Op-Ed | To eradicate HIV/AIDS, Hochul must support – not cut – safety-net providers

HIV positive blood sample
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When I tested positive for HIV in 2004, I thought it was a death sentence. I was sick, scared, and alone, going through the New York City shelter system and living in a tiny room with basically nothing. 

I isolated myself from family and friends. I was tired and depressed, and believed I had nothing left to live for. Only the knowledge that my sister would have to explain to my young nephew that “Uncle Tony is dead,” prevented me from stepping in front of a bus on Mosholu Parkway in the Bronx to end it all. 

In the depths of my despair, I was lucky enough to find my way to Harlem United. They understood what I was going through, and made me feel like I was more than just my diagnosis. I kept going back. Within three months, my health had stabilized, and I had my own apartment. 

Harlem United took care of me physically, mentally, and personally. They saved my life and showed me light and hope when I couldn’t go on. Now it’s time for me – and the thousands of others like me who receive life-saving care from safety-net providers like Harlem United across the city and state – to return the favor.

The Hochul administration is preparing to implement a plan that will rob safety-net clinics of more than $100 million in annual funding that helps 2.3 million vulnerable New Yorkers get medical care and nutrition, housing, and transportation services. The Medicaid pharmacy benefit carve-out will curtail HIV/AIDS clinics’ operations; close to three dozen would shut down entirely.

On this World AIDS Day, Gov. Kathy Hochul can prove she’s serious about her pledge to advance health equity and end the HIV epidemic by 2024 by canceling the carve-out immediately. 

The state’s original goal of reducing estimated new HIV infections to 750 statewide by 2020 has already been pushed back due to challenges presented by the Covid crisis. We can’t afford to delay any longer; too many lives are at stake.

Gov. Hochul has rightly said that the state’s “greatest responsibility” is to protect its most vulnerable residents. Yet she is standing idly by as her Health Department prepares to push through the carve-out, which disproportionately will impact lower income New Yorkers of color. 

Though the number of New Yorkers newly diagnosed with HIV decreased 51 percent between 2011 and 2020, Black and Latino New Yorkers continue to be affected in higher numbers. 

The rate of diagnoses among Black individuals was 8.1 times higher than that of whites, and AIDS remains a leading cause of death in the Black community. Latinos, who make up just 18 percent of the state population, account for 35 percent of new HIV diagnoses. Additional, gay, and bisexual men and individuals of transgender experience are disproportionately impacted. 

With these statistics in mind, the governor should be increasing, not reducing, access to life-sustaining services for all those living with HIV and/or AIDS – especially Black and Latino New Yorkers. 

The carve-out would transition the pharmacy benefit from Medicaid managed care to a fee-for-service model, eliminating the mechanism that gives covered entities like Harlem United access to the savings realized from the 340B program. 

Congress created the 340B program in 1992 to improve care for marginalized populations by providing discounts on prescription drugs as a condition of participation in Medicaid. The savings enable safety-net providers to provide care and services not covered by Medicaid at no additional cost to taxpayers.  

The carve-out will also dramatically change how people like me access pharmacy care. That means more than 15,000 New Yorkers who are members of HIV Special Needs Plans will lose access to pharmacists trained to handle problems in real time for those with HIV, mental health challenges and gender-affirming issues. 

I personally have benefitted from this service, which enabled me to remain on the strict calendar of HIV medications necessary to stay healthy and safe. 

Racially diverse underserved communities are hurting. Gov. Hochul recognized that fact by signing legislation that declared racism a public health crisis. As she prepares to take office as the first elected woman governor in New York’s history, Gov. Hochul must repeal the carve-out and prove she is indeed dedicated to protecting those who need her most. 

Anthony Randolph is a longtime Harlem United client.