Office of HIV/AIDS Policy

Promotes HIV Testing

• " DOHMH Public Health Laboratory conducts more than 120,000 HIV test each year, approximately half of all HIV tests in the city. Eleven STD clinics and counseling and testing sites run by DOHMH offer free confidential and anonymous HIV testing. These sites conducted 32,660 HIV tests in 2002.

Monitors trends in the HIV epidemic through surveillance for HIV/AIDS

• Surveillance for HIV/AIDS cases is conducted in 62 hospitals, 600 free standing clinics and 1,500 private medical doctors offices. In 2002, 7000 new HIV cases and 5000 AIDS cases were diagnosed and reported.
• Surveillance data are used to secure federal and state funding for HIV prevention ($>20 million) annually and federal HIV/AIDS Ryan White treatment ($104 million annually).
• Special surveillance studies are conducted to better understand and control the epidemic in high-risk populations.
• A new laboratory technique ("detuned assay") is being introduced to help identify diagnosed persons who are newly infected with HIV.

Allocates prevention resources within the DOHMH and the community to those populations at greatest need

• In conjunction with the HIV Prevention Planning Group, New York City's $33 million in prevention dollars are allocated based on the distribution of HIV/AIDS cases. Prevention services are directed to high-risk populations such as sex workers, injection drug users, and prisoners. Services include street outreach, individual- or group-level risk reduction, prevention case management, and capacity building in communities to deliver and evaluate services
• Nearly $17 million prevention dollars are allocated to contracts with over 60 community-based organizations that provided almost 500,000 service encounters in 2002.
• DOHMH devotes an additional $16 million in prevention funds to directly operated programs including the Office of Correction AIDS Prevention (OCAP) on Riker's Island, Women and HIV/AIDS Initiative, and Health Media and Marketing which produced media campaigns like the "BYOC (Bring your own condom) campaign.
• Contracts with CBOs are monitored through monthly reports to ensure that they reach target populations in agreed upon service areas.
• Almost 3,000 individuals from City and community-based agencies are trained annually by the HIV Training Institute to provide counseling, testing and related services to people affected by HIV/AIDS.

Promotes access to medical care, treatment, and support of HIV infected persons

• In conjunction with the Office of HIV/AIDS Policy Coordination, more than $103 million in Ryan White funds were distributed in Ryan White funds were distributed to provide health and support services for New Yorkers living with HIV and AIDS who are uninsured and underinsured.
• Title I Ryan White funds support 300 contracts in 37 program categories and reach 94, 872 clients. Services provided include outpatient medical and dental care, rehabilitative services, home health and hospice care, transportation and housing assistance.
• Ninety percent of Title I care dollars are directed to Black and Hispanic New Yorkers, the groups most affected by the HIV/AIDS epidemic.

HOPWA Program Overview
I. The National HOPWA Program
The Housing Opportunities for Persons With AIDS (HOPWA) program is a federally-financed grant program that provides housing assistance and related supportive services for persons with HIV/AIDS and their families. HOPWA was established within the U.S. Department of Housing and Urban Development (HUD) by the National Affordable Housing Act of 1990. HOPWA has helped countless persons managing their HIV infection to avoid homelessness by addressing their needs for housing and access to medical and other care. Programs support everything from the construction of new housing units to social services, such as independent living skills training. According to the legislative history of the National Affordable Housing Act, HOPWA was developed with an understanding that housing is the cornerstone of a comprehensive continuum of care for people with HIV/AIDS.

In Federal Fiscal Year 2003, $259.304 million in formula funds were distributed to 75 eligible metropolitan statistical areas and 36 eligible States (for areas outside of the EMSAs). Under the HOPWA formula, 75% of available funds are distributed to qualifying cities and eligible States based on their proportionate share of cumulative AIDS cases. The remaining 25% of formula funds are distributed to qualifying cities that have a higher than average incidence of new AIDS cases for the prior year. Eligible areas must have at least 1,500 cumulative cases of AIDS. Also in FY '03, an additional $28.8 million was awarded under a national competitive application process.

II. New York's HOPWA Program
The Office of HIV/AIDS Policy Coordination (OAPC) is the officially designated grantee for the HOPWA formula grant for the New York City Eligible Metropolitan Statistical Area (EMSA). In this capacity, OAPC oversees and monitors the planning and delivery of HOPWA-funded housing and supportive service programs by City agencies and other project sponsors throughout the EMSA. Currently, the New York City EMSA is comprised of the five boroughs together with the counties of Westchester, Putnam and Rockland. However, beginning in HOPWA Year 13 (4/1/04 - 3/31/05), the EMSA will be expanded to also include Bergen, Hudson and Passaic Counties in New Jersey.

