An elderly HIV-positive man who had been in and out of hospitals was evicted for non-payment of rent. The next day, he reached out to the nonprofit Terrific Inc. for help. That was one story Susan Shepard, the nonprofit’s director of education and prevention services, cited in her recent testimony at a D.C. Council hearing.
At-large Councilmember Anita Bonds asked Shepard how many cases like this she receives in a year, where seniors who have HIV are under medical care and require housing support. “Well, in a given day, I’ve gotten five calls since I’ve been sitting here,” Shepard said, including one regarding a man who was going to be evicted the following day.
She had been testifying for less than 30 minutes.
The exchange underscored Shepard’s characterization of the District’s housing resources for seniors with HIV as “minimal to not much.” The system for providing housing support for this segment of the population is increasingly under strain from a growing demand, coupled with cuts to the funding sources used to maintain it.
The HIV positive population of the District includes nearly 13,000 people. At 1.9 percent of the general population, it exceeds the World Health Organization’s cutoff of 1 percent to qualify as an epidemic. Seniors make up a large proportion of these cases. Forty-three percent of D.C. residents with HIV are 55 or older, and the 50-59 segment has the highest rate of HIV positive cases, according to Shepard.
An important factor in the growing population of seniors with HIV is the improvement in available medication since the beginning of the epidemic, according to Michael Kharfen, the senior deputy director of The HIV/AIDS, Hepatitis, STD and TB Administration. When Kharfen began work in 1985, the life expectancy of someone diagnosed with HIV was 6 – 18 months. Now, with proper medication, people with HIV routinely live to be seniors.
However, many people who contracted HIV years ago are facing new challenges. When they were diagnosed, treatment was not as effective and society’s acceptance of the LGBTQ community, where HIV was most common, was lower. Some people did not develop work skills when they were younger, out of a feeling that they would never need them. Now, they struggle to find employment in old age, according to Shepard.
Shepard added that many people lack a strong support system to help them as they age. “When you look at elderly or LGBTQ people, they may not have family or children to take care of them,” she said. “They moved away from towns where they lived, and now they have no support.”
Some of the people served by Terrific Inc., which is the D.C. Office on Aging Disability Resource Center for Wards 1, 2, and 4, have not developed strong supportive ties due to the legacy of anti-LGBTQ discrimination they faced.
“We have seniors in our housing who may not admit being part of the LGBTQ community,” Shepard said. “A lot of people are in isolation by acknowledging they are in the LGBTQ community.”
The core of the city’s resources to provide housing specifically for people who are HIV positive comes from the federal Housing Opportunities for Persons with AIDS program (HOPWA), disbursed by the U.S. Department of Housing and Urban Development.
Having already faced stigma and judgment in finding housing earlier in their lives, many LGBTQ seniors, particularly those who are HIV positive, now face additional challenges linked to gentrification, according to Shepard. “What is available is limited,” she said.
The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), of which Kharfen is the senior deputy director, is the local agency responsible for providing housing and other services to residents who are HIV positive.
HAHSTA receives slightly more than $11 million dollars from HOPWA, of which about 60 percent is allocated for the District. The rest is used for counties in Virginia, Maryland and West Virginia. The D.C. agency uses its funding to offer tenant-based housing assistance, housing information and referral services, transitional housing services and emergency homelessness prevention services.
However, these services have been limited by funding cuts at the federal level. Kharfen said HOPWA funding had decreased steadily for several years before plateauing at its current level, with more cuts on the way.
HUD changed the formula it uses to allocate funds in 2016 to prioritize areas with more emerging cases of HIV, rather than places with more cumulative cases, such as D.C. The change is set to take place in 2019 and will result in a $2 million reduction in funding, according to Kharfen.
HAHSTA has also been stretched thin by the expanding needs resulting from longer life expectancies for HIV-positive people. The agency’s tenant-based housing assistance program functions as a housing voucher program, according to Kharfen. But there is no restriction to how long a person can continue to receive vouchers. As rents city-wide have risen, subsidies for people already receiving the vouchers have taken up a greater proportion of total funding and reduced the ability to distribute new vouchers.
“We share the concern that we have not been able to help new people with these vouchers,” Kharfen said.
The system of funding for HIV-related services is outdated in other ways. For instance, grants from the Ryan White HIV/AIDS program, distributed by the U.S. Department of Health and Human Services, are an important component of the city’s resources for HIV programs. However, the grants reflect the needs that government agencies faced in the early days of the AIDS epidemic. HAHSTA had to obtain a waiver to get around the Ryan White program’s requirement that 75 percent of the funding be spent on medical care; according to Kharfen, with improvements in HIV medication and the expansion of health insurance in the District, housing services have become a more pressing concern than medical care.
HUD’s Housing Opportunities for Persons with AIDS program has similarly become poorly suited to meet the needs of agencies like D.C.’s HAHSTA.
