At the Belle Reve group home in New Orleans, residents are running for cover. What started as a sunny day in early October quickly turned into monsoon weather, with more than three inches of rain slamming the city within an hour and flooding the streets.
But on the back porch of Belle Reve, an assisted-living facility for low-income and homeless people living with HIV, executive director Vicki Weeks calmly takes a drag off an American Spirit.
“Are you ready?” she asks, stubbing out her cigarette before taking me to meet a few of the residents, some of whom have been there off and on since Hurricane Katrina decimated parts of the city in 2005. “This storm is nothing. At this place, we’ve been through a lot. And damned if I tell you we’re not being tried right now.”
Weeks is referring to the millions of dollars it takes to keep the nonprofit operational — hundreds of thousands of which are in jeopardy by the U.S. Department of Housing and Urban Development. The agency has determined the needs of people living with HIV have changed as the virus has become increasingly manageable and is no longer seen as a death sentence. As a result, the government is planning to shift funds and grants away from group homes like Belle Reve in order to direct more resources to helping HIV-positive people find permanent housing instead.
But for cities with high rates of HIV among homeless or drug addicted populations — New Orleans ranks second in the U.S. for transmission rates — group homes are critical in preventing the virus from spreading. Many of these facilities also treat drug abuse and offer other support services, like counseling, medical oversight and life-skills classes. This wraparound support helps keep the virus in residents at healthy, undetectable levels, making it statistically impossible for them to transmit HIV to others while also boosting their chances of obtaining work and, eventually, living on their own.
There are homeless shelters in New Orleans, of course, but the options for people who are both homeless and HIV positive — especially those who are also in need of drug rehabilitation — are limited. That, despite the fact that facilities housing HIV-positive patients have been shown to improve their health outcomes.
The group-home model helped Phaedra, a 55-year-old woman living with HIV, start to get her life back on track. Phaedra, who asked that her real name not be used to protect her privacy, credits the New Orleans nonprofit Project Lazarus, which provides housing as well as classes, therapy and case management, for her progress. After leaving the home in 2017, Phaedra has been living with her boyfriend and actively searching for work.
“I’m doing my best, and I can say I’m really trying,” she says.
Diagnosed with HIV over 20 years ago, Phaedra has been abusing drugs on and off for decades. “I did everything that could give me HIV, including using IV drugs,” she says now. “I wouldn’t even know whose needle I was using.”
Through proper medical care, her viral load is now at undetectable levels. In that sense, Phaedra is lucky: According to a 2013 report from Human Rights Watch, injection drug users in Louisiana were more likely to develop AIDS within six months of receiving an HIV diagnosis due to a lack of social services.
This dearth of statewide support and services is an obstacle that administrators at Project Lazarus are trying to account for by offering former residents aftercare assistance. So people like Phaedra are paired with specialists who guide them through the job-application process and help them secure permanent housing after they leave — all of which is crucial to keeping them healthy and unable to spread HIV.
This aftercare support is a large departure from the original mission of Project Lazarus and similar facilities caring for those with HIV and AIDS, most of which were established in the late 1980s and ’90s at the height of the AIDS epidemic.
“This used to be a place for people to come and die,” says Nicole Kiernan, an aftercare specialist at Project Lazarus, explaining that the home was formerly used for hospice care for people dying of complications from AIDS. “You didn’t come here to move out at some point, like most people here do now.”
Though medical advancements in treating HIV and AIDS no longer make end-of-life care as critical as before, group homes are sorely needed — at least in New Orleans — as the virus shifts away from primarily affecting gay men. Today, that burden is shared disproportionately with poor communities of color, particularly in the South. Even more to the point, several studies have linked homelessness with a higher risk of contracting HIV, especially for those who are both homeless and young.
“Sometimes we only have one bed available, but have five people who are applying to get it,” Weeks says. And it’s an issue that Kiernan alluded to as well: In an area with over 1,100 homeless people at risk of contracting HIV, there’s just not enough places to shelter them and provide them with life-prolonging medication.
That’s making things worse in Louisiana, where in the past two years HIV diagnoses among drug users has almost doubled, according to the state’s Department of Health quarterly report released last spring. In 2017, nearly 5 percent of those diagnosed were injection drug users. By March of this year, that number increased to just over 9 percent.
“We’re the ones standing here helping
these people, and we will continue to do
so until time runs out for us.”
Complicating an already dire housing situation? Access to funds — or rather, lack thereof.
Group homes that rely on grants from HUD through the program Housing Opportunities for Persons With AIDS (HOPWA) are expecting for the first time in 25 years to see their funding reduced.
“We’ve surveyed the people who get this money and we found that a lot of people who would use these funds actually need them more for permanent housing and not transitional [housing],” a spokesperson for HUD tells NationSwell, referencing that medical trends in HIV care have pushed the department to reevaluate where funds should go. “Even the name of the grants refers to people living with AIDS and, in reality, it’s just not at the prevalence it was. We need to modernize.”
Outside of Louisiana, that trend proves true, according to Kira Radtke Friedrich, services manager for the state’s STD/HIV program that monitors rural HOPWA funding.
“We saw a shift in the late ’90s to early ’00s. People didn’t want to live in group homes anymore,” Friedrich tells NationSwell. “We started hearing from our clients that, ‘I’m independent. I don’t want to live in a group-home setting.’”
But Friedrich admitted that the needs of rural populations are different from the needs of cities, where group facilities for homeless or addicted populations living with HIV are still warranted. “The burden is definitely heavier in New Orleans and Baton Rouge,” she says.
“We’re consistently ranked one of the worst in the nation for HIV and AIDS,” says Belle Reve’s Weeks of Louisiana’s two largest cities. “That’s not going to get any better if we just push these people out. And most of the people in these homes can’t function in permanent housing immediately.
“We’re the ones standing here helping these people, and we will continue to do so until time runs out for us. I just hope we can hang on.”