OAPC convenes regular meetings with HOPWA-funded City agencies to ensure effective collaborative planning and execution of the HOPWA grant. OAPC also receives from City agencies utilizing HOPWA funds detailed reports on their use of these funds during the previous year and their plans for proposed HOPWA programming in the upcoming year. These meetings focus on setting specific priorities and recommended spending levels based upon anticipated HOPWA and City Tax Levy revenues. The role of OAPC as the designated grantee includes negotiation and oversight of the planning, implementation, and monitoring of the use of HOPWA funds for capital development of HIV/AIDS housing projects as well as for delivery of housing and related supportive services.

Acting on behalf of the entire EMSA, the City applies for HOPWA funding as a part of its annual Consolidated Plan submission to HUD. Pursuant to HUD regulations governing the consolidated planning process, OAPC is required to solicit community advisory input into the development of the HOPWA portions of the Consolidated Plan. For this purpose, the Housing Work Group of the Ryan White HIV Health and Human Services Planning Council serves in a dual role as the HOPWA Advisory Committee (HAC), the identified vehicle for citizen participation in the HOPWA planning process. The HAC makes its formal recommendations to OAPC, which incorporates this input - along with citizen testimony received during two annual symposia and public hearings sponsored annually by the Department of City Planning - as appropriate in the development of the Consolidated Plan. The Housing Work Group/HOPWA Advisory Committee meets monthly throughout the year to monitor Ryan White and HOPWA programs and develop a work-plan for its strategic planning process. During the HOPWA strategic planning cycle, the HAC meets more frequently to formulate advice and recommendations for the allocation and administration of HOPWA formula grant funds.

The HAC's deliberations are informed by the participation of consumers and service providers, as well as current research, including formal data presentations from the Community Health Advisory Information Network (C.H.A.I.N.) (Initiated in 1994, C.H.A.I.N. is the only longitudinal study of people living with AIDS in the United States.). Other published data sources include, but are not limited to, epidemiological profiles, assessment of the service needs of affected populations, resource inventories, provider profiles, assessments of gaps in services, a description of the existing continuum of care, client utilization and program monitoring data, reports on ongoing longitudinal studies, reports and surveys of client satisfaction, and reports on community forums.

For HOPWA Year 12 (4/1/03 - 3/31/04), the New York City EMSA received $60,315,000 in HOPWA formula grant funding. HOPWA funds are currently used to support the following programs and services:

HIV/AIDS Services Administration (HASA)- HASA uses the preponderance of its HOPWA funds for case management personnel. The agency also devotes HOPWA funds for housing placement staff, SRO inspectors, contracts and procurement staff, transportation, quality assurance, training, automation, and operating contracts for transitional housing. Department of Housing Preservation and Development (HPD)- Through its Supportive Housing Loan Program, HPD is responsible for developing and arranging capital funding for the acquisition and renovation of buildings that are then owned and operated by non-profit community-based organizations that specialize in providing housing and supportive services for persons with HIV/AIDS. Department of Health and Mental Hygiene (DOMH)- Through its Division of Mental Hygiene, DOMH funds contracts with three community-based organizations to provide permanent housing programs for persons with dual and triple diagnoses of HIV/AIDS, chronic mental illness and/or substance abuse. One program operates a scattered-site housing program for HIV+ women with mental illness, including both single women and those with children. The other two programs operate scattered site housing for single adults. In addition, DOHMH has recently released a request for proposals that will fund two additional supportive housing contracts for dually and triply diagnosed consumers. HOPWA Master Contractor- OAPC holds a HOPWA Master Contract with the Postgraduate Center for Mental Health (PCMH). Under this master contract, PCMH is responsible for developing and maintaining a portfolio of over 35 subcontracts with community-based organizations that provide a wide array of housing programs and housing-related services for individuals and families with HIV/AIDS. This portfolio currently includes seven supportive housing program categories for special needs populations as well as programs that provide housing placement assistance, food and nutrition services, harm reduction outreach, independent living skills training, vocational training services, emergency and short term rental assistance, and technical assistance for HIV/AIDS services providers. The Master Contract is also funding a comprehensive HIV/AIDS housing needs assessment study for the New York City EMSA. This study will produce the data analysis and policy recommendations necessary to guide the continued growth and development of the City's HIV/AIDS housing system. Lower Hudson Valley Counties- In addition to the five boroughs of New York City, the EMSA also covers the three counties of Putnam, Rockland and Westchester. Together, these jurisdictions use HOPWA funds to support a wide range of activities, including rental assistance; case management; housing placement; short-term rent, mortgage and utility payments to prevent eviction; capital development; counseling; and nutritional services. As the grantee, OAPC works with these jurisdictions to plan and evaluate their use of HOPWA funds and to ensure the consistency of their efforts with those of the rest of the EMSA.