Needs Assessment Committee Meeting December 14, 2023

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Members Present: Emma Kaywin (Co-chair), Marcy Thompson (Co-chair), Graham Harriman (Governmental – chair), John Schoepp, Steven Wilcox, Freddy Molano, Marcy Sedlacek, David Martin, Arthur Fitting, Fay Barrett, Billy Fields, Beth Hribar, Raffi Babakhanian, Reginald Brown, Jennifer Irwin, Vanessa Decamps, Rasheed Ford, Reginald Brown, Alan Peralta, Mayra Gilborn, Maria Rodriques, Claire Simon, Beth Hbirar

DOHMH, PHS, NYS, CHAIN and Other Staff Present: Doienne Saab, Kimbirly Mack, Connor Reynolds, Adrianna Eppinger-Meiering, Maiko Yomogida, Amanda Lugg, Prima Manandhar-Sasaki, Nadine Alexander, Kaylee Lamarche, Monika Pathak, Patrick Padgen, Max Hadler, Albert Medina, Christina Rodriguez, Lily Ha, Alberto Medina

Agenda Item #1: Moment of Silence/Minutes:

Emma Kaywin and Marcy Thompson opened the meeting with a brief introduction of new and existing committee members, staff and guests. Raffi led the moment of silence. Marcy announced Graham Harriman’s departure as Governmental-Chair to the NY HIV Planning Council. The minutes of the July 13th meeting were approved with no changes.

Agenda Item #2: Introduction to NAC and Update on Workplan  

Doienne Saab provided a refresher to the Cmte.’s goals of the 2022-2023 Needs Assessment to update members on the origin of the emerging topics that were prioritized in the Cmte. July’s 2023 meeting. She explained that the Cmte. will develop a set of recommendations to address gaps in HIV care and related supportive services for immigrant/asylum seeker/migrant/undocumented communities of NYC, through information gathering to inform current RWPA programming. She also mentioned that there is an interest for this Cmte. to collaborate with the NYC Health Department’s HIV Testing Initiative Team, New York Knows – Immigrant Health Alliance, to host an Immigrant Health Townhall on issues impacting immigrant communities’ access to sexual health services. The introduction was followed by presentations from Prima of the NYC Health Department, Amanda Lugg of African Services Committee and Daniel Pichinson of Ryan Health – Chelsea/Clinton. 

Agenda Item #2: Guest Presentations – Immigrant Health/Asylum Seeker Communities of NYC  

