May 27, 2020

The HEROES Act: What Could It Mean for the Domestic HIV Response?

The HEROES Act, passed by the House of Representatives on May 11, proposes to allocate $3 trillion to fund our fourth national stimulus relief package in response to COVID-19. HEROES includes, among other things, $200 billion in hazard pay for essential workers, six additional months of COVID-19 unemployment compensation, and funding for hard-hit state, local and tribal governments. It would also boost food stamps and provide, among many other benefits, emergency grants to help small businesses temporarily disabled by the COVID-19 lock-downs.

The three previous federal emergency response packages proposed in March and April passed both Congressional chambers quickly to start blunting the pandemic’s devastation. However,  the Senate’s Republican leadership reversed its position on such collaboration and announced that the House of Representatives’ proposed HEROES Act was “dead on arrival” in the Senate. Senate Majority Leader Mitch McConnell instead declared that the Senate is likely to respond with a fourth bill of its own, but that it would not be under discussion until after Memorial Day.

Virtually all Americans, according to Forbes magazine, “including the unemployed, employed, employers, governments, students and families, have an interest in many aspects of the newest stimulus package.” At the Academy, of course, our primary focus is on how legislation affects HIV care providers and people living with or at high risk of acquiring HIV. Like many of you, no doubt, we are focusing on how people with HIV are likely to be affected and what we can do to help reduce their risk of COVID-19 exposure. Simultaneously, we are joining in advocacy to help ensure their access to supplies (especially antiretroviral prescriptions for more than 30 days) and other supports they need to “shelter in place” safely.

This means we are looking carefully at the HEROES bill and other emerging legislation likely to affect the HIV response – and how the Academy can use its voice to help ensure that the needs of people with HIV and their health care professionals are included. At present, the HEROES Act proposes to allocate an additional $10 million to the Ryan White Care Act Program for its use by September 30, 2022 “to prevent, prepare for and respond to coronavirus” by adapting their RWCA Programs as needed. It also includes $15 million for Housing Opportunities for People with HIV/AIDS (HOPWA) and modest increases for several other programs benefitting low-income people with HIV directly or indirectly. Among these are $11.1 billion for SNAP (the Supplemental Nutrition Assistance Program), $2.1 billion for the Indian Health Service, $100 billion for emergency rental assistance and several other assistance programs. Together with other organizations, we will be advocating strenuously to get these provisions included in whatever legislation emerges as Congress develops a fourth stimulus package in response to this pandemic.

While focusing on the above, we are also aware that the rate of new HIV infections are likely to escalate as more people are impoverished by this economic collapse. HIV transmission is associated with homelessness and inadequate and/or over-crowded housing conditions. An economics professor at Columbia University projects that homelessness is likely to increase by 40-45% between January 2019 and the end of 2020 (an addition of nearly 250,000 people) “if homelessness follows unemployment the way that it has done in the earlier part of this century.”

In a webinar last April hosted by the International AIDS Society, Monica Gandhi, MD of UCSF noted that, “in the setting of HIV, there’s an overlap with homelessness and food insecurity which is contrary to the directive that ‘people can shelter in place and stay home.” How can you safely shelter in place if the only “place” available to you is particularly vulnerable to COVID-19 outbreaks, Gandhi asked, adding that the largest COVID-19 outbreak in San Francisco recently occurred at a homeless shelter.

We know that the pandemic is leading to sharp increases in unemployment which, in turn, leads to increased homelessness. This dynamic puts impoverished people at higher risk of HIV and/or COVID-19. Finally, Gandhi noted that “the very people who spent all their time on HIV are being pulled for the COVID response” and are being required to figure out how to “work with telehealth in a setting of poverty” as more and more patients no longer have stable housing.

At the Academy, we are proud of – and grateful for – health care providers everywhere as you carry on with your jobs. We will continue to do what we can to improve the politics of this situation as you continue with the challenge of restoring health in the current environment.