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By Ruth Finkelstein, ScD
As we mark World AIDS Day today, NYAM's Senior Vice President for Policy and Planning selects a few highlights from NYAM’s 25-year record of response to the global epidemic.
Since the late 1980s, The New York Academy of Medicine has influenced the policy response to the HIV/AIDS epidemic through research, policy and advocacy, convening, and professional training.
In each of these activities, we based our conclusions and our policy positions on the best available scientific evidence and our central message was that policy makers should do likewise. I’ll mention a few high points.
• In 1988, NYAM’s Committee on Public Health was the first major medical organization to recommend syringe exchange to reduce the spread of HIV.
• At the same time, Dr. David E. Rogers helped the AIDS Institute to design New York State’s unique model of clinical care for people with HIV/AIDS, creating comprehensive, integrated Designated AIDS Centers.
• For the next decade, the Directors of those Designated AIDS Centers met at NYAM monthly to share the latest clinical information with one another more rapidly than the cycle of academic publication and presentation would allow.
• In 1990, NYAM President Dr. Jeremiah Barondess testified before scientific, technical, and Congressional committees in opposition to the CDC’s proposal to require all health care workers to be routinely tested for HIV.
• He also testified in opposition to a NYC requirement that all teachers pledge to “teach abstinence” as a means to prevent HIV.
• NYAM developed curricula to train social workers and other professionals about the specific needs of people with HIV/AIDS. Originally, these curricula focused centrally on issues about dying and the end of life; as treatment improved, the training evolved to help people navigate the complex systems of care and benefits.
• As NYS moved toward a managed care strategy for Medicaid recipients in the mid 1990’s, Special Needs Plans (SNPs) were designed for people living with HIV/AIDS (as well as for those with severe mental illness). NYAM’s SVP, Dr. Alan Fleischman was directly involved in the design of this new model of care.
• Once the breakthrough triple drug combination treatments were announced in 1996, NYAM turned research, program design, and policy attention to the complex issues of medication adherence, especially for people actively using substances and with other complications. NYAM SVP Ruth Finkelstein led research on these issues for nearly a decade, advising the national ADAP program, NYC Title I planning council, and HRSA on how to best support adherence.
• In the early 2000’s, NYAM researcher (and SVP) David Vlahov designed and conducted the research that proved that NYS’s new Expanded Syringe Availability Program (ESAP) – that allows syringes to be purchased in a pharmacy with out prescription – was effective in reducing HIV spread and did not contribute to increases in injecting. Based on this work, the ESAP program was reauthorized without a new sunset provision.
• Continuing to combine NYAM’s decades-long commitment to sound substance abuse policy to its work on management of HIV, Drs. Finkelstein and Weiss led a national study on integration of buprenorphine treatment for opiod dependence into HIV clinical care, showing that such integration decreased use of illicit substances, increased retention in HIV care, and was able to be integrated into the smooth functioning of HIV centers.
• Just last week, we received funding to further explore the opportunities and barriers to integration of syringe exchanges into health homes, providing another bridge to integrated, comprehensive care for people actively using substances and with or a great risk of getting HIV.
NYAM remains committed to promotion of the strongest evidence-base into policy to improve the health of populations, and remains a ready and willing partner when we can help NYC in its continued efforts to prevent the spread of HIV and to provide the best possible care tot hose who have HIV/AIDS.
Posted on December 1, 2013
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