The full text of the plan, which was approved 96-0, earmarks $90 million for the Ryan White HIV/AIDS Program and $65 million for Housing Opportunities for Persons With AIDS (HOPWA). The former, which was created by federal legislation in 1990, helps fund medication and treatment for low-income people living with HIV, while HOPWA provides assistance with the housing needs of this vulnerable population.
Rachel Klein, the deputy executive director of the AIDS Institute, said that advocates for people living with HIV are “thrilled” to see these critical programs included in the legislation, which Senate Minority Leader Chuck Schumer, D-N.Y., touted as “the largest rescue package in American history.”
“This whole bill is designed to make sure that as we're starting to see the economic impact of this epidemic, that people have additional support in order to help them deal with it,” Klein told NBC News. “We need to make sure that people living with HIV are able to continue getting the care that they need and those programs are going to need to adapt to this new environment.”
Klein said the additional funding for the Ryan White Program will help individuals “get the treatment that they need, with as little disruption as possible.” A brief from the National Institutes of Health stated that people living with HIV are not at greater risk from COVID-19, the disease caused by the coronavirus, if they take daily antiretroviral medication and have an undetectable viral load. However, that could be jeopardized if their medications for the chronic immune condition are impeded in any way.
Klein said people with HIV could be categorized as high risk if they are members of other groups more vulnerable to COVID-19, including the elderly and those with a history of respiratory infections. “People living with HIV tend to be older, and they tend to have higher rates of cardiovascular or lung disease,” she said.
Almost half of the 1.1 million people living with HIV in the U.S. are over 50, according to the Centers for Disease Control and Prevention.
In addition to expanding the Ryan White Program to make sure these vulnerable groups can get health care during the COVID-19 outbreak, advocates said funding for HOPWA is critical to ensure people managing HIV through daily medication retain their rates of viral suppression.
“When people are unstably housed, they can’t take their medicines every day,” Emily McCloskey, director of policy and legislative affairs for the National Alliance of State and Territorial AIDS Directors, told NBC News. “They might not have access to or storage for their medication, and they have a lot of other priorities that are critical to their basic survival, like food and shelter. Once they are in stable housing, they are able to transition their hierarchy of needs toward maintenance of their HIV.”
McCloskey noted that people with HIV are more likely than the average person to face housing instability. The Kaiser Family Foundation reports that 42 percent of people living with HIV rely on Medicaid, a government program to ensure access to care for low-income individuals, for their health needs, compared to just 13 percent of the general population.
“We see sort of this reliance on public health infrastructure and insurance in a way that is not the same for the general population,” McCloskey said. “It's really important to see that those programs are shored up and addressed.”
Following its passage in the Senate, the stimulus bill is awaiting a vote in the Democratic-controlled House of Representatives, where Speaker Nancy Pelosi has reportedly drafted her own version of the package. In addition to funding for federal HIV programs, the Senate plan includes a $500 billion loan program for corporations amid a national economic slowdown and over $100 billion in funding for hospitals as they respond to the public health crisis.
As of Thursday afternoon, there were more than 75,000 confirmed cases of coronavirus in the U.S., which have resulted in over 1,100 recorded deaths.
Should the stimulus plan pass with funding for HIV care attached, it will largely be due to the work of LGBTQ advocates and lawmakers who have been pushing for the needs of this vulnerable population to be addressed. Over 100 national advocacy groups — including the Human Rights Campaign, GLAAD and Lambda Legal — signed onto a March 11 letter urging federal authorities to ensure that LGBTQ people, who are disproportionately impacted by HIV, “are adequately served during this outbreak.”
That plea was soon followed by a letter from 11 Senate Democrats calling on the Department of Health and Human Services to reverse federal policies that negatively affect LGBTQ people and those living with HIV while seeking health care. This includes a 2019 proposal to allow doctors and other medical professionals to refuse to treat people or participate in care that goes against their moral or religious beliefs.
In an interview with NBC News last week, Sen. Bob Menendez, D-N.J. — who initiated the letter — said these communities are “right at the very heart” of the COVID-19 crisis in the U.S. but claimed that they had largely been ignored in the Trump administration’s response to the outbreak.
“They've done a poor job of meeting the needs of the community at large,” Menendez said. “They certainly have been paying no particular attention to communities that have special needs.”
In addition to Schumer and Menendez, the letter was signed by Sens. Tammy Baldwin of Wisconsin; Richard Blumenthal of Connecticut; Chris Coons of Delaware; Tammy Duckworth of Illinois; Kamala Harris of California; Amy Klobuchar of Minnesota; Gary Peters of Michigan; Chris Van Hollen of Maryland; and Elizabeth Warren of Massachusetts. The White House has yet to formally respond to the letter.