“There hasn’t been a change in the way HOPWA is designed as a program since 1990, which is a long time,” Kharfen said, noting the exception of the funding cut in 2016. “It was a different epidemic that we had when HOPWA was established than where we are today.”
For Earline Budd, a non-medical case manager at Helping Individual People Survive, the lack of adequate funding for housing is the driving force of the crisis.
Budd, a 59-year old, transgender woman who has experienced homelessness and was diagnosed with HIV 25 years ago, has had a similar experience to many of the clients who make up her caseload at HIPS, a health clinic dedicated to serving sex workers and drug users in the H Street Corridor. “I know what it means to be homeless because, first and foremost, I’m somebody who slept on the streets of D.C. when I was younger and my family put me out.”
[Read more: Joseph’s House, a welcoming final home for people who have experienced homelessness]
She has worked with homeless and HIV positive populations for 18 years through the D.C. Department of Health, the Community Partnership for the Prevention of Homelessness and other organizations. In the last several years, she said, the gradual decrease in federal HOPWA funding Kharfen identified has cut down the number of housing programs that serve people with HIV.
“They had about 10 to 15 providers that provided housing specifically for HIV positive [people], and of course, in the course of that, a lot of folks that accessed those services were LGBT individuals who were elderly,” Budd said. “A couple of years ago they started scaling back, and the only provider we have now that’s providing that resource, and emergency housing, shelter and transitional [housing], is RAP-Gaudenzia.”
The Ronald C. Clark behavioral treatment center, run by Regional Addiction Prevention (RAP) and Gaudenzia, offers a two-month emergency housing program paired with a ten-month transitional housing program.
The one center is not enough, according to Budd. “HOPWA is still there, but it’s very limited,” Budd said. “We need more providers who are serving people who are HIV positive.”
More broadly, the city’s array of homeless services are not designed to specifically target people who are HIV positive or part of the LGBTQ community. Budd said the District’s Ryan White Planning Council, which implements the eponymous U.S. Department of Health and Human Services funds, no longer prioritizes housing for LGBTQ people as highly as it used to.
“We used to be in the top 10, as far as prioritization for funding,” Budd said. “ Now we’ve moved way down.”
D.C.’s assessment tool for referring people experiencing homeless to services also does not necessarily take HIV-status into account when prioritizing people for housing placements, because the disease is now considered manageable, according to Budd.
“At the end of the day, if you were in the park, you got an assault and the police came, they may prioritize your case, but otherwise there’s no real prioritization when it comes to specifically LGTBQ HIV-positive [people],” she said.
Additionally, the LGBTQ population, and in particular the transgender community, continues to face housing discrimination, according to Budd.
The cumulative effect of these forces is a growing need for housing among the elderly HIV-positive and LGBTQ population, which the District’s resources are ill-suited to serve.
“Some don’t get in housing. Some die,” Budd said. ” I’m a funeral planner also, and I most certainly have laid away a lot of trans folks and those that were lesbian, gay and bisexual. People shouldn’t die because they don’t have housing.”
The decline in federal HOPWA funds and the decrease in providers of housing assistance like the Ronald Clark center remain the most important factors in Budd’s eyes.
“The Department of Health, HAHSTA has to do more, the mayor has to do more,” she said. “They prioritize what they want to prioritize.”
In the absence of HOPWA funding, though, Kharfen said that HAHSTA has had to look to other sources for money for temporary housing and to find new uses for the money it already receives.
For example, HAHSTA will be using repurposed Ryan White grants this year to reach out to recipients of HOPWA-funded housing vouchers, the kind HAHSTA has struggled to provide for new people in need, while housing costs rise and recipients continue to rely on the vouchers. “We’re actually reaching out to all the people who receive that assistance now to say, ‘What’s going on in your life, what are your plans, how can we help you figure out what makes the best sense to you for your housing needs?'” Kharfen said.
Between HAHSTA’s efforts to adapt through using Ryan White grants, and the help of D.C. government organizations that provide services specifically for HIV positive people and that work to create general affordable housing, there are still funds for housing for people with HIV in the District, despite funding cuts coming from the federal level, according to Kharfen.
Budd agrees the current level of support from the city is a step forward. “I stayed on 9th and O, 7th and O, slept in alleys, in vans and all that,” she said. “When I was coming up and homeless they didn’t have programs like this. But the point is, more can still be done.”
Until then, many seniors with HIV will continue to face a struggle to find housing, even after they have qualified for it through a housing assistance program. “When you look at people who are HIV positive or have other chronic illnesses, well, which will happen first?” she asked. “Will they live to be put into the permanent housing?”
Those remembered at the memorial service:
Fitz Roy Hunt
Tyrone Robinson
Yvette Green
Ashley McCutcheon
William Wright
Yohannes Gebremeskel
Edmundo Milhlo
Rakkia Chappelle
Grace Hogan
Robert Parker
Getachew Woldearegay
Aaron Gatewood
Regina Page
Michelle Harris
Anthony Thweatt
Camesia Brown
