HEALTH

New AIDS czar faces tight budget

By DUNCAN OSBORNE

Speaking to thousands of AIDS advocates attending the Community Planning Leadership Summit on AIDS, Mayor Mike Bloomberg set two goals for his administration.

“First, to become the national model in leading the Centers for Disease Control and Prevention goal of reducing new H.I.V. infections in the United States by 50 percent by 2005 and, second, to provide the best H.I.V./AIDS care and treatment in the world,” he said at the March 13 event.

Dr. Thomas R. Frieden, commissioner of the Department of Health and Mental Hygiene, and Verna Eggleston, commissioner of the Human Resources Administration, were at the summit. Their departments oversee much of the city’s H.I.V. prevention and AIDS care services. With his commissioners standing nearby, Bloomberg announced his point man on those efforts.

“The challenge for achieving both of these goals is in Frank Oldham, Jr., our recently appointed citywide coordinator for AIDS policy,” he said. “He will insure that all city agencies, community organizations, medical providers, and partners are working together and I will be directly involved to make sure that New York has the most innovative, effective, and comprehensive plan to confront H.I.V./AIDS in our city’s history.”

That is a big job for an office that has a staff of roughly ten and an annual budget of $700,000.

“It is a monumental weight on your shoulders,” Oldham said in an April 10 interview at his City Hall office. “I am humbled completely by it.”

Oldham convenes a meeting with commissioners and assistant commissioners from several city agencies each month. His office also oversees the $104 million in federal funds distributed to the city under the Ryan White Comprehensive AIDS Resources Emergency Act and $60 million from the feds for AIDS housing.

“We have the mayor’s authority to work with the other agencies,” he said. “He has said that he would like to have all agencies involved in helping us reach this goal.”

Oldham, 54, was born and raised in Brooklyn. He attended the Brooklyn Academy, Rhodes Prep School, and graduated from New York University with a B.A. in English. He was pursuing a singing career in a band called Klaus when he lost two friends to AIDS. That experience moved him to join the fight against AIDS in 1988.

“I became the first assistant director of education at G.M.H.C.,” he said, referring to the Gay Men’s Health Crisis.

In 1989, he joined the city’s Health Department. Oldham held a series of jobs with increasing responsibility there until 1993, when he went to Washington, D.C. to head the AIDS programs for that city’s health department.

One year later he was back in New York for a four-year stint as the deputy assistant commissioner for H.I.V. Program Services. From 1998 through 2003, Oldham held senior positions with the Chicago health department, a Chicago non-profit, and, briefly, the Los Angeles Gay and Lesbian Center.

With his appointment in January as AIDS czar, Oldham has begun implementing Bloomberg’s vision.

“The first thing to do is assess what we have and we are doing that on a fast track,” he said. “What do we have? How much money are we spending? What programs exist? How effective are those programs?”

Achieving the mayor’s first goal of cutting new infections requires implementing effective H.I.V. prevention programs such as safe sex education and exchanging used needles for clean ones. The mayor endorsed needle exchange in his March 13 speech.

“We actually do know what to do,” Oldham said. “It’s not as if we have to learn what to do. It has to be far more intensive.”

The city wants more people getting tested for H.I.V. Testing leads to treatment and it can also indicate where new infections are increasing as a tool in directing H.I.V. prevention efforts.

“Increased numbers of people are in counseling and testing,” Oldham said. “They have to know their status.”

The need for better care was illustrated by a recent Health Department study. Among 42 city neighborhoods, the number of AIDS deaths per 1,000 AIDS or H.I.V. cases was 42.2, the second highest in the city, in Central Harlem-Morningside Heights and 15.9 in Chelsea-Clinton, New York City’s leading gay neighborhood. The number of new H.I.V. infections per 100,000 people was identical in both neighborhoods.

The highest death rate was in the Lower East Side at 43.9 deaths per 1,000 cases. The rate in the city’s poorest neighborhoods ranged from 41.6 in Crotonia-Tremont to 35.5 in Brooklyn’s East New York.

“The real indicator will be... when the rates of death in areas that are twice that of Chelsea become similar [to Chelsea’s],” Oldham said.

He must meet these goals while the city is dealing with multi-billion dollar shortfalls in its budget.

“These are not bad times, these are horrific times in terms of the city budget,” Oldham said after Bloomberg’s speech. “Part of our job will be to get new federal resources, state resources, and, when available, city resources. The commitment is there.”

But since Bloomberg’s speech, the city learned from the federal Health Resources and Services Administration that its most recent application for Ryan White funds had resulted in a $14 million cut. AIDS activists said the city had blown it.

“We feel that our application did meet H.R.S.A.’s requirements,” Oldham said. “We feel that it did not deserve a 12 percent reduction in funds or a $14 million cut.”

H.R.S.A. staff defended the cut in an April 9 meeting with Oldham and other city officers. The application was at fault, but New York also has roughly $14 million in unspent Ryan White funds that it has accumulated over the past four years.

“They based their case on the application, and also New York City has not spent AIDS money,” Oldham said. “We always have a lot of carryover. Those are things they used to rationalize what I considered a very unfair cut.”

The Ryan White cut was the second hot potato Oldham had to contend with. In his March 13 speech, Bloomberg said he wanted to amend Local Law 49, a 1997 law that created the H.I.V.-AIDS Services Administration that addresses the social service and income support needed by people living with H.I.V.

AIDS activists have long battled for an improved HASA even as they have fought to preserve the agency. Local Law 49 is seen as the crowning achievement in that effort.

“This is not an attempt to reduce resources,” Oldham said. “This is not a way to reduce services for people who need support services as well as AIDS housing.”

AIDS activists generally approve of Oldham, but his success depends on the support he gets from City Hall.

“I have a great deal of respect for him,” said Ronald Johnson, associate executive director at the Gay Men’s Health Crisis, who held Oldham’s post under Mayors Giuliani and Dinkins. “The office can certainly provide leadership and coordination to that effort. If the mayor is committed to seeing his goal accomplished then, yes, it can happen.

Keith D. Cylar, co-president of Housing Works, an AIDS service group, expressed a similar sentiment.

“I’ve known Frank for a very long time and I actually have really good expectations about what he should be able to do,” he said. “Frank is capable, but if the mayor doesn’t have his back it doesn’t matter. We need to be fair to Frank and hold the mayor accountable.”