Local experts say HIV figures in the state are skewed by the high numbers seen in New York City
By Deborah Jeanne Sergeant
New York ranked fourth in the nation for new cases of human immunodeficiency virus (HIV) in 2015, and ninth in 2016, according to statistics provided by the Centers for Disease Control and Prevention. Of those infected with HIV, one in seven doesn’t realize it.
Physician William Valenti, staff physician and co-founder of Trillium Health in Rochester, said that New York’s high ranking is somewhat skewed by New York City.
“We identify 50 to 100 new cases in the Rochester area per year,” he said.
That’s a far cry from the 2,052 people in New York City diagnosed in 2016, according to www.aidsvu.org.
More than 108,000 people living in New York City have HIV/AIDS and 20 percent do not know they are infected, states the website of Gay Men’s Health Crisis, a provider of HIV/AIDS prevention, care and advocacy in New York City.
Valenti said that although the rate of new HIV infections is higher in New York City than in Upstate, the rate is decreasing in New York City, unlike Upstate’s stagnant figures.
He said that behavioral intervention, such as using condoms and limiting sexual partners “are not as effective by themselves as a part of a medical and health care intervention. Medical care will become biomedical intervention. That is going to help turn this around.”
Physician Gale R. Burstein, commissioner of health for Erie County Department of Health, echoed Valenti’s opinion. “That population is higher in New York City than Western New York. The New York City rate drives those high numbers statewide.”
The CDC states that 9 percent (3,425) of new HIV infections nationwide are among those who inject drugs (that figure also includes 1,201 diagnoses among gay and bisexual men who inject drugs).
The CDC also says on its website that gay and bisexual men accounted for 67 percent (26,570) of all new HIV diagnoses in the U.S. and heterosexual contact accounted for 24 percent (9,578) of HIV diagnoses.
By identifying higher risk populations, health organizations can know where to target their attention.
Burstein said that upon a notification of a new HIV diagnosis, Erie County disease intervention specialists assess risk.
“We try to find those individuals who were exposed through sexual contact or injectable drug,” Burstein said. “We get them in to be tested to break the cycle of transmission.”
Those who test negative receive an offer of post-exposure prophylaxis. It should be started within 36 hours but no later than 72 hours after exposure to HIV. Taken within that timeframe, it’s 80 percent effective.
Those with an infection receive anti-viral therapy to decrease their viral load.
“They hopefully won’t have any virus in their blood stream or genital excretions to transmit it,” Burstein said. “It’s about decreasing the community’s viral load.”
HIV-positive patients also receive regular follow-up to ensure medication compliance.
People with other sexually-transmitted infections (STIs) may be at higher risk for HIV, according to physician Alyssa S. Shon, an infectious diseases specialist with UBMD Internal Medicine and medical director at Evergreen Health, a local provider who serves those who are living with chronic illness or who are underserved by the healthcare system.
“When diagnosed with those infections, it’s a good time to discuss it with those patients,” Shon said. “Many think they’re at low risk, but the vast majority of HIV transmissions are people who don’t know their own status. They have unprotected sex and spread it to other people.”
Shon feels like the war on HIV is progressing toward the goal of fewer than 750 new HIV infections by 2020, which would end its status as an epidemic.
Daniel Stapleton, public health director for Niagara County Department of Health, also said that New York has made progress in reducing HIV.
“In Niagara County, the rate has decreased to a quarter of what New York state had,” Stapleton said.
He also believes the numbers from New York City skew the figures for the whole state. Niagara County had five new cases of HIV last year. Stapleton said that public health education is a big part of the reason for the decrease.
Though organizations combating HIV still promote condom use, treating people with medication to suppress the virus represents the means of prevention that they believe will end HIV’s status as an epidemic.
“It’s a success story in public health, that’s a great accomplishment,” Stapleton said.