Fifty-six-year-old “Mr. E.” is in a much better place today than he was five years ago. Diagnosed with HIV in 1993, Mr. E. (who asked to withhold his full name for internet privacy) has been clean and sober since going to rehab in 2016. He shares an apartment and a car in Birmingham, Alabama, with his male partner, works part-time in a health care facility, and enjoys socializing at a nearby recovery center.
“I’m at a peaceful, comfortable place in my life,” he says. But he admits that finances are extremely tight. He brings home about $1,300 a month, $450 of which goes to his $550 monthly rent. (His partner, who is on disability, pays the other $100.) That means he has to stretch that remaining $850. He and his partner can’t afford a second car, which would make their lives easier. They can’t even afford full insurance on the car they have, which Mr. E. is currently still paying off.
Unexpected expenses are cause for alarm. Once, he says, when he got an unexpected water bill—because they have to pay for their own water—he had to live on $20 for four days to make it to the next pay cycle.
There’d be more breathing room if, as a low-income person living with HIV, he could put less of his salary toward rent. That’s why, for a year, he’s been on a waiting list for what’s called Tenant-Based Rental Assistance (TBRA), a component of Housing Opportunities for Persons With AIDS (HOPWA), which Congress created in 1990—the same year as the Ryan White CARE Act (RWCA), which pays for HIV medication and treatment—to fund various forms of housing assistance.
According to Tonya Jackson, grants management director at AIDS Alabama, where Mr. E. is a client, if Mr. E. got onto TBRA, he could push his share of rent down to about $300, and even more if he can show co-pays or other medical expenses he is currently responsible for. That would put at least another $150 in his pocket every month.
A Big HOPWA Funding Jump Could Make a Big Difference
And Mr. E.’s savings would be thanks to HOPWA, which, like RWCA, has consistently enjoyed bipartisan support in an otherwise highly divided Congress for more than 30 years. Even in the Trump years, the program grew by a third, from $330 million to $430 million.
“And that’s incredible,” says Lauren Banks Killelea, director of policy and advocacy at National AIDS Housing Coalition, the main group that lobbies (in coalition with many other groups) on behalf of HOPWA. “But that’s still small when it comes to housing.”
To give you a sense of how small, consider that RWCA is currently funded at nearly $2.4 billion.
What’s more, says Killelea, next year, formula changes to funding will kick in. These changes will shift funding to areas with more recent HIV cases (such as in the South) and away from places with older HIV epidemics, such as New York and San Francisco.
“That means we’re going to need a significant increase in HOPWA funding to make sure that all jurisdictions can keep housing people” and to not lengthen already existing waiting lists, such as the one that Mr. E is on in Alabama.
That’s why, this year, HIV housing advocates have organized to push Congress for a HOPWA increase of $600 million. According to Killelea, more than 100,000 people living with HIV in the U.S. are currently homeless, either on the street, in low-grade shelters, or couch-surfing—a number that may grow due to the economic fallout and unemployment from COVID. The U.S. Department of Housing and Urban Development (HUD) estimates that 400,000 people are currently eligible for HOPWA, says Killelea—but right now it is only serving 55,000.
Plus, advocates stress, more HOPWA funds could not only serve more people, but could do so in so many ways—not just via rental assistance.
“We love how flexible HOPWA funds are,” says Kathie Hiers, CEO of AIDS Alabama, where Mr. E. is a client. “It’s up to the jurisdiction how the money is used, and it can go toward housing ‘wraparound’ services like case management, transportation, mental health and substance use help, food support. There’s almost no public transportation in Alabama. If we didn’t have the vans we operate through HOPWA funding, our clients would struggle to get to medical appointments. I call HOPWA the glue that holds all these services together. It works very well with [the primarily medicine and care services of] RWCA.”
Around the country, HIV agencies say they could do amazing things with more HOPWA funding.
In North Carolina, Shannon Farrar, executive director of Carolinas CARE Partnership, says that a HOPWA bump “would give us the resources to purchase additional housing stock, and to find new ways to fund agencies and hopefully open up more units of housing for people living with HIV. And of course, more sustained funding can translate to more [housing unit] vouchers. We don’t want to offer just vouchers for short-term housing, because we don’t want someone to lose their housing just because their voucher funding ends.”
With HOPWA funds thus far, she says, her group has funded a partner agency to link HOPWA-eligible clients to supportive services in addition to housing. Plus, she says, HOPWA funds have been combined with city and state funding streams to secure and rehab 18 units of affordable housing, six of them set aside for HOPWA clients.