2a. HIV among people born outside of the U.S. in NYC, 2022 data Prima highlighted the epidemiological trends among people born outside of the U.S., the care outcomes among newly diagnosed with HIV and living with HIV. The number of new HIV diagnoses among people born outside of the U.S. decreased by 37% from 2018 to 2022 in New York City. The basic statistics of HIV among people born outside of the U.S. includes 408 people newly diagnosed with HIV, 309 people newly diagnosed with AIDS, 20,500 people with HIV, and 251 deaths (6.0 deaths per 1,000 people with HIV) among people with HIV. It was noted that between 2018 and 2022, there was a 137% increase in people newly diagnosed with HIV with an unknown place of birth, which complicates interpretation of the data. The proportion of new HIV diagnoses among people born outside of the U.S. by region of origin was highest people from the Caribbean, South America, and Mexico/Central America. Men consistently experienced the highest number of new HIV diagnoses, representing 77% of new diagnoses among people born outside the U.S. in 2022.  Latino/Hispanic people consistently experienced the highest number of new HIV diagnoses, representing 59% of new diagnoses among people born outside the U.S. in 2022. People aged 20 to 39 years consistently experienced the highest number of new HIV diagnoses, representing a combined 62% of new diagnoses among people born outside the U.S. in 2022. Men who have sex with men consistently experienced the highest number of new HIV diagnoses, representing 54% of new diagnoses among people born outside the U.S. in 2022. Timely initiation of care among people born outside of the U.S. increased five percentage points from 2018 to 2022. Viral suppression among people born outside of the U.S. increased two percentage points, and was 4% higher than U.S. born people in New York City from 2018 to 2022.  Raffi B. expressed concern about the extent of the situation involving newly arrived people in New York and questioned whether there was a way to differentiate between long-term residents and recent arrivals. Daniel responded, stating that the Department of Health ACE team collects data on when people move to New York and the United States, but this data is not included in their standard dataset. A data request to access this information can be submitted. There was expressed interest by the Cmte to have access to HIV testing data (including at home testing) by a person regardless of test result outcome. Doienne to find out if this data can be requested by the Department of Health’s HIV Prevention Program.   2b. CBO and Non-Profit Service to Immigrant/Recent Asylee Communities   Amanda Lugg, Executive Director – African Services Committee (ASC) gave a background to the health, housing, legal, educational and self-sufficiency services provided to African and Caribbean immigrants, refugees and asylees impacted by displacement, socio-political oppression, and discrimination. Amanda also highlighted the partnerships with other community groups, the increased demand for services, and the organization’s initiatives to promote mental well-being and resilience Daniel Pichinson, Executive Director – Ryan Health Chelsea-Clinton gave a background .   He also described the work flow process for 2c. Language Barriers Amanda L. noted a significant increase in the number of Africans seeking assistance, particularly from West Africa and Central Africa, and the language barriers this presents for newly arrived clients. She mentioned that the language barriers are compounded by ASC’s temporary shutdown of legal services due to staff vacancies, and the lack of French speakers to provide language translation services. Providing services to clients belonging to the Senegalese community has been significantly challenging due to the lack of written translations in their primary language, Wolof. She noted the need for Wolof-speaking staff to cater to this population. Dan, from the Ryan Chelsea Clinton Community Health Center, echoed Amanda’s concerns about the language barrier, particularly regarding the Wolof-speaking population.   The issue of migrants obtaining insurance cards but not fully understanding their healthcare rights was also discussed, regardless of . They emphasized that their center provides care to everyone, regardless of their ability to pay or insurance status.   and Service Demand Increase   Workflow and Healthcare Challenges for Asylum Seekers in New York Dan discussed the challenges faced in managing the workflow for handling asylum seekers in New York, focusing on documentation and health records. They highlighted the issues of language barriers and the loss of health records during journeys, which can affect the duration of visits. Dan also emphasized the immediate needs of asylum seekers, such as getting their children into school and accessing work opportunities. They concluded by mentioning that asylum seekers are eligible for Medicaid in New York State. Additionally, Dan discussed the challenges faced by their healthcare center due to the influx of patients, including increased costs, longer waiting times, and strains on resources. They highlighted the difficulties in managing interpretation services and navigating patients through the complex healthcare system.   Health System Inequities and Asylum Seeker Challenges They highlighted the lack of French-speaking social workers and the lack of a functioning health system in their countries of origin as contributing factors. Dan also mentioned the capacity issues at their health center near the Port Authority bus terminal due to the influx of asylum seekers and the need for additional financial support for interpretation services, patient navigators, and mental health services. Marcy expressed gratitude for Dan’s team’s efforts and acknowledged the heartbreaking nature of the stories shared.   