of new cases since 2001.

Age, Gender, and Ethnic Disparities

In New York, African-Americans and Hispanics or Latinos comprise over three-quarters of the total HIV cases diagnosed in 2017. As per the year 2018 statistics, of all the people living with HIV in the state, 71% were males and 28% females. Regarding the racial/ethnic disparity, 37% of the infected individuals were blacks, 35% Hispanics/Latinos, and only 17% were white.

Age-wise, people above 55 years of age accounted for the highest number of cases with 42%, followed by the 45-54 age group that reported 26% cases in 2018. People between the ages 13-24 had the lowest number of cases (2.2%), while the 24-34 and 34-44 age group reportedly had 12% and 15% of all new diagnoses. Black men who have sex with meh were the most at-risk community regarding the rate of HIV transmission. While heterosexual black females were the most at-risk group among females.

References

  • AIDSVu. 2019. New York City - Aidsvu. [online] Available at: https://aidsvu.org/local-data/...
  • AIDSVu. 2020. New York State - Aidsvu. [online] Available at: https://aidsvu.org/local-data/...
  • Campbell, J., 2019. New York Had A Huge Drop In HIV Diagnoses Last Year. [online] Democratandchronicle.com. Available at: https://www.democratandchronic...
  • Cdc.gov. 2020. HIV Testing | HIV/AIDS | CDC. [online] Available at: https://www.cdc.gov/hiv/testin...
  • Culliton, K., 2019. HIV Reaches Historic Lows But Lurks Among New York City's Poor. [online] New York City, NY Patch. Available at: https://patch.com/new-york/new...
  • Dodge, B., 2019. More Than 90 Percent Of People With HIV Diagnoses In New York City Receive Treatment, Mayor Says. [online] Newsweek. Available at: https://www.newsweek.com/more-...
  • Health.ny.gov. 2019. New York State HIV/AIDS Annual Surveillance Report. [online] Available at: https://www.health.ny.gov/dise...
  • Morne, J., Tesoriero, J., Martin, E., Birkhead, G., Holtgrave, D., Hagos, K. and Zucker, H., 2020. Ending the HIV Epidemic: New York’s Quest to Become the First State to Reduce HIV Prevalence. Public Health Reports, 135(1_suppl), pp.65S-74S.
  • National Institutes of Health, 2015. Starting antiretroviral treatment early improves outcomes for HIV-infected individuals. NIH-funded trial results likely will impact global treatment guidelines, http://www. niaid. nih. gov/news/newsreleases/2015/Pages/START. aspx#(2015, accessed 1 October 2015). Google Scholar.
  • Quinn, A., 2019. Brooklyn Still Sees Most HIV Cases In NYC, Data Shows. [online] Brooklyn, NY Patch. Available at: https://patch.com/new-york/bro...
  • Riback, L., 2016. NY Increases Efforts To Fight AIDS. [online] Democratandchronicle.com. Available at: https://www.democratandchronic...
  • Statista. 2019. HIV Diagnoses Rates Leading U.S. States 2018 | Statista. [online] Available at: https://www.statista.com/stati...
  • Www1.nyc.gov. 2019. HIV In New York City 2014-2018. [online] Available at: https://www1.nyc.gov/assets/do...

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