Leaked City Document Sparks Fears And Frustrations for New Yorkers with HIV/AIDS


An HIV/AIDS advocacy group has got its hands on an internal government document that the group says is cause for major concern — and not just because the city is making policy changes behind closed doors, advocates said today.

Voices Of Community Advocates & Leaders (VOCAL-NY), an organization that advocates for the rights of HIV-positive New Yorkers, released a document last night that organizers say outlines a risky restructuring of the city agency responsible for supporting this population.

The document, a letter from the Human Resources Administration commissioner to “senior staff,” with the subject “Agency Reorganization,” lays out a plan to alter the oversight system for New Yorkers who rely on the HIV/AIDS Services Administration, or HASA, which is a part of the city’s HRA agency.

The letter, dated February 16th and written by Commissioner Robert Doar, says, “I have determined that an organizational restructuring is necessary.” In the letter, Doar writes that this reorganization of HRA must take place as a result of changes to Medicaid and national Health Care that “will have a fundamental impact on HRA’s programs and the City’s future role in the delivery of health care.”

As part of the necessary changes, Doar writes that as of March 1st — a week from today — the HIV/AIDS Services Administration will become a part of Customized Assistance Services (CAS): “There is substantial alignment and overlap in the mission and populations served by both HASA and CAS, and this change will enable an even closer collaboration among these programs.”

Let’s not get lost in the acronyms and confusing bureaucratic reshuffling here. Currently, HASA, under HRA, is responsible for helping New Yorkers with AIDS or symptomatic HIV access benefits and social services, such as housing, financial security, and medical care.

CAS, also under HRA, is a welfare-to-work program for clients who have disabilities and medical conditions. It is designed to help provide services to New Yorkers who remain on cash assistance and struggle with medical and mental health problems and drug abuse.

For the advocates who obtained the city’s memo, one of the central concerns in this possible reconfiguration is whether this would change the work requirements for those struggling with HIV and AIDS. Under HASA, those with disabilities or continual health problems, can have work exemption. So when they saw that the city is going to move these clients under a program that is focused on jobs and employment opportunities, it raised some eyebrows — though VOCAL-NY stressed in its release that it doesn’t actually know what the potential fall-out could be.

Additionally, VOCAL-NY is concerned about bringing New Yorkers with HIV/AIDS under the jurisdiction of CAS and its associated WeCARE program, which, according to some reports, has a reputation of poor job training and placement, unnecessary sanctions and case closings, and problematic medical assessments.

If that was all too confusing, above all else, the advocates said they are angry because this move signifies a serious lack of transparency — a reorganization that they said was not presented to HASA clients, service providers, or the City Council for feedback. (A rep from VOCAL-NY said that the organization got its hands on the document when someone from HASA accidentally forwarded it to someone close to the advocacy group).

And when programs within a city agency are folded into each other, it often raises concerns about potential loss of services or resources, advocates added.

“Some people want to go back to work. I don’t think I’m physically able to do it,” Bobby Tolbert, a 59-year-old HASA client, told Runnin’ Scared this morning, expressing his concerns about the impact this move might have on employment standards HIV-positive residents.

Tolbert, who serves on the board of directors of VOCAL-NY, is a disabled Bronx resident who is HIV-positive and has been with HASA since 1995.

“I see a pattern of [HRA and HASA] being secretive,” he said. “It could be brought to the City Council, or they could have a press conference discussing this in the open with a town hall meeting…They should do things publicly so everyone can share their opinions rather than letting them know after they’ve already made the decision.” (He said he was still really concerned with a drug screening policy and budget cuts, which the group protested last week).

The HRA, in response to these criticisms, pointed Runnin’ Scared to a Huffington Post op-ed written last year by the commissioner, which the HRA claims actually explains the reasoning behind this kind of restructuring. In the piece, Doar argues that HASA clients have improved their health over time, and the city now has a responsibility to shift its focus to helping clients find economic stability and jobs:

We can accomplish HASA’s forward-looking focus to best meet clients’ current needs by asking them to consider what they want out of life, and giving them the assistance they need to help them achieve it.

Today, we don’t just focus on providing emergency care. HASA caseworkers talk to clients about where they see themselves in the future, if they want to return to work or complete their education. We can help them achieve their goals, by first assessing their readiness and skills, and then linking them to volunteer work, part-time work, job training, skills-building activities, job searches and job placement. Many who survived the AIDS crisis of the ’80s and ’90s left their jobs and careers, expecting to succumb to the fate of their disease, too sick to continue employment. But when life-saving medications were introduced, many experienced improved health and a renewed interest in returning to work.

Several studies of individuals living with HIV/AIDS have found positive effects from employment, including a higher perceived quality of life, lower anxiety and a reduced risk of depression. Work is a good thing apart from the obvious financial benefits. When someone has a job to go to — even if it’s limited in hours and scope — a person feels a sense of purpose, and a positive sense of identity.

Meanwhile, advocates aren’t the only ones complaining about the memo. The office of Bronx Councilwoman Annabel Palma sent Runnin’ Scared a statement this afternoon criticizing the HRA for its lack of transparency.

“I have a number of serious concerns related to this merger and its potential impact on the HASA clients who literally depend on this program for survival,” the councilwoman said. “However, HRA has not engaged my office or the City Council on this issue, and in fact, I was only made aware of this proposal after a memo from Commissioner Doar laying out the plan was leaked to the public.”

She added, “I expect Commissioner Doar to provide full details to the City Council of these plans and I will continue to advocate on behalf of these individuals until we get the answers we deserve.”

UPDATE, 8 p.m: A spokesperson from the HRA sent Runnin’ Scared this official statement in response: “It is common practice for city agencies to realign programs in order to achieve efficiencies and better organization of services. Customized Assistance Services (CAS) is unique in that it provides individualized and clinically focused services to assist in a person’s well-being. Realigning HASA with (CAS) makes sense and clients will now have an even greater emphasis on the clinical aspects of their care, while building their futures.”