February 16, 2007
CRISIS AVERTED?
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Movie heroes or savvy AIDS advocates? |
For AIDS advocates, last week was like something out of Men in Black. While many PWAs didn't know it, their world was nearly destroyed by space aliens-or in this case the Health Resources and Services Administration (HRSA). HRSA wanted to retroactively implement a harsh amendment to the Ryan White Care Act that could have booted thousands of people with HIV/AIDS out of their homes starting March 1 (yes, you heard us, March 1). Fortunately, a flood of calls from advocates and community members—not necessarily wearing snappy black suits and black sunglasses—seem to have saved the day, at least for now.
At press time, an official extension of the March 1 deadline to September had yet to be published in the Federal Register, but sources close to Nancy Bernstine, executive director of the National AIDS Housing Coalition (NAHC), told her an extension was in the works and that HRSA would be meeting about it today. NAHC told its members on Thursday: "An extension of the implementation of this proposed policy amendment will allow HRSA more time to consider the community comments received and work toward a revised policy that will make the most sense for and create the least harm to the people who receive assistance through the RWCA."
Back from the brink
In December, HRSA announced its plans to implement a new policy starting March 1 that would impose a cumulative lifetime cap of 24-months for PWAs receiving transitional or emergency Ryan White-funded housing. Advocates initially thought that meant that the 24-month clock would start ticking for people receiving housing assistance on March 1&mdashthey were caught off guard last week when HRSA explained that the new rule would, in fact, be retroactive: Housing providers would be expected to begin reviewing the number of months active clients had received services, and work on transitioning them immediately to "alternative housing," i.e. evicting them.
The brutal new rule could leave thousands of people homeless and unable to access care and treatment, undermining the very goals of the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which acknowledges a causal relationship between stable housing and health.
Advocates knew the policy was on the table, but were caught off-guard when HRSA attempted to implement it so quickly. Housing Works and others sounded the alarm and flooded Health and Human Services Secretary Mike Leavitt with hundreds of calls imploring him not to let HRSA evict people living with HIV/AIDS, to hold off on any new Ryan White rules on housing assistance for at least 6 months and to block any lifetime cap on help for tenants who need it most.
If HRSA doesn't stay its unmerciful policy, it could affect over 600 people in New York and thousands more across the country.
Sasha Vazquez, 35, who lives at a Housing Works East New York facility thanks to Ryan White funds, is one of them. Once a vigorous woman who could keep up with the hectic pace of being a professional baker, Vazquez's HIV-meds caused her to developed neuropathy and other side effects that kept her from working-her dried-out hands would crack and bleed. In the two years she was without permanent housing, her T-cell count dropped to 79. But since she's had 36 months of steady housing, her T-cells are up to 500, and she's back in school studying for a less physically demanding career as a jewelry designer. "Without a house there is nothing," Vazquez says succinctly.
Unreasonable time frames
Where did it all go wrong? The new policy comes as a result of a 2003 audit of Ryan White Title I and Title II funds. HRSA found that Ryan White jurisdictions were housing clients for unreasonable time frames, sometimes as long as 8 years. They also found that the programs lacked exit plans to shift residents to permanent housing. HRSA's new policy is actually intended to make the housing system run more efficiently and get more people into permanent housing. Activists applaud that goal, but disparage the agency's plan as unrealistic at best, deadly at worst.
One problem is that HRSA views all open-ended housing as unreasonable, despite the fact that some communities have wildly tight housing markets. One of the audits was performed in San Francisco, where the competitive housing market yields one of the lowest vacancy rates in the nation. After evictions "the next place they'll contact you is under a bridge," says Bernstine. "The problem is there's just no affordable housing available anywhere. You're moving people to homelessness." What's more, a lifetime cap of 24 months on housing does not reflect the cyclical nature of the disease. HIV is characteristically episodic. People tend to intermittently move through times of need and independence.
If advocates are unable to convince HRSA to scrap this harrowing policy, some folks may avoid getting thrown out of their homes right away because the process of determining how long someone has been in transitional or emergency housing can take time. On the other hand, for those in clear-cut situations, the evictions could come with terrible swiftness. For Sasha Vazquez, losing her housing would be like replacing a miracle with a nightmare. "The home I have now is the best thing that's ever happened to me. It's given me the opportunity to get my health together and move on with my life," she says.
Fortunately, there are plenty of "men in black" left to keep fighting the policy, whether or not HRSA has indeed granted the extension. Sen. Sherrod Brown (D-Ohio) wants to work with NAHC to scrap the proposal altogether, and seven senators in total signed on to a letter opposing this rule. That could put serious heat on Leavitt. Not to mention those space aliens.
For a list of agencies and congresspeople who have opposed the lifetime cap, go to http://www.nationalaidshousing.org/updates.htm#HRSACongressLetters.