Advocates press officials to act on HIV housing

Brooklyn City Councilmember Mathieu Eugene endorsed housing funds for asymptomatic hiv-positive New Yorkers at Tuesday’s City Hall rally.

By Paul Schindler

Three weeks after City Council Speaker Christine Quinn met with two leading academic experts on the impact that housing asymptomatic people living with HIV could have on reducing transmission of the virus, advocates pressing to broaden the city’s commitment to provide such housing held a large and boisterous rally on the steps of City Hall.

The Sept. 25 gathering, which drew a crowd of roughly 250, was the latest episode in a months-long standoff between Quinn—who dating back more than a decade has been an outspoken AIDS advocate—and leading AIDS organizations, including the Gay Men’s Health Crisis (GMHC), Housing Works and the New York City AIDS Housing Network.

The city health department made clear this week that it supports Quinn’s side in the debate.

“I cannot tell you how embarrassed and ashamed I am when an allegedly progressive speaker of the New York City Council says that we can’t house everyone who is HIV-positive because then we might have to house everyone who has cancer or diabetes,” Charles King, president of Housing Works, told the crowd. “I am embarrassed and ashamed when more than 20 years into this epidemic the speaker of the New York City Council says that thinking about housing as prevention is some radical, unfounded idea.”

No one else who spoke at the rally was as direct or personal in criticizing Quinn, and several made the point that the administration of Mayor Michael Bloomberg has not yet indicated its stance on proposed legislation that the advocates favor. King himself said as much.

“I’ve spoken at a lot of other rallies about Chris Quinn,” he said. “But I don’t want the other side of City Hall to go unnoticed in this fight. They’ve not taken a position on this and they need to.”

The groups rallying Thursday support a measure known has HASA For All, sponsored by City Councilmember Annabel Palma, who represents the Parkchester, Castle Hill and Soundview sections of the Bronx. Under the legislation, those living with HIV who have remained asymptomatic would gain full access to the housing assistance programs available through the city’s HIV/ AIDS Services Administration, or HASA, currently open only to New Yorkers with an AIDS diagnosis or a history of specified HIV-related illnesses.

Advocates say that the proposal would add 10,000 people to a HASA caseload currently just over 30,000. The cost, they estimate, would be $68 million annually. Several months ago, a spokesperson for Quinn said the estimates developed by Council staff are in the range of $75–$100 million a year.

Advocates are quick to point out, however, that spending those funds will save the city money overall. They argue that stable housing is critical to an HIV-positive person’s ability to maintain their health, a point that has become conventional wisdom, but also, more controversially, that it helps prevent infected people from transmitting the virus to others.

“The idea of giving housing to people so that they will have stability to prevent transmission of the virus is one of the key ideas in housing people,” Robert Bank, GMHC’s chief operating officer, said just before Tuesday’s rally. “And it goes without saying that when someone is living with an illness that requires stability and lack of stress to prevent further incidence of the disease, housing is a critical issue.”

Bank added, “We respect the speaker enormously and we hope that the scientific evidence that we brought to her about the impact of housing on people in terms of treatment, care, and prevention has been persuasive.”

At the urging of HASA For All advocates, Quinn sat down with them and two researchers, Dr. Angela Aidala of Columbia University’s School of Public Health and Dr. David Holtgrave of the School of Public Health at Johns Hopkins University, to discuss the potential savings available to the city from reduced HIV transmissions by people living a more stable life, and therefore less likely to engage in risky behaviors such as survival sex and needle sharing.

Based on a model developed by Aidala and Holtgrave, longtime AIDS advocate Ginny Shubert, now a principal in a consulting firm, found that if housing assistance were given to asymptomatic HIV-positive New Yorkers, the prevention of just 221 new infections would justify the public expenditure. If the standard value assigned in social science research to a year of life saved of $50,000 is factored into the analysis, only 80 new infections would have to be prevented in order to merit the public spending.

But Quinn has been publicly skeptical about the prevention benefits of housing this population. In a May interview with Chelsea Now’s sister paper Gay City News, the speaker said, “It’s a very radical shift to decide that housing is the best prevention tool possible.” As for the legislation’s other goal, slowing or preventing the progression of an individual’s HIV infection to AIDS-related illness, Quinn, noting the substantial cost of HASA For All, said, “The question becomes. ‘Is there a better way?’”

In an e-mail response to a query this week, the speaker wrote, “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.” She pledged to work with the departments of health and of homeless services and advocates to “find the best ways to improve and expand services for HIV-positive homeless New Yorkers.”

The posture of the Bloomberg administration toward the housing proposal has to date been less clear, and King for one thinks that may be due to the fact that “they want to lay low and let Quinn be the target of attacks.” He and other advocates point out that Dr. Thomas Frieden, the city health commissioner, has made money available in recent budgets for housing services targeting asymptomatic HIV-positive New Yorkers. King said that Frieden “knows the science” and “would have a hard time making the argument” against the proposed legislation.

Asked for a response to these comments, the health department, in a written statement, said, “This proposal would impede our ability to tailor services in the most appropriate way to those who need it most.” The statement went on to note that though some asymptomatic New Yorkers with HIV can access housing assistance, the city’s programs, developed in line with federal and state guidelines, “were specifically designed to address the needs of people with HIV or AIDS who require intensive support. 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.”