Could Raising the Minimum Wage Be the Best Way to Fight HIV?

On Jan. 22, President Biden announced his intent to increase the federal minimum wage to $15 an hour by 2025. But of the many benefits a minimum wage could hold for Americans in general, there’s also a benefit in store for many of society’s most marginalized when it comes to health.

While minimum wage could have a bunch of overall health benefits, an updated study from 2019 suggests that there is an “inverse relationship” between baseline state minimum wages and HIV infection rates among Black people, specifically Black heterosexual people, living in metropolitan areas within the U.S. In other words, this group sees lower HIV infection rates when they make more than the minimum wage.

Using data collected from 2008 to 2015, this study on population health found that HIV diagnoses among Black straight men and women dropped by 27% when they made at least $1 more than the baseline minimum wage. This was true even after adjusting for the cost of living and inflation.

Economic and Social Determinants Factor Into HIV Vulnerability

Researchers were guided by the idea that socioeconomic determinants affect how vulnerable Black people are to HIV. It has long been known that people living in poverty are more vulnerable to HIV infection for a host of reasons, including unstable housing, depression, exposure, and lack of medical care. Additionally, due to limited economic opportunities, people living in poverty are more likely to engage in behaviors that increase their risk for acquiring or transmitting HIV.

The current minimum wage is no less than $7.25 an hour in every state in the union except for Georgia and Wyoming. In those states, employers are allowed to pay employees $5.15 an hour unless they are subject to the Fair Labor Standards Act. But even in states with lower costs of living, these rates are nowhere near a livable wage.

For instance, according to MIT’s living wage calculator—which determines how much money full-time working adults need to make per hour in order to cover their basic needs—the living wage for adults with no dependents in Wyoming is $11.05 an hour and $10.67 an hour in Arkansas.

Fixing Minimum Wage Does Not Fix Homelessness

While raising the minimum wage can be considered a reasonable step toward combating the HIV epidemic, it does not go far enough for Black people who continue to face increased job losses and reduced prospects, as well as taxes, rising costs of living, and inflation.

For Jose de Marco, a longtime leading activist with ACT UP Philly, increasing the standard of living for all Americans by eliminating poverty outright is the only viable solution. He says, “At ACT UP, we believe that homelessness is the root of all evil.” Much like its sister organization in New York, ACT UP Philly is committed to ending the HIV crisis by using confrontational, hands-on approaches.

This past year, even as the coronavirus pandemic was raging, ACT UP Philly continued to stage actions at the deputy mayor’s house over his inaction around the homeless crisis. De Marco himself sent funeral wreaths to punctuate the consequences of this austerity, which led to increased deaths of homeless people throughout Philadelphia during the coronavirus pandemic. “Many people died on the street homeless with AIDS,” he says. “And I’m not talking about the 80s; this was 2020. Had they been housed and on treatment, they probably would not have died.

“It’s always been a life-or-death situation out here—and it’s that much worse because of COVID,” de Marco says. “If you don’t have a roof over your head, you can’t do much of anything—especially people of color, because we’re already at a higher risk for HIV.”

He cautions that homelessness and the ongoing HIV crisis cannot be fixed by increasing wages alone. “Black people have always faced reduced opportunities in this country,” he says. “Even when there are jobs, extra education demands, bias, and outright racism prevent them from going to us. And improving employment does not mean that we get to drop our duty towards people in need.” For instance, he says, “Philadelphia doesn’t put a dime into directly housing people with HIV. All of that money comes directly from Housing Opportunities for Persons With AIDS, and it is nowhere near enough.”

Employment Inequities

De Marco’s words point to a major blind spot within the study on minimum wage and HIV rates: the failure to consider employment trends. According to the Economic Policy Institute, even before the coronavirus-related economic depression, one in nine people in the U.S. working full-time schedules were paid amounts that left them in poverty, and Black and Latinx people were almost twice as likely as white people to be paid poverty-scale wages.

Additionally, the study focused exclusively on Black heterosexual people. Though all Black people suffer from racism in this country, the social determinants that affect Black people within the queer community—including stigma, homophobia, and violence—are on another level altogether. Case in point: At current conversion rates, Black women face odds of one in 48 of being diagnosed with HIV during their lifetime; for Black men, the odds are one in 20; and for same-gender-loving Black men, the likelihood is a one-in-two chance of seroconverting.

This says nothing of Black people who are working at part-time levels or those without work at all. According to the U.S. Bureau of Labor Statistics, in 2018, Black people made up 23% of marginally attached workers (those who want work but stopped looking recently), 27% of discouraged workers (those who have given up looking for work), and about 6% of unemployed people who were actively looking for work.

That’s why Sarah Oltmans, chief of grant strategy for Robin Hood, says, “Raising the minimum wage will not necessarily impact homelessness or the lives of people with HIV directly.” Unlike the stock-trading app that has been in the news, this Robin Hood is a 30-year-old granting organization that partners with nonprofits to create scalable solutions that lift families living in New York City out of poverty.

Oltmans says, “Raising living standards can have an impact, but expanding access to health care through Medicaid and the Affordable Care Act have had the greatest impact on viral suppression.” That gels with TheBody’s own reports that viral suppression rates were better under Obamacare than they were even under Ryan White drug coverage. The Ryan White program covers primary medical care, medications, and essential support services for under- or uninsured people living with HIV, whereas Obamacare allows people to access care regardless of their status.

Design Programs That Work for People

Rather than focusing on figures from a singular study or raising the minimum wage as a standalone action, Oltmans believes that scaling up effective solutions and making them available to everyone is essential to the fight against HIV. As an example, she cites a pilot project that Robin Hood funded with Housing Works in 2014; that program paid cash incentives to people living with HIV who stayed adherent to their medication.

She says that the program was incredibly effective and helped participants maintain viral suppression because it was “driven by people who are experiencing poverty” and provided cash incentives, to remove barriers.

For the ongoing fights against HIV, poverty, and homelessness to work, Oltmans says, “We have to design programs and policies that work for people,” instead of placing onerous conditions on their lives. This means acknowledging that people make choices that work for their own wellbeing as well as their family’s, removing benefit clips―such as losing 25% of your unemployment benefits if you work for one hour on one day or having to decimate one’s savings in order to qualify for a program—and providing incentives that inspire people to participate rather than to fall off the grid.

Though the idea of spending money to help people take care of themselves may strike some as unpalatable, it is important to note that when we don’t, society ends up bearing an even greater cost than an increased minimum wage could ever cover.