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Brian Lehrer: Brian Lehrer on WNYC for our first show in the month of June. We say Happy Pride. It is LGBTQ Pride Month. For our first segment about it this year, we will note that the LGBTQ community is among those unhappy about proposed cuts to public health programs in Mayor Adams's proposed budget for the new fiscal year, which begins at the end of the month, technically July 1st. Council and the mayor are deep into negotiations over all kinds of programs and their funding at a time when lower revenues for a variety of reasons means there will be cuts. The question is where?

As our health reporter Caroline Lewis writes on Gothamist, HIV services, including a program that has been shown to help hard to reach patients reduce their viral loads are among those targeted for cuts. That would be $5.3 million less in spending on HIV programs as part of 75 million overall in cuts to the health department. Caroline reports that the mayor's health commissioner, Dr. Ashwin Vasan said about 80% of the cuts come from reducing department overhead and spending on non-public facing programs, but another $15 million is spread out among direct services to the public, including the 5 million taken from HIV programs.

Public health activists, including HIV activists, are activated. Getting into that Act is ACT UP, the legendary AIDS and HIV activist group that had such an impact on awareness and policy in the 1980s and 1990s, especially. With us now, two organizers for ACT UP, Nia Nottage and Brandon Quickie. Nia is also with Come Forever Mutual Aid. Nia and Brandon, thanks for coming on. Welcome to WNYC.

Brandon Cuicchi: Thank you for having us.

Nia Nottage: Thanks so much, Brian, for having us.

Brian Lehrer: First of all, Nia, many listeners may be wondering, ACT UP still exists? Can you talk about what the group is these days? Did it exist continuously since the early days of HIV? What's the group largely about today?

Nia Nottage: Yes, for sure. ACT UP does still exist, because, unfortunately, HIV has not been cured yet. Last Thursday, ACT UP held a town hall where we invited representatives from the Department of Health to discuss the proposed budget cuts that they're facing and what they mean for New Yorkers living with and at risk for HIV. Then, as you were saying, it turns out the Department of Health is facing $75 million in cuts this year if the mayor's proposed budget is allowed to go through at the end of June. Pride Month this month is actually-- or Pride Month this year, rather, fully overlaps with our last chance to fight these Department of Health budget cuts before a final budget is approved at the end of June. We're really calling on the LGBT community to make noise about this to the city council and the mayor's office during Pride this month.

Brian Lehrer: We'll talk about details of that, focusing on that issue right now. Brandon, anything to add generally about what ACT UP is in 2024?

Brandon Cuicchi: ACT UP has met all this time since the late '80s. We still meet every Monday night at 7:00 PM at the LGBT center on 13th street like we have for 36 years. We try to stay on the front lines of the city and state, fight for people with HIV and to prevent HIV spread here in the city and state.

Brian Lehrer: Nia, I see in your email signature that you're also with Come Forever Mutual Aid. What's that group? What do you do with them? Are they related to ACT UP, or is that something totally separate that you do?

Nia Nottage: That's not related to ACT UP. It's something completely separate, but it is a health mutual aid where we pass out COVID tests and masks in Brooklyn, and also we do free clothes, free food. It's like a free store in Los Sures, Brooklyn.

Brian Lehrer: Certainly something we talked about a fair amount, especially at the depth of the pandemic in the beginning era, was how much mutual aid groups around the city, citizen groups that were not the government, were doing on their own to bring protective equipment, to bring food, all of that. Don't sleep, listeners, on mutual aid in general and its importance to communities in this city.

Brandon, how would you describe the state of HIV and AIDS in New York City these days? I think most listeners who may not have direct contact with people in the HIV community for one reason or another realize it's never-- people do realize that it's never completely gone away. Also that this is not the 1980s. Prevention techniques are much more common, and dramatic advances in treatment made decades ago have made it a disease many people can live a long life with, which is not to say it's easy, but how would you describe the state of HIV and AIDS in New York City these days and where the problems are?

Brandon Cuicchi: In 2014, New York state announced a statewide plan to end the AIDS epidemic by achieving the first-ever decrease in HIV prevalence in the state. Currently, we're seeing the epidemic focused on in poor, marginalized, mostly Black and brown and LGBTQ communities. We had this plan to end the AIDS epidemic by 2020, and then we had the COVID pandemic came and wiped out a lot of our hopes for reaching those levels in this decade.

