Governor Cuomo V. The Supreme Court!

I highly doubt Governor Andrew Cuomo has read my novel, but his recent announcement of a three-point plan called “Bending The Curve,” reads like he has.  At the very least, Cuomo is listening to AIDS activists in a way that few politicians (outside of President Obama), have listened in the past two decades.   His announcement of the plan, outlined in the New York Times last week, on Gay Pride was clearly an appeal to gay male voters, but I say, if any politician wants to pander with a bold move like this, then let them appeal away.  I for one, am grateful to see someone at a state level stepping up to the call for an AIDS Free Generation.

But I have to point out that even the New York Times coverage makes the plan seem PrEP-centered.  His plan involves more than just getting HIV Negative men to take PrEP.  It works because it is holistic, and attempts to provide for all.  In addition to PrEP, it also uses state money to find HIV positive people who are unaware of their status and to get them into effective treatment.  It also helps pay for effective treatment for people who are positive but can’t afford medication that suppresses their viral load and keep them undetectable.  Studies indicate that an undetectable viral load makes it almost impossible for the infected person to spread HIV.   For any plan to bring an effective end to HIV in the US, both strategies are needed.  You can read more about the reasons why these are both important in my blog about National HIV Testing Day.  

Cuomo’s plan is simple, straightforward and it makes good fiscal sense. Cuomo has sold his plan as a fiscal investment, outlining that an outlay of cash now, saves the state money later when the total population of people infected with HIV is reduced.  But a large assumption of this plan assumes that many of these people will be covered by health insurance from employer benefits. 

What is most fascinating about Cuomo’s plan is that it came mere hours before the Hobby Lobby decision of the Supreme Court.  The decision of the Supreme Court sets a precedent that allows employers to exclude medical treatment they find morally objectionable based on the religion of the company’s owners.   While this decision first and foremost effects women and their reproductive rights, many have begun to speculate on the way it might have a trickle-down impact LBGT people, PrEP users everywhere, and other “morally objectionable” health care needs.

What happens to a plan like Cuomo’s if and when employers choose to use religious grounds as a reason not to cover PrEP or other STD related drugs?  Could that undermine Cuomo’s sales pitch that the state’s investment in “Bending The Curve” is worth the cost? I grew up in a world where AIDS was seen as God’s retribution to the sin of homosexuality, and it is not at all hard for me to imagine someone taking this leap.  If employers begin to choose to interpret the ruling as a right to exclude HIV prevention treatments on so-called “moral” grounds, then a plan like Cuomo’ would get instantly more expensive.

None of us can predict how this will turn out.  But I for one am simply excited to see that this ball is in play at all.  As disappointed as I am in the Hobby Lobby ruling, I am equally glad to see Cuomo using his resources to call for an end to AIDS.  Living with HIV for the past two decades has meant drowning in a sea of apathy.  I have witnessed literally hundreds of gay men become positive when there was no need, but the near deafening apathy of our country did little to prevent the practices that gave them their results.  In announcing this plan, Cuomo has a new fan in me, if for no other reason than his insistence that more can and should be done to stop HIV.   

Leslie SmithComment