Although progressive Democrats’ plans to raise the federal minimum wage to $15 an hour by 2025 have hit a snag in the Senate, many people in the HIV community know that a living wage and housing are two great methods of prevention in the fight against HIV. And no one knows that more than longtime human rights activist Charles King, CEO of Housing Works, a nonprofit that fights HIV and homelessness in New York City.
King says, “Vocational activity of any kind serves as an HIV prophylaxis and enhances HIV viral suppression,” and a “$15 national minimum wage would protect people a whole lot more than a $7.25 minimum wage.” But he cautions that employment is not guaranteed. To overcome homelessness, he says, “It’s got to be a stable job with security” that accommodates people living with chronic health conditions or who have children at home.
But the scarcity of living wages and affordable housing is just part of an interconnected series of oppressions that keep marginalized people at higher risk for HIV. One of these is mass incarceration.
“One in three Black men is going to have a felony conviction following them for the rest of their lives,” King says. Years of data show that a prison record prevents people from finding work, meaning that, in King’s words, “a misdemeanor charge for jumping a turnstile in New York’’ can result in devastating consequences if “a DA asks for a cash bail that you can’t meet.”
“You might spend three to six months on Rikers Island before you get released—and three to six months is more than enough time for somebody to lose their home,” he says. He adds that it is just as bad for single mothers with dependent children, especially if domestic violence is an issue.
King has a point. In New York, the necessary living wage for a single adult balloons from $17.99 an hour to $32.91 an hour if that person has one child. Mathematically, there is just no way to put down a security deposit and first month’s rent on $15 an hour, even with a rental-assistance housing voucher. Particularly when people with felony or drug-related convictions are barred from any public housing, even if they have the option of staying with family.
What it comes down to is whether or not stable housing is a fundamental human right. For King, it absolutely is. Looking at communities that have been most affected by the coronavirus, he says that after homeless populations, there are a lot of essential workers who have been glorified for “getting paid minimum wage for the riskiest work” but who are living “in the most crowded housing.” They are applauded for risking their lives to bag our groceries—and ignored when they go home and become sick.
For King, the obvious solution is prevention. In this instance, that means spending money to provide adequate housing with enough space for social distancing. That means state and local jurisdictions will have to match federal funding from Housing Opportunities for Persons With AIDS (HOPWA). Despite the initial cost, it is the correct financial and moral decision.
It’s a simple case of health economics, which studies the amount of money that medical interventions can save. For example, cancer treatment or dialysis costs taxpayers more money than funding prevention, such as paying for a homeless person’s rent. When legislators hear this, King says that they are quick to say there isn’t enough money for it, but they’ll “spend a million dollars on treatment even if the result actually hastens that person’s death. We don’t think about that because Sloan Kettering makes money off of treating cancer.”
Ultimately, taxpayers end up footing that bill. For HIV, it is instructive to consider the price of medication, which can cost $36,000 to $48,000 a year. That does not include blood work or doctor visits, which can add tens of thousands more dollars to the total. Meanwhile, the average cost to rent a one-bedroom apartment in the U.S. is about $1,200 a month, or $14,400 a year.
At those rates, even an austerity-minded deficit hawk would have to agree with King: Providing stable housing to people is much less expensive than allowing a person to seroconvert. The good news is that, thus far, President Biden seems to think so as well. Unlike the previous administration, which cut $45 million from HOPWA’s budget, Biden has promised to take a “housing-first approach” toward homelessness.
This includes a promise to enact Rep. Maxine Waters’ Ending Homelessness Act, which would devote $13 billion in federal funds over five years to creating more than 400,000 housing units for people who are homeless. In her capacity as the chair of the committee on financial services, Waters commissioned a study that found that homelessness is much worse than was previously reported due to chronic undercounting in rural areas. Additionally, the study included new data that suggests that homelessness increases by 9% when there is a $100 increase in median rental prices.
Given the ongoing loss of jobs, the pandemic, and natural disasters, here’s hoping that Waters and Biden press forward with their plan. As King says, a multi-pronged attack is the only way to end the entwined HIV and homelessness epidemics.