Through the pandemic, we saw sexual health clinics closed to be turned into COVID vaccine centers. We haven't seen some of those clinics restored to sexual health services. New Yorkers are hurting if they need HIV tests, STI tests, abortion services, pregnancy consultations. New Yorkers are at a loss for services right now, because we're mostly down to one sexual health clinic in each borough.

Brian Lehrer: Nia, anything you want to add on the state of HIV and AIDS today and who's most at risk or most suffering?

Nia Nottage: Yes, for sure. HIV is a chronic health disorder that can be managed with medication, and also people who are at risk for it can manage their risk levels with us with medications like HIV and PrEP. At these health department clinics, which are about one in each borough, they provide free HIV PrEP continuity of care and services for people with HIV, but it's a bit spotty. I think they have PrEP continuity at Corona, Queens, and the only thing that's stopping it from having PrEP continuity in each borough is cuts like these where the Department of Health has to pivot and decide what they can offer at each one and pick and choose instead of just have it for everyone in every borough.

Brian Lehrer: The article I mentioned on Gothamist, and there's been a radio version, too, by our health reporter Caroline Lewis, says city health officials haven't responded to questions about how much total city funding goes toward HIV services. Are you having that difficulty, too, Nia, getting that number?

Nia Nottage: We have the number that $5.3 million from the 75 million in total health department cuts were specifically cuts to HIV programs.

Brian Lehrer: Yes, and that's the specific proposed cut. I guess what Caroline was referring to was how much total city funding goes to any kind of HIV services. Brandon?

Brandon Cuicchi: Brian, the city's budget is very opaque in terms of specific funding streams for specific diseases like that. It is information that we would like, and it would help us craft the overall plan for the coming year in the upcoming budget.

Brian Lehrer: Whether or not the proposed cuts are justified, how can they not have a budget number for public consumption for how much HIV funding there is? That's transparent. Dr. Vasan comes on with us frequently. We'll have to ask him to clarify that next time. How are you arguing, Brandon, that the proposed cuts of 5.3 million would affect prevention and treatment for what at risk or current HIV positive populations?

I want to cite, again, as I did in the intro, Dr. Vasan's stat that 80% of those cuts would come from non-public facing programs, that's cuts to the health department overall. He told the city council hearing, as our Caroline Lewis reported, that even with the 5 million in proposed cuts, HIV services are still "extraordinarily well funded" due to robust federal support which amounts to nearly $200 million annually. There's a pass at that number. Do you dispute that, or does that figure make the cuts more palatable, or what do you see as the likely tangible outcome of these cuts that have activated you on this issue?

Brandon Cuicchi: I would say that most HIV AIDS service organizations in the city receive this funding and are facing cuts. We have a local service organization, GMHC or Gay Men's Health Crisis, which was started in the early 1980s, in response to the first wave of the epidemic, and they are set to lose over $1 million in funding, which would affect or wipe out their undetectables program which makes sure that people with HIV can keep low or an undetectable viral loads. Even aside from that, on the back of this budget cut, we can expect to see longer lines and no expansion of hours at sexual health clinics, which as of now are currently only open Monday through Friday 8:30 AM to 3:30 PM.

They have to turn people away because of overcrowding. It means less money available for mpox vaccines, which in April, just underwent commercialization, meaning that it's harder to get them free of charge. It means a loss of COVID PCR tests. It means the Condom Availability Program which lost its funding last year and put millions of condoms in specifically LGBTQ bars and other spaces where people are at higher risk for HIV. It prevents that program from going forward and moving forward. The fallout from even $5 million in cuts is felt across the city and across the HIV AIDS community.

Brian Lehrer: Now, listeners, help us report this story. Are you involved with HIV prevention or treatment or activism for that matter in any way as a provider, or recipient, or anything else? What's the state of the virus as you see it in your life or work? 212-433-WNYC. Call or text. What's the connection, if any, to the vulnerability to other viruses like COVID and mpox which Brandon just brought up, or who has a question for Brandon Cuicchi or Nia Nottage from ACT UP? 212-433-WNYC, 212-433-9692. Let's take a call right now. Ivy in Manhattan, you're on WNYC. Hello, Ivy. Ivy, turn on your radio off. Listen through your phone. All right, Ivy, we're going to get back to you. Maybe you'll hear me on the radio in 10 seconds say that. Let's try Marcelo. You're on WNYC. Hello, Marcelo.

Marcelo: Hi. Can you hear me?

Brian Lehrer: I can hear you.

