Tri-County Steering Committee Minutes December 11, 2024

TRI-COUNTY STEERING COMMITTEE MEETING

December 11, 2024, 10:00-11:30am

By Zoom Videoconference

Members Present:       L. Cyrus (Co-chair), J. Palmer (Co-chair), V. Alvarez, M. Diaz., L M. Acevedo, J. Braithwaite, V. Carlone, J. Gago, J. Gobler, B. Malloy, A. Milian, K. Palencia-Lua, A. Pizarro, K. Scott

Members Absent:      R. Agarwal, L. Best, L. Bucknor, A. Contreras, A. Desir, P. Germinaro, L. Hakim, A. Hardman, K. Mandel, A. Ruggiero, S. Servadio, S.Thomas

Guest Present:               M. Yomogida

Staff Present:                  NYC DOHMH: D. Klotz, D. Saab, M. Navejas, J. Acosta, S. Kramer, S. Spiegler, H.K. Mok

Agenda Item # 1-3: Opening/Moment of Silence/Minutes/Public Comment

Julian P. and LaShonda C. opened the meeting followed by introductions and a moment of silence. The minutes for November 13^th, 2024 meeting were approved.     

During public comment Julian P. expressed his agency’s concern around the implementation of Social Care Networks (SCNs) and how those services would align with those provided by Ryan White Part Afor the Tri-County region. He asked TCSC members if their organizations were joining the SCNs and if so, how they were planning and preparing for its implementation. He also asked if members would be interested in learning more from the SCNs Regional Administrator on SCNs and how the program would align with services already provided by RWPA. Some members expressed that they are already preparing for SCNs by working closely with their leadership teams and attending regional planning meetings on the topic. Overall, most TCSC members shared that they would like additional information on the SCNs at an upcoming TCSC to discuss and ask their questions concerning SCNs and RWPA services, as well as the State’s guidance and support to implement this program.

Agenda Item #4: Updates

Recipient Report

Johanna A. reported news from HRSA and other federal partners, including commemorating World AIDS Day and Homelessness Awareness Month. Changes in Medicare Part D will significantly reduce prescription costs, including those paid for by ADAP and other Ryan White programs. HRSA HAB launched a new webpage dedicated to information about the Ryan White Program 2030, which prioritize efforts to reach PWH who are out of care and not virally suppressed by leveraging partnerships, focusing interventions, and engaging community to end the HIV epidemic. Sessions and materials from the August National Ryan White Conference have been posted online. DOHMH has made 27 awards under the Behavioral Health request for proposals (RFP) for programs beginning March 1, 2025. The Behavioral Health service categories are Mental Health Services, Supportive Counseling Services, and Harm Reduction Services, funded at a total of $13,203,171 annually. One award was also made for Non-Medical Case Management Services for Currently and Recently Incarcerated PWH at a total of $1,436,644 annually (the rest of the service category allocation goes to H+H Correctional Health for services on Riker’s Island). A list of the awardees was provided.

On October 22, the DOHMH HIV Care and Treatment Program (CTP) successfully submitted the HRSA Ending the HIV Epidemic (EHE) in the U.S. – Ryan White HIV/AIDS Program Parts A and B grant application. CTP applied for the ceiling amount totaling $16,700,000 for year one (effective March 1, 2025) and a total of $112,311,308 for the five-year period of performance for the grant. Final allocations are dependent on appropriations and grant application scoring. the EHE initiative expands the program’s ability to meet the needs of clients, specifically focusing on linking PWH who are either newly diagnosed, diagnosed but currently not in care, or are diagnosed and in care but not yet virally suppressed, to the essential HIV care, treatment, and support services needed to help them reach viral suppression in the four boroughs of Brooklyn, Bronx, Manhattan, and Queens. From October 21-24, 2024, CTP delivered a four-day training with RWHAP Part A Care Coordination 22 subrecipients throughout the Lower Hudson Valley (Tri-County) region. The NY EMA Quality Management (QM) Program delivered a new quality improvement training on October 11 entitled, Addressing Stigmatizing Language in Healthcare Settings and Care Services Documentation. On December 4, DOHMH hosted its World AIDS Day 2024 citywide event at Brooklyn Public Library. On December 4, the New York City Health Department released new user’s guides on HIV testing, daily PrEP, injectable PrEP, PrEP on demand, and emergency PEP, and two new infographics: A Snapshot of HIV Among Women in New York City, 2023, and A Snapshot of HIV Among People Ages 50 and Older in New York City, 2023. These new materials join the new PrEP Prevents HIV pocket guide in multiple languages. DOHMH also released data on drug overdose deaths.

On October 21, Dr. Michelle Morse became Acting Health Commissioner for the New York City Health Department following Dr. Ashwin Vasan’s departure. Dr. Morse also serves as the agency’s inaugural Chief Medical Officer.

Planning Council Update

David K.  announced that the November and December full NY HIV Planning Council was the first hybrid session in a year, with 30 in-person attendees and others joining virtually. The Council approved the revised Emergency Financial Assistance (EFA) services to ensure that there are geographically accessible programs in both NYC and the Tri-County region starting in March 2026. The Priority Resource and Spending Allocation Committee are reviewing the 2025 Spending Scenario Planning in preparation for worst-case funding reductions due to federal budged budget uncertainties. The Integration of Care Committee is currently revising the Medical Case Management – Care Coordination service directive.

