Hundreds of people rallied on the steps of City Hall last week to support expanding the services of the HIV/AIDS Service Administration (HASA) to provide housing assistance to all needy low-income and homeless HIV-positive New Yorkers.
A coalition of more than 40 advocacy organizations pledged support for prospective legislation called “HASA For All” and is pressing the city to act on the draft bill, which was announced to coalition members early last month by Councilwoman Annabel Palma, a Bronx Democrat who has not actually introduced it in City Council.
“If the city is serious about reducing the transmission of HIV, which it says it is, the most significant thing to do is to expand HASA,” said Charles King, CEO and president of Housing Works, one of the groups pushing for HASA For All.
Currently, HASA provides rental assistance and other benefits to approximately 31,000 New Yorkers diagnosed with AIDS, as defined by the federal Centers for Disease Control and Prevention, or with clinical symptomatic HIV illness, as defined by the New York State AIDS Institute. This excludes an estimated 8,000 to 10,000 HIV-positive New Yorkers who have not been diagnosed with AIDS.
Advocates say the HIV-positive men and women that remain out of HASA’s reach are, for now, doing what other homeless people do: staying with friends or relatives until they wear out their welcome, sleeping outside, and shuffling through the city’s shelter system. But these precarious housing situations can translate to less stable treatment.
“Individuals who are HIV-positive and homeless are much more likely to develop AIDS, are much more likely to have interruptions in care, and are much more likely to have challenges in adhering to medication regimens,” says Marjorie J. Hill, CEO of Gay Men’s Health Crisis (GMHC), another group supporting the changes to HASA.
Despite the conviction the crowd of supporters demonstrated Sept. 25, the legislation’s vital signs are not vigorous at present. Last week both City Council Speaker Christine Quinn and Mayor Bloomberg’s chief spokesman – speaking both for the mayor and the Human Resources Administration, which oversees HASA – released statements opposing the HASA For All concept. Meanwhile Palma attended the rally but did not address the crowd, and her office did not respond to requests for comment.
Said Quinn, “I do not believe the HASA for All initiative is the best way to support HIV-positive homeless individuals or prevent the spread of this disease. Further, I am concerned this bill could set a wide-ranging precedent that would require additional costly benefits, diverting limited resources to an unnecessary mandate instead of allowing us to target funds where they are most needed.”
Bloomberg spokesman Stu Loeser echoed that, saying, “This proposal would impede our ability to tailor services in the most appropriate way to those who need it most. … We oppose this proposal because it could result in the diversion of resources from services that help people successfully manage the disease to other, less effective measures.”
But the current situation can create perverse incentives, says Diana Scholl of Housing Works. She says caseworkers have told her of people who try to make themselves sicker, intentionally trying to lower their T-cell count in order to qualify for the housing assistance.
And there seems to be good reason that housing is so sought-after. A recent CDC study found that housing status is one of the strongest predictors of health outcomes for individuals with HIV and AIDS. King also points to research by Angela Aidala, a senior research scientist at Columbia University, that shows a clear correlation between housing stability and an aversion to the risk behaviors that spread HIV. Work by David Holtgrave, chairman of the department of health, behavior and society at the Johns Hopkins Bloomberg School of Public Health (endowed by the mayor) also is cited.
“What you see across the board is that the more stable peoples’ housing is, the less likely they are to use illicit drugs, or use them in an unsafe manner, and the less likely they are to engage in risky sexual behavior,” says King.
Those pressing for change all agree that implementing HASA For All would cost the city upward of $50 million per year. But they argue that it’s a matter of paying for prevention now or paying more later – in higher rates of infection, higher health care costs and possibly higher death tolls.
“In the long run it will save money, because you will have people who are not getting sick,” says Scholl.
Her point is echoed by cost-analysis research done by Ginny Shubert at Shubert Botein Policy Associates. Shubert finds that HASA For All would cost the city approximately $66 million per year. Yet for each month the program remains unimplemented, she says, “we could expect up to 66 new [HIV] transmissions each month” among those denied housing. She says this translates to an estimated $31 million in lifetime medical and service costs for each month of inaction, or a cost of $372 million per year. “It’s expensive not to do this,” she says.
However, it remains unclear how much support HASA For All has in the City Council. Councilmembers Charles Barron, Mathieu Eugene, and Letitia James were at last week’s rally, and have pledged their support. Housing Works’ King sees Quinn’s opposition as the largest obstacle to HASA’s expansion.
As part of a campaign to convince her of HASA For All’s merits, GMHC, Housing Works, and the New York City AIDS Housing Network brought in the leading researchers in the field to talk with her early last month. The advocates say it’s unclear if the presentation has changed Quinn’s mind.
“We’re going to need to lean on some of the more progressive council members who have leadership roles and ask them to have enough courage to take on the speaker,” King says.
Shubert notes that HASA already won one uphill battle for service expansion, when litigation in the late 1980s led to the creation of Local Law 49, which extended services for the income-eligible from those with AIDS to those also suffering HIV-related diseases. “This is just the right thing to do, and I think we’ll get there sooner or later,” she said.