In Texas, Traswell C. Livingston III, CEO of AIDS Services of Dallas, says that his agency gets $1.8 million annually from HOPWA, which funds just under 300 people via two different kinds of housing, including units on which his agency is the leaseholder. HOPWA also funds client case management, vocational and employment support, transportation, and food services.
But he says that his agency currently has 221 people on a housing waiting list, up 67% from last year.
“Most of our working clients are front-line service workers, and many have lost employment because of COVID,” he says. With more HOPWA funding, his agency could lease more housing of its own to clients, as a way of getting around the ongoing challenge of getting landlords to rent to low-income people living with HIV—or to those eligible for any kind of voucher, for that matter. (Many agencies said that landlord reluctance was a major obstacle to making more housing units available to clients.)
If his agency’s HOPWA allotment went up to, say, $2.5 million, he says, “We could probably increase our client assistance 100%.” The extra money would not only help them expand their own number of apartments but also the case management and support services for newly housed clients that make them more palatable to landlords.
“We prepare folks for independent living,” he says, “because when you’ve been living in a tent community, transitioning to your own one-bedroom apartment—learning to cook, clean, and use a washer and dryer—is not as easy as you’d think.”
Meanwhile, in Honolulu, Hawaii, Jonathan Berliner is executive director of Gregory House Programs, which provides housing and food for about 600 clients living with HIV. He says that about 100 clients are currently on his agency’s housing waitlist—because of a shortage of affordable housing, not a shortage of HOPWA funds per se.
“But,” he explains, “if we had even 25% more HOPWA funding, about an additional $255,000, we’d be able to house them because we could use the money not just for rent but to hire more case managers to build more relationships with landlords. We could really work our way down our waitlist, prioritizing folks who are street homeless.”
And homelessness has increased in Honolulu, he says, because COVID has made the area’s tourism rates—a huge economic driver—plunge from about 35,000 to around 7,000 to 8,000 visitors a day. “Most hotel jobs have been laid off.”
Berliner was not alone among providers who said that, when it comes to housing low-income people living with HIV, the larger problem beyond HOPWA funding is the lack of units in metropolitan areas, especially gentrifying ones, with landlords or management open to accepting HOPWA or other low-income vouchers.
Advocates have long said that the U.S. government’s plan to essentially end the HIV epidemic by 2025 is not possible without more stable housing for low-income people living with HIV.
So What Is the HOPWA Funding Timeline?
The quest to secure more funding for HOPWA “will play out in 2021” within the process for the 2022 federal budget, says Hiers, “but I’ve stopped trying to predict when federal budgets will get passed.”
Step one, says Killelea, is waiting for the White House to release its proposed budget, likely in late March, which signals to Congress its national priorities. After that, Congress begins deciding how much money will go to its big appropriation committees, such as T-HUD, under which HOPWA funding falls.
TheBody reached out to Rita Harcrow, who administers the HOPWA program at the Department of Housing and Urban Development (HUD) in Washington, D.C. We asked Harcrow if she expects the administration to put more money for HOPWA in its budget proposal, and how the Biden administration views HOPWA, especially in its plan to End the HIV Epidemic by 2025.
The largely unrevealing reply came not from Harcrow but from HUD press secretary Meaghan Lynch.
“Under the Biden-Harris Administration,” she wrote in an email, “HOPWA will continue serving as a critical component of the country’s efforts to end the HIV epidemic. HUD is currently working to assist HOPWA grantees to make strategic use of the $65 million in HOPWA grants provided through the CARES Act to meet the housing and health needs of people living with HIV/AIDS. HUD looks forward to working closely with federal partners in this administration. We cannot end the HIV epidemic without support for housing.”
Killelea says she is happy to hear that. “We’ve already had several good meetings about our [funding] asks with our appropriators [in Congress],” she says, “but we’re going to have to fight like hell. HOPWA gets a fraction of [funding allotted to] other housing programs, as well as Ryan White. We need a bigger HOPWA pie.”
And if Congress bakes a bigger pie, so to speak, a slice might make it all the way down to Mr. E. in Birmingham, whose rent remains just too damn high for what he brings in. A little relief could mean, for example, the ability to get a second car, so that his disabled partner can get himself to and from the sober community center independently while Mr. E. drives the other car to work.
Either way, says Mr. E., over the next five years, “I’m going to work and elevate my life to become a better person and continue in my recovery, which is a big part of my life. I want to retire at 62, in five years, and spend more time helping people beat their addiction.”
And he wants to finally take a vacation, he says. “That’s something I’ve never been able to do.”