The record-setting $2 trillion deal Congress reached on Wednesday to stimulate the economy amid the devastation of the coronavirus pandemic contains $155 million to bolster HIV programs serving the nexus of communities affected by both diseases.
For the Ryan White HIV/AIDS Program, the deal includes $90 million for existing contracts under the law and the Public Health Service Act. At the same time, the deal appropriates $65 million for the Housing Opportunities for Persons with AIDS, or HOPWA, to maintain operations and provide rental assistance amid the coronavirus crisis.
In both cases, the money must be used by Sept. 30, 2022, although appropriations for HOPWA afford some additional flexibility. The money is on top of the $330 million Congress appropriated in December 2019 for Ryan White and other initiatives in fiscal year 2020 as part of the Trump administration’s initiative to beat HIV by 2030.
The money for the HIV programs is geared toward ensuring recipients — which include cities, states and community health centers — can continue and expand those services as the coronavirus pandemic complicates efforts to address HIV.
Rachel Klein, deputy executive director of the AIDS Institute, said the additional money for Ryan White programs, which provides care to low income people with HIV, is essential for HIV-positive people trying to obtain services amid the coronavirus pandemic.
“The program itself needs to be able to adapt to provide care in different ways,” Klein said. “People are trying to avoid sitting in public meeting rooms unnecessarily right because they don’t want to be exposing themselves potentially to a new virus. The programs are going to need to be able to be flexible, to find creative ways to ensure that people are able to still get the care that they need, and that’s going to come with some costs.”
There are mixed opinions about whether people with HIV are more at risk for COVID-19. On one hand, HIV if left untreated will depress a patient’s immune system and make them more susceptible to disease, but Dr. Susan Henn, chief medical officer for the D.C.-based Whitman-Walker Health, has told the Blade for people with well-managed HIV, the increased risk would only be “very slight.”
Lauren Killelea, director of public policy of the National AIDS Housing Coalition, said money for HOPWA is needed because people with HIV without access to housing “are less likely to be virally suppressed and therefore more susceptible to COVID-19.”
“HOPWA is uniquely situated to be a great, flexible resource for low-income people living with HIV during the coronavirus pandemic,” Killelea said. “HOPWA can not only provide permanent housing but also short-term assistance as well as critical supports like access to transportation and nutrition services.”
After failed votes in the U.S. Senate and negotiations throughout the week, congressional leaders had announced Wednesday morning they had reached a deal on Stage 3 for congressional action in response to the coronavirus crisis.
A vote was expected earlier Wednesday after the Senate returned from recess, but proceedings were halted over objections from a small cadre of Republicans — including Sens. Tim Scott (S.C.), Ben Sasse (Neb.) and Lindsey Graham (S.C.) — over language they say could lead to the exploitation of unemployment benefits. After leaders agreed to an amendment to appease these lawmakers, the Senate voted to approve the measure 96-0.
The next step is House approval for the stimulus package and President Trump signing the package into law, both of which were expected to happen expeditiously.
A number of parties had pressed Congress for the HIV funds in the stimulus package. Last week, AIDS United and a coalition of 90 HIV/AIDS and LGBTQ groups, including GLAAD, the Human Rights Campaign, Whitman-Walker Health, NMAC, NASTAD, NCSD and the AIDS Institute, sent a letter to every member of Congress urging them to consider people with HIV and “craft a relief package that takes the unique needs of this population into account.”
In a letter to Congress dated March 17 and obtained by the Blade, the White House Office of Management & Budget sought money in the stimulus package for Ryan White and other health programs to the tune of $1.336 billion. An attached request from Health Resources & Services Administration makes that request for “health centers to expand triage and treatment capacity and telehealth, rural hospital technical assistance and the Ryan White HIV/AIDS Program, in response to coronavirus.”
The request, however, makes no mention of HOPWA funds, which the Trump administration sought to cut earlier this month in its budget request for fiscal year 2021. OMB didn’t respond to the Blade’s request to comment on whether it welcomes the HIV money appropriated in the stimulus package.
Killelea said the HOPWA money was inserted by the Transportation and Housing & Urban Development Act appropriations staff headed by Sens. Susan Collins (R-Maine) and Jack Reed (D-R.I.) and Reps. David Price (D-N.C.) and Mario Diaz-Balart (R-Fla.). (Diaz-Balart was the first member of Congress confirmed to test positive for the coronavirus.)
Congress makes the appropriations at the same time the Trump administration has made a pledge to beat HIV in the United States with a PrEP-centric plan that aims at reducing new infections by 75 percent in five years and 90 percent by 2030.
Carl Schmid, executive director of the HIV & Hepatitis Policy Institute and co-chair of Presidential Advisory Council on HIV/AIDS, told the Blade the extra money is needed because the coronavirus threw a “monkey wrench” in the HIV plan.
“I was just talking today to someone at the CDC that several people from the center for that are working on HIV are being used to address COVID-19, and it’s a significant amount of their staff, because they all have the expertise in infectious diseases, and the doctors, too, in the field,” Schmid said. “That’s why I can see a lot of this 90 million being used to, for the doctors in the workforce.”
As Congress advances the deal, the Health Resources & Services Administration’s HIV/AIDS Bureau was set to have a phone conference with grant recipients and stakeholders across the country on Thursday at 3:30 p.m., according to a notice shared with the Washington Blade.