Marcelo: I'm [unintelligible 00:13:02], and I was at this forum first of all last week. [unintelligible 00:13:07] for me is that we don't know who and for how much this $5.3 million in cuts on HIV services are going to effect. Which services are being cut? How much? We don't know that. This is information that I asked to Dr. [unintelligible 00:13:30] who is Assistant Commissioner, and she's trying to get that data for us. I think that the most important thing is to know what services are being cut and how much.

Extra is to really consider cuts. Consider also the trend to end the epidemic in-- [unintelligible 00:13:51] in New York City, which is illegal since COVID. We are not going to reach that number. Then the idea is to have 750 HIV positive results a year. We're having more than double, almost double that. We are far from getting to the end of the epidemic in New York, and with cuts now, I feel that that's going to be even more complicated.

Brian Lehrer: Marcelo, thank you very much. Thank you for your call. Oh, go ahead. Do you have another thing? Go ahead.

Marcelo: Yes. 80% of the people who got HIV in New York City are either Black or Latino. 80%. Thanks so much, Brian.

Brian Lehrer: Thank you so much. There's some relevant numbers, Nia. One, that 80% of people getting HIV at this point are Black or Latino. Marcelo, who's a member of your group says. Also, did I hear him right, that there's a target of having just-- Any case is serious, but just in historical terms 750 new HIV diagnoses per year, and now there's more than double that. Did I hear that correctly?

Brandon Cuicchi: Yes, Brian. I believe that is right for the NME epidemic plan. The plan was to get HIV transmissions to below 750 per year. I believe that that was in New York State. That was the number.

Brian Lehrer: For statewide. Now I think we have Ivy in Manhattan ready to go. Ivy, you're on WNYC. Thank you for calling in.

Ivy: Oh, hi, how are you doing? This is Ivy [unintelligible 00:15:38]. I've been a positive person as a woman since 1990. In doing this work this last week, and the last couple of months, what we were asking also as ACT UP is that we want a bigger space to discuss the budgets with Mayor Adams, as he does not have us in the table, but the amount of money that we spend in policing is about $29 million. We are investors since the '80s and '90s in science and in PrEP. All the people are benefiting now. We don't know what those cuts are going to be. There are people that are born in the '80s and '90s that are now adults that need that support and that care for their continuing education. As investor, we're asking the mayor to include us in their budget planning. That's never spoken about.

Brian Lehrer: You don't feel you have a seat at the table in meaningful terms.

Ivy: Yes. We used to have a very meaningful space. That investment turned out to half the size that we have. That science is not just HIV related. We also invested with our bodies with-- There's treatment for COVID and people forget that. There was no vaccine center in this country until HIV activists implemented that in the '90s. People forget that. When we talk about COVID vaccines or research or even treatment. When you take Paxlovid, one of the HIV drugs, the science technology is based on HIV people's lives that changed the science for this country. We deserve, especially in New York City, a space to discuss budgets with the mayor's office, not just for the Department of Health.

Brian Lehrer: Thank you very much, Ivy. I appreciate your call. Few more minutes with Nia Nottage and Brandon Cuicchi from ACT UP as they lobby against HIV-related funding cuts in the Department of Health budget as proposed by Mayor Adams as council, city council, and the mayor are in the homestretch of finalizing the city budget for the next fiscal year, which begins on July 1st. Nia, there's the fact of life that the budget has to be balanced each year by law, unlike the federal budget where they can run a deficit and borrow money, and the cuts have to come from somewhere.

We've had other segments like this with advocates for the libraries, for education programs, for community cultural institutions. You can say cut the police, as your press release did, as that last caller did, but I think the percentage of the overall budget is under 10% plus other uniform public safety totals 11% of the budget. Can all come from there. How do you see yourselves in the context of so many worthy city services and a revenue shortfall projected for the new fiscal year?

Nia Nottage: Thanks, Brian. I believe that the health budget for the city is around 1% of the entire budget. I know it's been said that we are trying to keep most of these programs not to affect direct services, but that's why I'm trying to focus specifically on the clinics as one place where this is hitting New Yorkers directly. At our town hall on Thursday, we actually had the Commissioner of the Department of Health's Bureau of Public Health Clinics, Joaquin Aracena come to confirm that the reason that we're not seeing HIV PrEP, mpox vaccines, COVID, PCR testing, abortion, birth control services, and STI treatment and testing at these free clinics in each borough as a one-stop shop, it's just because of lack of funding.

These clinics are really important because they're free, they don't take insurance or ID, and so they're the only place in the city to go to receive these health services for low-income people, uninsured, teens, houseless people. The PCR clinics have not received any funding from the city, and are set to close by July. Most of them already have. We only have one right now, which is in Crown Heights that's just barely hanging on.

