Council Member Corey Johnson Unveils 'HASA for All' Legislation

On February 26, NYC Council Health Committee Chair Corey Johnson was joined by elected officials and advocates for public health, homelessness & HIV/AIDS at City Hall, to unveil long-sought legislation that would expand HIV/AIDS Services Administration (HASA) benefits to all low-income, HIV-positive New York City residents.

"HIV/AIDS is a disease of inequities," said Council Member Corey Johnson. "Poverty, homelessness and a lack of access to healthcare are conditions that fuel the epidemic. The inability to obtain housing, food and other basic subsistence needs results in disconnection from HIV care, failure to achieve and maintain viral suppression, an increased risk of transmitting HIV to others. Our shared vision of ending the AIDS epidemic in our state by 2020 will remain out of reach if we do not connect persons living with HIV access to proven intervention strategies."

HIV/AIDS activists lauded the move as a key step in ending the HIV/AIDS epidemic in New York State. Allowing more individuals to qualify for housing, nutrition and transportation services through HASA will give low-income, HIV-positive individuals a foundation from which HIV treatment and care can be fully managed, reducing community viral loads and preventing significant numbers of new infections.

Current HASA regulations require those who receive benefits from HASA to have an AIDS diagnosis or symptomatic HIV infection, meaning a T-cell count of 200 or less or two opportunistic infections, such as pneumocystis carinii pneumonia or toxoplasmosis. This legislation would expand this definition to include individuals with asymptomatic HIV.

"It is heartbreaking when New Yorkers living with HIV come to GMHC in desperate need of housing and other assistance, only to find out that they are 'too healthy' to be eligible for HASA benefits," said Kelsey Louie, GMHC's CEO. "No one should have to wait until they have an AIDS diagnosis to receive the life-saving support proven to not only help them stay healthy, but also prevent new HIV infections. Thank you Council Member Corey Johnson for ensuring equal access to HASA's housing and support services. This bill is critical to ending the HIV/AIDS epidemic in New York by 2020."

The HASA system has been extremely effective delivering coordinated benefits and services. For decades, the program has provided a single point of entry for access to enhanced rental assistance, case management and other public benefits, including a transportation allowance.

Eligibility for the program is currently tied under NYC local law to a NYS Department of Health AIDS Institute definition of HIV-related illness (more recently described as "clinical/symptomatic HIV infection"), a definition that has not been changed since the mid-1990s, is now out of date and no longer used by the AIDS Institute for any purpose. Furthermore, this definition is inconsistent with current treatment guidelines and HIV prevention strategies.

"The impact of HIV is not limited to the medical aspects of the disease; they are in fact much greater and more complicated, and powerfully influence basic human needs like housing," said Carrie Davis, Chief Programs and Policy Officer at New York City's Lesbian, Gay, Bisexual & Transgender Community Center. "By expanding HASA's medical eligibility to include asymptomatic HIV, Council Member Johnson is helping New Yorkers who live with HIV gain the equal footing they need to address the disease and be productive, healthy citizens."

In New York City, an estimated 10,000 to 15,000 people with HIV -- including 800 or more who reside in NYC shelters on any given night -- remain medically ineligible for the publicly funded HIV-specific non-shelter housing assistance, case management and transportation allowance that are provided for persons with symptomatic HIV infection through HASA. Homeless people with asymptomatic HIV infection are often forced into the Hobson's choice of initiating treatment and remaining homeless or delaying treatment until they qualify for rental assistance or supportive housing.

A large body of research demonstrates that homelessness and unstable housing are strongly associated with greater HIV risk, inadequate HIV health care, poor health outcomes, and early death. A 2005 New York City study found the rate of new HIV diagnoses among homeless persons sixteen times the rate in the general population, and death rates due to HIV/AIDS five to seven times higher among homeless persons. For people living with HIV, lack of stable housing poses barriers to engagement in care and treatment success at each point in the HIV care continuum.

"The HIV/AIDS epidemic is one that is fueled by poverty," said Jim Bolas, Executive Director at Coalition for Homeless Youth. "This legislation, if passed, would allow our homeless HIV positive youth in NYC to finally access the essential, life-saving services that are needed to keep themselves healthy, and reduce the spread of the virus and potential risks to their lives."

Numerous studies consistently find that PWH who lack stable housing are more likely to delay HIV testing and entry into care following HIV diagnosis, more likely to experience discontinuous care (dropping in and out of care and/or changing providers often), less likely to be on antiretroviral therapy and are less likely achieve sustained viral suppression. With homelessness being one of the primary drivers of the spread of HIV and the progression of the virus into AIDS, if passed, this legislation would have a direct impact on the dual crises of HIV/AIDS and homelessness, particularly among LGBT youth.

"HASA for all takes the important next step of expanding HASA benefits to all people with HIV before they get sick," said Council Member Steve Levin, Chair of Committee on General Welfare. "Providing life-saving services to New Yorkers in need is the right thing to do and I'm proud to support HASA for all. Thank you to Council Member Corey Johnson for introducing this legislation."

Expanding HIV/AIDS Services Administration (HASA) benefits for all low income New Yorkers living with HIV is essential in the struggle toward containing and eventually eradicating this epidemic echoed Council Member Annabel Palma.

"We can only end the AIDS epidemic through bold leadership from local government representatives like NYC Council Member Corey Johnson," said Charles King, CEO/President of Housing Works. "People with HIV need access to housing and essential services, and we look forward to our leaders in Albany working with local elected officials across the state to end AIDS."