For Americans suffering from HIV/AIDS, New York has been the most magnanimous of cities. In 1985, a mere three years after scientists gave the still mystifying disease a name, the city created an agency to care for low-income patients. Today that agency, now known as the HIV/AIDS Services Administration, or HASA, helps AIDS victims get physical and psychiatric assistance, food stamps, SSI benefits, and Medicaid. It provides homemaking services, free transportation to doctor appointments, vocational training, and counseling. The federal government has several sources of funding for housing for HIV/AIDS patients, but New York is just about the only municipality to add millions of local tax dollars to the federal pile. This allows the city to provide “enhanced” and “above-enhanced” cash assistance for its approximately 33,000 patients and their over 13,000 dependents; “above-enhanced” adds up to well above double the amount of assistance given to poor people not ill with AIDS. The city also promises emergency shelter with medical services for homeless patients as well as money toward broker fees for people relocating into new apartments. HASA’s annual budget is now over $400 million—a 40 percent increase since the beginning of the Bloomberg administration alone.
Well, as my grandmother liked to say, no good deed goes unpunished. Over the 25 years of HASA’s existence, AIDS advocates, with at least tacit and often vociferous support from their many supporters in the city council and in the Albany legislature, have engaged in endless protests and lawsuits against the city for not doing enough. Now, once again, they’ve taken to the streets near the Human Resources Administration offices and the Brooklyn Heights home of HRA commissioner Robert Doar, blowing whistles, beating drums, and waving signs saying “Poor and HIV? Billionaire Mayor Doesn’t Care” and “Make Wall Street Pay, Not People with AIDS.” A vastly changed landscape for AIDS treatment and survival? A public consensus about promoting self-sufficiency whenever possible? The worst budget crisis since the 1970s? They don’t want to hear about it.
Advocates are on the march this time around because of two recent policy changes. First, HASA has introduced drug screening and, if deemed appropriate, referrals for treatment, for those applying for cash rental assistance. Officials say that the screening will be in the form of a verbal interview, rather than urine testing, and that refusing treatment in the case of positive screening might result in lower cash assistance—from “above enhanced” to “enhanced”—or at worst a demotion to supportive housing. They point out that drug use is widespread in the AIDS population; intravenous drugs account for about a quarter of new HIV/AIDS cases each year in New York. Drugs not only make the sick sicker; they also spread the disease through needle sharing and the high-risk sexual activity addicted men and women often engage in.
The decision to introduce drug screening also reflects a much-needed philosophical and policy shift within HRA in the post–welfare reform era. In the early days of the AIDS epidemic, patients were almost entirely white, gay men with little chance of long-term survival. The city couldn’t do much more than offer emergency medical care, temporary housing, and burial assistance. By the late 1990s, however, successful public health campaigns and anti-retroviral drugs transformed HIV/AIDS from an acute to a chronic and sometimes symptomless disease, at least for those following the recommended medical regimen.
Meanwhile, New York, which has always had the largest number and among the highest concentrations of AIDS patients in the country, saw the infected population become increasingly poor and minority. Today, close to 80 percent of new patients are black and Hispanic, most of them low-income, with many of the problems of the general welfare population along with their illness. Recognizing this, HASA officials decided to update the agency’s policies, with the goal of encouraging clients to become self-sufficient. Among the changes were a greater emphasis on job training and placement—and, it follows logically, drug treatment. HASA is also introducing work requirements for the 1,300 able-bodied adult dependents, most of them adult children of AIDS patients, who up until now the city has supported.
The other complaint that has advocates taking to the streets is familiar to every New York City employee and client: budget cuts. Last year, HASA cut clients’ allowance for rental broker’s fees from a full month to a half month’s rent. Now, like every city agency, it must cut more—another $8 million. This amounts to less than 2 percent of its total budget and is in line with the haircuts other city agencies are taking. Since some of the assisted-housing vendors provide case workers in addition to HASA’s own staff, officials have proposed easing the budget gap by eliminating the redundancy.
But the advocates and their city council allies don’t appear to believe that the laws of basic math, personal responsibility, or even medical science should apply to them. At a February hearing of the city council’s General Welfare Committee, Councilman James Van Bramer chastised HASA and HRA officials for “punishing people”—meaning AIDS patients, not taxpayers—by screening for drug use. Wanda Hernandez, board chair of VOCAL-NY, one of the most aggressive of the dozens of AIDS advocacy groups, denounced the policy as “a violation of the individual.” Strangely, though, any mention of individuals is hard to find on the group’s website, where we learn that “homelessness, poverty and mass incarceration,” rather than people’s taking intravenous drugs or having unprotected sex, are the “causes” of the HIV/AIDS epidemic. Housing Works, VOCAL-NY’s comrade in arms, is equally unresponsive to current fiscal and moral realities. Redundant case managers? They’re apparently a necessity for this population, and required by law—an assertion the city disputes. Reduce rental broker fees to half a month’s rent? Clients, it seems, would then sell their HIV medication or prostitute themselves to get the money for the other half of the fees. AIDS victims may be individuals deserving of both compassion and dignity, but according to advocates, they have no free will.
One hopes that, as city council members mull over HASA reforms, they will resist the advocates’ rationalizations and remember that the times—and AIDS—have changed. But don’t bet on it.