Are Women Living With HIV 'Incentivized' to Remain Poor?

Naina Khanna
Naina Khanna

For many women, an HIV diagnosis is a sentence to a lifetime of poverty, notes the Positive Women's Network - USA (PWN-USA).

The group hosted a recent webinar entitled Advancing Economic Justice and Employment Opportunities for Women Living With HIV, where PWN-USA Executive Director Naina Khanna called for a review of government policies requiring people living with HIV to keep their income under a certain level in order to qualify for subsidized medications and other benefits.

"We have a situation where we have effectively created a biological underclass of people with HIV where we incentivize people with HIV to stay poor in order to access benefits and to take care of themselves," she said.

"Because of the way many of our entitlement programs have been set up, people with HIV become incentivized to stay poor because you can't, for example, earn over a couple of thousand dollars a month and still qualify for ADAP [the AIDS Drug Assistance Program]. In some states, that number might be as low as a thousand dollars or even less."

The intersections between poverty and HIV are well documented. In the U.S., 64% of women living with HIV and receiving regular medical care had annual incomes under $10,000 compared to 41% of men, according to the Research and Development Corporation's 1996 HIV Cost and Services Utilization Survey.

"There's a lot of data showing that poverty increases vulnerability to HIV, especially for women in the United States, through housing instability, food insecurity and a whole range of other factors," Khanna said. "But what doesn't get talked about as much is the fact that HIV also leads to poverty and often keeps people in a cycle of poverty."

Speaking after the webinar, she explained many women struggled with poor health, medication side effects and inflexible work environments. Women engaged in temporary or shift work were at a particular disadvantage.

Khanna explained, "A lot of women might be working multiple jobs ... Maybe she's cleaning a house from nine to one, then she goes to work a shift at MacDonald's from two to eight, and then maybe she does security somewhere else for a few more hours at night. In that kind of situation, you really don't have flexibility to be sick and not show up for work."

In addition, women living with HIV continue to experience stigma and discrimination when seeking employment and on the job.

"The surveys that have been done, looking at stigma among the American public, show really high levels of stigma against people with HIV in food service settings, childcare setting and school settings ... and a lot of those professions are professions women have historically held," Khanna noted.

Webinar participants called for increased investment in policies and programs that support women's right to work and to be paid a living wage, regardless of HIV status.

"It's very hard to reenter the workforce. Computer technology has changed; a lot of things have changed in the last years so, while people may be healthy enough to reenter the workforce now, and may want to take that chance, it can be really hard," Khanna added.

"So part of what's needed are back-to-work programs and employment programs for people living with HIV -- stuff like resume writing and specific skills building, especially around computers and technology, and a whole range of other things."

However, back-to-work programs should be seen as one piece of a holistic response to economic disparities among women living with HIV, she emphasized.

"There are lots of things individuals can do, but we need more accountability at the systems level on this issue," she said. "People living with HIV want to work, and should have the right to work, and we need stronger protections that enforce consequences for discrimination in workplace settings, and we need greater opportunities and more resources that actually focus on getting people back to work."

Speaking on the webinar, National Working Positive Coalition (NWPC) President Mark Misrok said that, even as HIV became a chronic manageable condition, government policies were slow to respond to positive people's need for financial autonomy.

Misrok noted a number of positive developments in the past few years, including several promising federal and state initiatives, but said there was still much work to be done to secure economic justice for women living with HIV in the U.S.

"We have a long road to go to have the changes that are needed to equip communities of women living with HIV -- and all people living with HIV -- to really have anything approaching a level playing field to control our economic destinies and develop our own economic empowerment," he said.

Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.