Workflow, Stakeholder Engagement, and Immigrant Impact Discussion The team discussed the workflow on slide 7, particularly the policy of not seeing more than one family member at a time, with John expressing confusion and Dan explaining the rationale behind it. They also highlighted the challenge of balancing the needs of sick children and the importance of stakeholder engagement, with Amanda suggesting starting a community-based initiative in the New Year and Dan proposing a role for elected officials. The team agreed to focus on stakeholder engagement in the New Year. There was also a discussion about the impact of the influx of immigrants on their regular customers, with Amanda clarifying that the newcomers are predominantly walk-in clients and their services have not been affected.   LGBTQ+ Mental Health Capacity Concerns Dan and Amanda discussed the increased number of patients, especially from the LGBTQ community, at the healthcare center. Raffi raised concerns about capacity issues, particularly in mental health services, and suggested proactive training of peers. Amanda mentioned a budget increase for encouraging minority communities to enroll in mental health degrees. They also discussed the challenges of collecting data due to the lack of an agency-wide database and concerns about data safety. They agreed on the potential benefits of using bilingual peer navigators to assist with mental health services.   Asylum Seekers’ Legal Support and Demographics Amanda, David, Dan, Marcy, Raffi, and Doienne discussed the need for improved country demographics and increased legal services for asylum seekers. They highlighted the lack of information about the asylum process among asylum seekers, which can negatively impact their status. The team suggested specifying the type of legal support provided due to increased demand for immigration-related legal services. Amanda proposed revisiting the issue in a few months to assess evolving needs. The team also discussed the importance of language services, with Amanda suggesting a language capacity survey by Amoa. The next meeting was scheduled for January 11th.   Next steps Amanda will explore ways to create a navigation system for asylum seekers, taking into account their trauma and distrust of the system. Advocate for additional financial support for interpretation services and patient navigators. Amanda will follow up with Councilmember Stevens about the Town Hall information. David will look into who to contact at HRA about the language needs survey.    2B. Coordinating Health Services The subcommittee discussed the importance of coordinating health services for migrants with a specific focus on STIs and HIV service referrals and screenings. Concern was expressed about the lack of initial health screenings for individuals entering the country. Several members suggested the need for a visual workflow to better understand the process one goes through when seeking assistance through the various City coordination sites for asylum seekers.  Doienne requested a map to track the path of someone seeking asylum or healthcare services. Monika agreed to help find a solution, while Max clarified that such a map does not currently exist in his office. Doienne agreed to start a draft on a workflow process map with the subcommittee’s feedback. The subcommittee recognized the involvement of multiple city agencies and considered collaborating with the New York Immigrant Coalition for a comprehensive view. Marcy proposed the formation of a subcommittee as a next step and highlighted the need for a document illustrating the current interactions between key stakeholders like DHS, HPD, and HHC. 2C. Costs and Funding There was an expressed interest in the daily or monthly-per person costs associated with housing migrants, which Max and Monika agreed to investigate. Beth Hribar noted that the Department of Homeless Services used to receive $3,000 a month per family in 2010. Max estimated that the influx of migrant cost to the City over the past three years is estimated at around 12 billion dollars, based on public reporting. Mayra Gilborn discussed the high cost of running the three sanctuary shelters for families being operated at privately owned hotels. She mentioned that the cost for these shelters is more than that of the regular family homeless system in NYS. Marcy highlighted the need for a more coordinated approach and questioned the best use of funding. 2E. Migrant Response Outside of NYC Doienne asked if there were any conversations between NYC and other Right to Shelter jurisdictions (outside of NYC) to coordinate efforts to offer the newly arrived with the option of settling elsewhere. Monika confirmed that there’s been some coordination with other counties within NYS, however no coordinated effort with out of state jurisdictions. Beth asked if there were any good models for managing the migrant crisis, and Max mentioned that refugee resettlement programs have good models that incorporate a lot of services. However, he noted that scaling these models for the size of the population of NYC and with urgency posed a challenge. Marcy asked about the process of completing applications for migrants and whether they are done electronically or with hard copies. 2F. Attitudes and Perceptions The subcommittee discussed the historical rhetoric of racist immigration policies and the need to address misconceptions about immigration to avoid perpetuating hate, stigma, and xenophobia among towards this community. Graham discussed the poor attitude of people in shelters and how it negatively impacts how sites are operated. He also mentioned that these City sites are often overstaffed, leaving many with nothing to do during work shifts. He suggested that the funding used to pay third-party staffing companies be used more efficiently to better meet the many and dire resources needed by migrants. The subcommittee also discussed the need for better communication and understanding of the situation. Graham mentioned that we should approach this issue from a position of compassion. Others agreed that this issue presented numerous opportunities and was a matter of human rights and social justice.  

Agenda Item #3: Public Comments and Announcements

There being no further discussion, the meeting was adjourned.