Agenda Item #5: Presentation –  Grant Year 2025 Spending Scenario Plan

Doienne S.provided an overview of the Grant Year (GY) 2025 Spending Scenario Plan as a precursor to a more in-depth discussion and vote during the next TCSC monthly meeting. She reminded members that for each planning year, the steering committee reviews the spending scenario plan for the year ahead, to strategize and prepare for potential funding adjustments under reduced funding cuts and/or conditions. Doienne S. displayed the GY 2025 Spending Scenario Plan, which showed a total of  $4,469,82 for TC program funding in 2024 (5.9% of the NY EMA’s overall program funds), reflecting no changes from the current spending plan.

She also highlighted that, as of Dec. 31, 2022, the TC region accounted for a smaller share of people with HIV (PWH), representing only 2.7% of living HIV cases in the EMA for 2022. As a reminder, Doienne S. noted that members will need to make a recommendation for the allocation of Ryan White Part A funds in the TC region should there be any reduction in the grant award at the January 2025 TCSC meeting. Both City and TC will be making worse case scenario planning decisions for GY 2025 Spending.

Agenda Item #6: Presentation – Needs Assessment Committee’s Recommendations to Enhance RWPA Services for People Involved in Sex Work

Doienne S. presented a set of recommendations developed by the Needs Assessment Committee (NAC) on enhancing and improving RWPA services for People involved in Sex Work. She described the process used to develop the recommendations which included compiling knowledge from literature reviews and presentations delivered to the NAC from May to Oct. Several big picture themes were drafted and shared during each meeting, including sex work criminalization, client-centered care and autonomy, harm reduction and improvement and engagement strategies to develop each of the recommendations. 

1. Theme – Sex Work Criminalization
2. The Recipient should emphasize to RWPA providers the importance of patient/client privacy, confidentiality, and informed consent. RWPA providers are encouraged to make the disclosure of a patient’s profession optional and must never disclose this information to others, including authorities, nor document it in the patient’s chart. It is crucial that RWPA providers collaborate with the patient to ensure they are comfortable with any information being recorded or documented during their visit.
3. The Recipient should provide RWPA providers with the necessary resources and tools to deliver services in a way that protects and upholds the human rights of all sex workers (see: UNAIDS released statement in solidarity with sex workers) . 
4. The Recipient should ensure that RWPA providers are trained on non-discrimination and the rights of sex workers to access high-quality, non-coercive care, while also guaranteeing confidentiality and informed consent (suggested resource: Amnesty International Policy on State Obligations to Respect, Protect and Fulfil the Human Rights of Sex Workers).
5. The Recipient should encourage RWPA providers to inform their clients about the anonymous reporting tool from the NYC Commission on Human Rights, which can be used to report instances of discrimination in businesses, workplaces, housing, or public accommodations (see online form or call (212) 416 – 0197). Additionally, encourage RWPA providers should also be encouraged to promote the NYC Health Department’s LGBTQ Bill of Rights to both providers and clients.

• Assign a Recipient staff to regularly attend NYC Health Department Sex Work/er Workgroup (WG) meetings to stay informed on strategies, legal developments, and policy issues (e.g., DecrimNY, Sex Worker Protection Act) related to the health and safety of sex workers in the NY EMA.

1. Theme – Patient-Centered Care and Patient Autonomy
2. The Recipient should ensure RWPA providers coordinate real-time training calendars and resources focused on crisis counseling, psychological first aid, and trauma-informed care for all RWPA provider staff. These trainings will help staff understand the specific behavioral and mental health needs of sex worker clients (as outlined in the NY EMA Framing Directive).
3. Theme – Harm Reduction
4. RWPA providers should have free naloxone kits, drug testing strips and other drug checking reagents for Fentanyl or Xylazine available at their sites and provide clients with training on how to use harm reduction materials. RWPA staff should also receive training on overdose prevention education. For more information on obtaining kits, strips, or trainings, visit nyc.gov/naloxone ; https://oasas.ny.gov/prevent-overdose ; NYS AIDS Institute .
5. RWPA providers should provide and make available safer sex and hygiene kits and materials to clients who express a desire or need. Suggested items can include a variety of condom options (e.g., internal, external, lubricated, un-lubricated, non-latex, flavored, vary sizes and brands), lube packets, tampons, band aids/finger cots, Q-tips, snacks, travel-size – handi-wipes, hand sanitizer, mouth wash, toothbrush/paste, pipes for drug use rather than syringes e.g., safer smoking supplies are essential items to include in sex worker kits at their agency locations. 
6. Improve and Strengthen Engagement
7. Recommend that RWPA providers engage and consult with community-led sex work organizations and programs to gain insights, enhance engagement within this population for reducing sex work-related stigma and harm (see slide 9 for suggested programs). 
8. The Recipient should develop and distribute a comprehensive list of community-led sex worker advocacy groups, organizations, and programs to connect clients seeking additional services and support within the community (see slide 9 for suggested programs). 

Lastly, Doienne S. highlighted Cecilia Gentili’s Coin Clinic, National Harm Reduction Coalition, Urban Justice Center, and Red Umbrella Fund community-informed, sex-worker led organizations as exemplary programs providing rich information and resources to promote and support the health and safety of sex workers.

Agenda Item #7: Adjournment

The meeting concluded with expressions of gratitude and holiday wishes. The next meeting will occur on January 8^th, 2024, from 10- 11:30 am. There being no further business, the meeting was adjourned.