Like many HIV-positive patients, Alan Perez has struggled with homelessness. After contracting the virus in 2001, he split up with his partner and briefly spent time in a shelter. The Bronx resident finally found a permanent place to live with the help of a little-known city housing benefit.
But the benefit wasn’t easy to get. In order to qualify for the rental subsidy, Perez says he had to make himself sicker.
“I took a risk. I took a big risk,” he said.
Under a housing assistance program run by the New York City HIV and AIDS Services Administration, HIV-positive patients can get rental benefits only if they meet low-income requirements and have T-cell counts that are 200 or lower.
T cells are white blood cells that help fight off bodily infections. When a patient’s plasma has fewer than 200 T cells, doctors classify an HIV infection as fully developed AIDS.
"I wasn’t going to qualify for the program because my T-cells weren’t that low," Perez said. "I stopped taking my meds."
Kristin Goodwin, director of policy and advocacy at Diaspora Community Services, an AIDS advocacy center, said she believes Perez is one of many New York City HIV patients who have purposely lowered their T-cell counts in order to qualify for housing. She said she first heard Perez share his story in a roundtable discussion.
"Alan told a story in a group that I was in, and I just remember feeling really sad that he had to make that choice," Goodwin said. "Clearly he was not the only person in the room who has had to make that choice. There were a lot of people that agreed with him. They said, 'Yeah, I remember when I decided that I was going to stay on treatment but I didn’t get my apartment.'"
AIDS researchers have long warned how dangerous it can be to stop an HIV medication regimen, even for a few days or weeks. Taking a break from treatment can result in virus mutations -- which can make HIV more drug-resistant in the future, according to Dr. Jeffrey Laurence, director of the laboratory for AIDS virus research at Weill Cornell Medical College.
"We’re talking about not taking medications that are going to leave not only a person vulnerable, but his or her community vulnerable," Laurence said.
Salina Smith, a spokeswoman for the Centers of Disease Control and Prevention, said people who start and continue HIV drug treatment are 96 percent less likely to transmit HIV to others.
The New York City HIV housing program is uniquely generous among cities. Most cities do not offer housing benefits to HIV-positive residents, no matter how poor or sick they are.
In an email statement to the I-Team, Laura Hart, a spokeswoman for the city’s Human Resources Administration, said the T-cell threshold is being re-evaluated.
"The rules for who does and does not receive housing assistance were set many years ago, and as part of our reforms at HRA, we are reviewing whether those long-standing policies still make sense," wrote Hart.
Hart added that the city has already worked with Gov. Cuomo and state lawmakers to lower the cost of housing for AIDS patients -- regardless of their income bracket -- and implemented a law that caps rents for New Yorkers living with AIDS at 30 percent of income.
According to World Health Organization guidelines, HIV-infected patients should begin drug therapy whenever a T-cell count less than 350 is recorded.
Laurence said using 200 T-cells as a benefits threshold is particularly dangerous because that is when drug treatment becomes most critical.
"Organizations in third-world countries are saying we should be treating someone at 350 T-cells at the lowest," said Laurence. "I’m surprised that 200 is the count that enables you to get treatment and housing in a place like New York."
In October, Cuomo announced the formation of an AIDS task force aiming to reduce new HIV infections in New York to just 750 per year by 2020. Advocates for HIV patients are pushing the taskforce to recommend increased funding so that the city’s housing benefits can be extended to patients with any T-cell count.
In 2008, NYC Council Speaker Melissa Mark-Viverito (D – East Harlem) co-sponsored a bill that would have eliminated the T-Cell threshold and expanded housing benefits to all impoverished HIV patients in New York. The bill never made it to a vote.
The speaker would not say whether she would support the same bill today when asked by the I-Team.
"No bill has been re-introduced on the matter in the most recent session but if it was we’d be happy to review it," wrote Eric Koch, a spokesman for Mark-Viverito.
By some estimates, providing housing for thousands more HIV patients, regardless of their T-cell counts, could cost taxpayers as much as $100 million.
Laurence said his own research shows homeless HIV-positive patients are much less likely to take their medications and there are real costs associated with failing to provide rental assistance.
"Economically, the longer you wait to treat a person, or the lower their T-cells get, the more hospitalization expenses you will have, and the greater chance there is that they will develop expensive opportunistic infections," Laurence said.