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.
