We must rise up in support of our Puerto Rican brothers and sisters, both on the island and the U.S. mainland, after the devastation of Hurricane Maria -- not just by responding to their cries for help with charity and compassion, but by amplifying them to such a pitch that the rest of the country and the elected officials who represent us in Washington are forced to take note and act accordingly.
The unfortunate truth of the matter is that HIV service providers and HIV advocates in Puerto Rico were already struggling to meet the needs of people living with or affected by HIV before Hurricane Maria showed up. With over 20,000 people living with HIV on the island, Puerto Rico ranks in the top 10 among U.S. states and territories for total HIV cases and has an HIV death rate higher than any U.S. state or territory.
Today, the deepest wounds inflicted on the people of Puerto Rico by the deafening tumult of Hurricane Maria have been caused by the subsequent silence. First, there was the silence that came after the 155 mile-per-hour winds had torn through the island, severing power lines, tearing down transformers and cell towers, leaving the entire population -- close to 3.5 million -- sitting in darkness and stranded from the world around them. Then came the silence of the American news media, which was able to send cadres of journalists to Texas and Florida and even Mexico City to breathlessly report on their catastrophes, but could not summon the will to send more than a handful of camera crews to San Juan and Ponce and Arecibo.
And lastly, there was the silence of the president whom, despite having U.S. citizenship, they were forbidden to vote for (or against). After five long days, when President Trump finally remarked on the humanitarian disaster worsening under his watch, he took the occasion to blame the Puerto Rican people for their misfortunes, focusing the lion's share of his tweets about Hurricane Maria on the massive debt incurred by the island.
The HIV community cannot be complicit in the perpetuation of these deadly and devastating silences.
This situation would be difficult enough if Puerto Rico had the same resources and accessibility to federal funding as even the poorest U.S. states, but it does not. Neither a full-fledged state or independent nation, Puerto Rico finds itself almost completely dependent on a U.S. government that seems to view it as little more than a resource colony.
As a recent feature in POZ noted, Puerto Rico's health care funding structure is fundamentally different than that of the 50 U.S. states. The way that Puerto Rico receives Medicaid funding -- via grossly insufficient block grants that don't fluctuate based on need -- is a sobering reminder of what Medicaid policy would have looked like for the entire country had Congress passed the Graham-Cassidy health care bill. As of right now, a one-time payment of $6.4 billion for the Puerto Rico Health Insurance Administration included in the Affordable Care Act is barely keeping the island's Medicaid program afloat -- but that money was set to run out within the next year or so even before Hurricane Maria came along.
In conjunction with Puerto Rico's overall economic decline, this criminal underfunding of the island's health care system has led to an exodus of Puerto Ricans to the mainland, with HIV care providers and other health care providers among them. The College of Physicians and Surgeons of Puerto Rico estimates that two doctors leave the island every day for opportunities on the mainland; the devastation wrought by Maria is sure to speed up the rate of their departure.
Helping to Meet Immediate and Basic Needs: What You Can Do
But right now, larger issues around health care infrastructure have taken a backseat to the more immediate and basic needs of Puerto Rico's residents. Electricity has been knocked out for almost all 1.57 million households that previously had access, and a combination of factors has made the acquisition of fuel to run gas-powered generators extremely difficult, with six-hour lines for gas becoming the norm. Currently only 56% of the island has access to potable water and food shortages are becoming more prevalent as time goes on and the response from the U.S. government remains sluggish.
Given the lethargic and insufficient mobilization of aid from President Trump and Congress, it is up to the American people in general -- and the HIV community specifically -- to answer the bell and provide our Puerto Rican brothers and sisters with the help they so desperately need.
There are a number of excellent Puerto Rico-based community groups with recovery funds that will make excellent use of your donations, such as Taller Salud, a women's health organization that has set up The Hurricane Maria Community Relief & Recovery Fund, which focuses on providing aid to low-income communities of color. For those who might be short on cash but have useful items such as medical supplies or solar/battery-powered appliances to donate, this exhaustive list of drop-off centers across the country should help.
Funding Available to Groups Serving Those Affected by Hurricanes Irma and Maria
Perhaps most importantly, there are ways you can specifically assist people living with or impacted by HIV in Puerto Rico. An HIV Hurricane Relief Effort was set up by AIDS United (where I work as a policy associate) in concert with NMAC and Gilead Sciences in the wake of Hurricane Harvey. This has since been expanded to provide aid for victims of Hurricanes Irma and Maria, as well. On a weekly basis, the staff at AIDS United is reviewing funding requests from non-profits affected by Hurricanes Harvey, Irma and Maria and dispensing funding awards of between $10,000 and $15,000 to qualifying organizations.
Due to the massive power outages and lack of reliable cell phone service, it is proving exceedingly difficult to connect with AIDS service organizations in Puerto Rico and process the funding applications that need to be filled out if they are to receive aid. We encourage anyone who is reading this article who has any connection to an AIDS service organization in Puerto Rico to continue trying to get in contact with them and to provide them with the forms required to apply for an HIV Hurricane Relief Fund award. Here you can find AIDS United's HIV hurricane funding opportunities page, which includes funding applications in both English and Spanish, along with English- and Spanish-language versions of the eligibility requirements and instructions.
Again, if you know anyone who works for an AIDS service organization based in Puerto Rico -- and this includes individuals who live in the mainland U.S., but work for organizations that provide services on the island -- we strongly urge you contact them and make sure that somehow, some way, they are able to fill out this applications and get the funding they need to begin the long, slow process of recovering from Hurricane Maria.
You can also donate directly to the HIV Hurricane Relief Fund by clicking on this link.
Pushing Back Against Damaging Economic Policies
Currently more than $70 billion in debt and largely under the control of a presidentially appointed seven-member Financial Oversight and Management Board, Puerto Rico was unable to adequately fund social programing and medical services even before Maria hit.
Yet, Trump's tweets pointing to the island's massive debt have conveniently neglected the central role that America's draconian economic policies have played in its formation. For example, the federal government continues to enforce the antiquated Jones Act, which mandates that only American ships helmed by American crews can ferry goods and passengers from one American port to another. It serves only to drive up the cost of living for Puerto Ricans and provide a monopoly for American shipping interests. Because of this and other factors, the cost of living for Puerto Ricans is 13% higher than in 325 urban areas in the United States, in spite of the fact that Puerto Rico's per capita income is less than half of the poorest state in the Union.
Thus, even as we work today to help meet the pressing needs of people in Puerto Rico in the wake of the storm, the HIV community must commit to revealing and confronting the longstanding practices of economic injustice that have made the island and its residents uniquely vulnerability to harm.