HIV and the Recession: Living Well in Tough Times
"I'm a praying person, so I said, 'OK, Lord, what do I do?'" she recalled. The answer? "Take it one thing at a time and deal with stability first."
That meant tackling housing before she started figuring out how to cover her health care. According to social worker Rice, there's a good reason for that priority.
"The biggest challenge to staying healthy with HIV and other chronic illnesses in New York City is housing," he said. "If you don't have appropriate housing, many things fall [into the gaps], even if you have insurance."
And that's not just true in New York. A 2007 review in the journal AIDS and Behavior found that housing stability was strongly and positively associated with adherence to antiretroviral regimens and the ability to keep appointments and follow up on medical care.
"When you lose your housing, it doesn't just mean losing shelter," said HELP/PSI's Reyes. "It means losing access to healthy food," since you may no longer be able to prepare your own meals. "Many times it means losing medications, because when you get thrown out of your home, your medications get thrown out, too," continued Reyes. "Or you end up in a shelter and someone may steal your medications."
But things do not have to get to that point. To help maintain housing stability so you can focus on your health, consider the following tips.
"It can be overwhelming when you're sick to get a really important piece of mail that contains critical information," said ALRP's Hirsh. "People think, 'I don't know what to do so I won't respond.'"
Instead of ignoring frightening news, invite an ally into the situation: Ask someone you trust -- a friend, family member, social worker, or financial benefits counselor -- to sit with you when you read a letter from a creditor or make a particularly intimidating call to your landlord. The good news is that most creditors and landlords just want to get paid. And they want to know you are not ignoring them.
In some cases, saving your home from foreclosure may depend on catching your financial problems early, Hirsh continued. It can be hard to enroll in mortgage modification programs if you have let your home go into default for too long.
Other programs, like Section 8 -- the U.S. Department of Housing and Urban Development's low-income housing assistance program -- have waiting lists. The sooner you add yourself to the list, the more likely you are to get help when you need it.
But first, you have to acknowledge that your situation is serious. Gray found that she had to again face the fact of her diagnosis and admit that she needed help as much as anyone else. It wasn't easy for her; she has always worked for organizations that provide services for people with HIV/AIDS, but never used them herself.
"I just had to say to myself, 'OK, you now have to recognize that you're positive and you have to address this,'" she said. "There are a lot of us like that: We've not ever used the system for services before -- we just go get our medications and go home. I had to get over it real quick."
HOP To It
HOPWA funds organizations around the country providing housing assistance for individuals with HIV/AIDS. These organizations do everything from offering short-term rent relief to paying a portion of rent so your money can go toward other expenses. Gray found an organization that would pay her entire rent for five months so she could concentrate on getting her health care covered and figure out where she would move at the end of her lease.
"I know this is literally saving my life," Gray said of the support of HIV service organizations. "I hate to have to use it, but I'm so glad it's still here."
But Gray found that there is a trick to getting assistance fast. "A lot of people call at the beginning of the month, and they find out all the funds for the month have been paid out," she said. "At least here in Houston, it's better to call between the 15th and the 30th so you can get in line to have your rent paid on the 1st."
Call an Emergency an Emergency
If you are close to losing your housing, there are emergency groups you can contact. For example, the San Francisco AIDS Foundation administers a housing subsidy program for HIV positive people on the city's housing waiting list, which is usually long.
San Francisco also has the AIDS Emergency Fund, designed to provide short-term help for low-income people with AIDS or disabling HIV disease. The program provides a one-time boost of $500 to cover rent, overdue utility bills, health insurance, or other critical expenses.
When Mike (who asked that his full name not be used) was laid off from his job last year, his stress level rose and his frustration grew as he searched without success for new employment. But one thing he did not worry about was continuing his antiretroviral therapy.
"Medications would have been my biggest concern when I lost my job but, fortunately, my husband has incredible benefits with the city," said the 41-year-old San Francisco resident. "Since we registered as domestic partners and got married last year, I've been on his insurance, and it's been an amazing gift."
Registered domestic partners and/or spouses may be able to take advantage of their employed partner's insurance coverage; ask your partner to speak with his or her employer's human resources department to find out what coverage is available.
If you are not as fortunate as Mike, there are still many ways to get your medications covered. And there's good reason to do so: a growing body of evidence indicates that treatment interruptions (or "drug holidays") can be hazardous, leading to declining immune function as well as a host of non-AIDS conditions linked to resurgent HIV replication.
"It's not a good way to save money, especially in the long run, because you get sick and it's much more difficult to work or deal with whatever you need to in the rest of your life," said nurse practitioner Reyes.
If you're like many people with HIV, you have to advocate for yourself most strongly in the health care system when you feel least able to do so: when you're sick, you're stressed, and you're worried about the future.
But it is important to take even the smallest step you can toward help. Maybe it's as simple as asking your doctor for a referral to a comprehensive clinic that might better suit your budget, said Steven Boswell, MD, CEO of Fenway Health in Boston.
"To have an established relationship with a good clinician who is connected to resources can be tremendously helpful in difficult times like these," he said. "When you have the right provider who knows what he's doing technically with regard to caring for someone with HIV and also understands the available resources and how they can be brought to bear to help someone, that's critical to keeping that care seamlessly intact."
"Seamless" is the key word. Your ability to monitor your health does not have to be dependent on your ability to pay.
COBRA -- the Consolidated Omnibus Budget Reconciliation Act of 1985 -- is a federal law that allows people to stay on their employer's health plan after being laid off. They must pay the full cost, however, and COBRA premiums can be very expensive. COBRA eligibility typically lasts 18 months, though some states mandate extended coverage; California's Cal-COBRA, for example, extends coverage for an additional 18 months.
As part of the 2009 American Recovery and Reinvestment Act (the economic stimulus package), the federal government agreed to pay up to 65% of COBRA premiums for qualifying individuals whose employment ended between September 2008 and December 2009. People who declined COBRA coverage because they could not afford it when they were laid off were given another chance to accept coverage.
With or without the subsidy, COBRA may be a good deal compared with available alternatives. "It's not cheap, but it's less expensive than an individual policy in New York, by far," said Alexandra Remmel, Assistant Director of Coordinated Care at Gay Men's Health Crisis.
The AIDS Drug Assistance Program pays the cost of medications to treat HIV and related conditions for low-income individuals. Funding comes from both the federal government and the states, and states determine what services to cover. In some states, ADAP covers more than just medications: In New York, for instance, it may also pay for HIV-related doctor visits and COBRA or other insurance premiums and co-pays; in California, ADAP may help pay Medicare Part D premiums.
Even if you think you do not qualify for ADAP because your income is too high now or was too high before you lost your job, think again. Eligibility varies by state, and ranges up to about 400% of the federal poverty level, or more than $40,000 for an individual.
"One of the things about ADAP is that you can have some assets," said financial benefits counselor Novogrodsky. "You have to be HIV positive, but you don't have to have AIDS. And even if you earn more than $43,000 a year, you can still get some coverage. You may have to pay a co-pay for your medications."
Signing up for ADAP is not like the arduous process involved in applying for Social Security Disability Insurance or other federal or state-funded programs. And once you are signed up, the program kicks in fast, typically within 24 hours.
This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.
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