Erie County Medical Center's Immunodeficiency Clinic is medical ground zero for those who are infected with HIV. There was a time when it was the center of death, as hundreds of local residents died under the pressure of the retro-virus. However, people today are living much longer with the illness.
Clinic Director Dr. Jonathan Claus said he is seeing the ailments of age.
"I have a patient that's like in 70s, 80s, someone that's 80," Claus said. "Most of the diagnoses, or two-thirds of them, are people that were diagnosed when they were very young. They're living much longer. And so half of the people who are positive are over 50 because they're living that long now."
Besides patients at ECMC, many HIV-positive local residents head over to Evergreen Health on the edge of Allentown in Buffalo. They get medical advice and they get life advice. However, the life advice has become very different, with potentially decades to look forward to.
Matthew Crehan-Higgins, an associate vice president in charge of enhanced medical services, said the days of telling people the risks of sex have been replaced by medications and advice.
"If you have on-going risk or if you're found to be positive, you can go down one of two paths," he said. "If you're negative and have on-going risk, you can get on PrEP. You're able to then say, you can't get HIV from me and I will not become positive by virtue of being adherent to this medication. If you come in and you find out that you are positive, we start people on treatment generally that same day. They're undetectable within a few months and then they are able to say the same thing as the negative population on PrEP, which is you cannot get HIV from me."
It is a very different world, although there are hundreds of people out there who have tested positive but aren't receiving treatment. Albany says there are hundreds more who are positive but won't come in for testing. Basically, they don't know, don't care or may be unable to think far enough ahead for treatment.
Some people are still becoming infected. Irvin Sommerville has watched the changes since he was found to be HIV positive 37 years ago. Today, Sommerville is an AIDS educator and a dad, trying to catch up to his teenager.
"When you have a child that's 12-13, my son keeps me up and going. He's into football. I'm in school at least once a week, Boys Club, football field, basketball. So chasing behind a teenager keeps me on my toes," Sommerville said.
Sommerville said he does not know who infected him four decades ago. Claus said that is not unusual, even in intimate partner situations, where Albany can step in to determine transmission trails.
"Anyone that you could have, if you know or don't know, you could have gotten it from and they kind of ask you for help, you have them tested," Claus said. "I have some people that know that they got it from their partner and their partner refuses to be tested because they just don't want that in black and white, unfortunately."
Crehan-Higgins said Evergreen wants patients on meds, like PrEP, which can push HIV loads down so far a person cannot pass it on. New state figures show 32,000 New Yorkers used PrEP last year.
"The social stigma around disclosure is almost a disincentive to that, and so our work currently is around making sure that people know that whatever their status is, if they don't know it, if they haven't had an HIV test this year, last year, in the last 10 years, that whatever they come here with, we're going to work with them to develop a plan that let's them self-actualize toward being able to say, you cannot get HIV from me," he said.
The Evergreen official said that can be difficult, because there is so much incomplete knowledge out there about HIV, transmission and how it has changed over the decades, going back to the "bad years."
Gov. Andrew Cuomo has said vast human effort and hundreds of millions of state dollars are having a major impact on new infections.
"Last year, we saw a record decline in the number of new HIV cases, more than double a decline from previous years, over 11%, and at that rate we will end AIDS as an epidemic by 2020."