Federal dollars for homeless people with HIV declines; advocates complain of no input
In January, the U.S. Department of Housing and Urban Development announced that since Congress had slashed federal funding by $13 million for subsidized housing for people living with AIDS, New York City, with the highest concentration of recipients of such assistance, would lose $9.75 million in aid.
Ever since, community-based housing advocates here have been preparing for the worst.
So far the city’s health department, which is in charge of the federal housing money, has not consulted with community-based groups and AIDS advocates to determine where to trim funding without drastically impacting the lives of people with AIDS.
“The city is clearly having discussions about how to absorb the cut, and yet there is no mechanism for the community or input from low-income people,” said Gina Quattrochi, CEO of Bailey House, an AIDS housing group that received about $250,000 from the federal Housing Opportunities for People With AIDS, or HOPWA, program. “We don’t know what programs they’re going to cut. It’s important to have providers and consumers at the table. We’re on the ground—we know what services are needed. We need some input in the decision making.”
A city advisory committee made up of HIV-positive community members and AIDS advocates, including Quattrochi, is on target to give the health department advice about how to allocate federal AIDS funds this spring. However, last April, Mayor Michael R. Bloomberg restructured the committee into various planning councils, but gave none of the new groups jurisdiction to weigh in on how HOPWA money is spent.
“The community would love to speak to [the health department] about HOPWA dollars, but there’s been a decrease in communication about HOPWA dollars,” said Daliah Heller, executive director of CitiWide Harm Reduction, an AIDS services group. “The commissioner has told several of us that they will be reconstituting some sort of advisory group, but we haven’t heard anything about it.”
What advocates call the city’s “disproportionate” share of the HOPWA cut results from the formula used for determining how to distribute the money. The federal government uses raw numbers of AIDS cases to figure out which locations need the most cash, without taking into account how many of those cases represent low-income people.
“The formula reflects the number of cases. It’s not necessarily accurate with respect to need,” said Quattrochi. “For instance, in New York City, 60 percent of people with an AIDS diagnosis are receiving housing assistance from the city because they qualify as low-income. But that’s not one of the weighing factors [in the HOPWA formula]. They don’t take that into account.”
Currently, 46,000 city residents rely on such federal funds for housing assistance, 31,000 of whom are HIV-positive and the others are their dependents.
A city health department spokesman said the agency was still reviewing the budget to “determine the impact of these federal budget cuts so we can make the most effective use of available resources.”
Many advocates say that the delay in presenting a new plan in the wake of the cuts underscores their concerns that without community input, city officials will make haphazard decisions that might imperil people’s housing.
"We will employ a fair process, and make every effort to minimize reduction in direct services, particularly for communities most in need,” the health department spokesman emphasized.
Typically, the federal government hands the housing money over to the city in two parts. About 60 percent goes to pay for the city’s programs and caseworkers and 40 percent is given to community-based organizations like the ones run by Heller and Quattrochi. There has been a long-running controversy about the relative share of HOPWA money going to the city rather than community groups. For years, $25 million dollars of the total city grant has gone to cover caseworker salaries above and beyond the typical split, in a mechanism known as the HOPWA swap and widely decried by groups that serve people with AIDS. Advocates worry that the health department will take the $9.75 million cut out of the community’s already low share, leaving organizations that provide essential services to HIV/AIDS populations without the money to fund them.
“[The cuts] are going to dismantle them,” said Terri Smith-Caronia, director of New York City public policy at Housing Works, another AIDS housing group. “While you’re testing everybody and their mother so they can find out if they’re HIV-positive, and then you start to not increase services but allow services to be reduced, it’s problematic. Why would anyone want to get tested if there’s no services for them? If there’s no housing for them?”
But for Smith-Caronia and other advocates, no monetary salvation is in sight. Pres. George W. Bush recently released his budget proposal for 2006, which rolls the HOPWA program back to its pre-2002 days by cutting its budget by about $14 million. With the number of cities and states that qualify for the grants always increasing as the disease spreads, advocates say the money will be spread thinner than ever before.
The federal government’s allocation method “could be a decision that would have a devastating effect on the lives of homeless people living with HIV/AIDS,” said Quattrochi.
But groups in the AIDS advocacy community are gathering steam. They have begun to quietly discuss strategies for getting the city to listen to them, saying they want to open a dialogue before doing anything “more playful,” as Smith-Caronia puts it.
“Hopefully, we can reach out to the city to be a part of it. New York has lost part of its money already,” said Quattrochi. “If we take another huge hit to appropriations, we’re going to lose even more money next year. We need a strategy that will potentially try to limit the effect on New York City.”