Brian Lehrer: Do we need those anymore? Listeners may be wondering, "Oh, the PCR test. I remember those." Now everybody takes their test at home.

Nia Nottage: The problem is that for diseases like long COVID, in order to get treatment for them, if you don't have a valid PCR test, then a lot of it's like you're not accepted at these new experimental clinics. That means that anyone who's underinsured, uninsured, pretty much the poor, have no hope of treating themselves if they contract long COVID. Also, COVID has more severe impacts for people with HIV. It's exacerbating the HIV pandemic as well.

Brandon Cuicchi: Brian, we do want to see the COVID clinics and PCR testing wrapped into the services of our normal sexual health clinics. It was very unusual, I would say, that we had sexual health clinics that became COVID vaccine centers exclusively. It seemed like the Department of Health and Mental Hygiene was pitting COVID against sexual health. We believe that those can all be wrapped into the same services at the same clinic. There's no reason that we have to pick and choose between COVID or sexual health or general health. There's absolutely no reason those all can't be wrapped into one clinic and service.

Brian Lehrer: Listener writes in a text message, pretty straightforward question, "Why are the Black and Latino communities being hit so hard by HIV?" Brandon?

Brandon Cuicchi: Traditionally, they I have been underserved by things like sexual health clinics, which we currently have only one of in each borough. Also, I can say that the education in high schools has been plagued by misinformation, outdated information, reluctance to share sexual health information in schools. ACT UP before the pandemic, we visited a high school-- I visited personally a high school in Chelsea, New York, in Manhattan. Many of the students, and even a couple of the teachers, were operating under outdated misinformation from the 1980s.

If our schools are not up to date with the information on pre-exposure prophylaxis or PrEP, if we don't have sexual health clinics more frequently in boroughs with, might I add, hours operating outside of school, because how are young people, how are students supposed to access services if they're only open Monday through Friday, 8:30 to 3:30? This has been falling on the backs of marginalized and poor communities for decades. We need the city to step up. We need Mayor Adams to step up. He's eager to talk about public safety and consistently maintaining the NYPD's annual budget of $100 billion a year, but he's ignoring the health and sexual safety of New Yorkers with these millions in cuts to health care and HIV and AIDS. It's really on Mayor Adams to step up and provide all of this for New Yorkers.

Brian Lehrer: Nia, anything to add about why the particularly vulnerable groups are the particularly vulnerable groups?

Nia Nottage: It's because places like these clinics that they would go are always at the avant-garde of being closed. We only see people who have higher income and are able to access really nice health insurance that doesn't put them in these smaller clinics like Callen-Lorde or Apicha, and they don't have to rely on free city services. Those are the people who can take care of themselves in the city.

Brian Lehrer: By the way, here's, before we run out of time, an example of how so many worthy things compete for the same finite dollars. Listener writes, "HIV/AIDS gets funded at a significantly higher level than multi-drug resistant bacterial infections, which kill more New Yorkers than HIV/AIDS, and PrEP, the medication, is free." Listener writes as a member of the American Academy of Microbiology, they say. I don't know. Those comparisons, they're heartbreaking, and I don't know where we go after that. What are you thinking listening to that? Nia?

Nia Nottage: That sounds like another part of the 75 million in health department cuts that we're facing, because it's all this, and that's 1% of the budget.

Brian Lehrer: Last question. Brandon, do you have allies on City Council? Because that's where the rubber meets the road on this. The negotiation is between City Council and the mayor for what will be in and what will be out of the new budget for the fiscal year that begins at the end of the month. Do you have overwhelming support or majority support on City Council, veto-proof support on City Council to make sure these clinics and the other things you're raising awareness about are in? Or how's your allyship on Council?

Brandon Cuicchi: We have some support on City Council. I don't believe we have veto proof support on City Council. We need all New Yorkers to call their City Council members and the mayor's office and tell them that we want the $75 million in Health Department budget cuts that are being proposed in the upcoming fiscal year restored, and definitely the $5.3 million that are earmarked for HIV and AIDS. It's really on New Yorkers now. We have to step up. We have to make our voices heard. We have to make a lot of noise, or these budgets are going to go away, and they may never come back again.

Brian Lehrer: Brandon Cuicchi and Nia Nottage, co-organizers for ACT UP, which is still acting up. Thank you very much for joining us today.

Brandon Cuicchi: Thank you, Brian.

Nia Nottage: Thank you so much, Brian.

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