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World Aids Day 2011: New York's Continued Battle

As we celebrate World AIDS Day, we look to the future of HASA, and remain as committed as ever to providing the highest quality of service to those living with clinical symptomatic HIV or AIDS.
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The New York City Human Resources Administration's HIV/AIDS Services Administration, known as HASA, has been in existence since the 1980s and was one of the first local government responses to the AIDS epidemic in the country, providing emergency and support services for people in crisis.

Today, HASA is the most comprehensive program of its kind in the country, helping New Yorkers living with clinical symptomatic HIV or AIDS live healthier and more independent lives. In 2010, HASA's 1,200 employees served 32,000 clients, and more than 50 percent of the program cost was funded by the federal and state governments. By law, the program is required to provide intensive case management, timely delivery of benefits and services, and emergency housing for all HASA clients who are homeless.

Thankfully, because of medical advances, people diagnosed with the illness are living longer and the need for crisis intervention is no longer the norm for the vast majority of HASA clients. HIV/AIDS is a much more manageable disease and, according to the New York City Department of Health and Mental Hygiene (DoHMH), a 20-year-old who is diagnosed as HIV positive today can have a life expectancy of nearly 50 years, if he or she follows a proper medical regimen.

While many HASA clients have improved their health with the help of appropriate medical care and New York City's HIV/AIDS policies, the next steps -- the responsible steps that we have implemented -- are to shift the program's focus and help clients currently struggling to escape poverty and substance abuse receive treatment and rebuild their economic lives. 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.

We have been successful, and within HASA supportive housing, clients whose health situations have stabilized have become gainfully employed, allowing them to transition to less restrictive and service intensive housing. With the right set of supports, we believe clients can and will want to transition towards financial independence. The second critical step is to help clients who have substance abuse issues pursue treatment, improving their quality of life and removing barriers towards wellness.

HASA clients who have suffered from a history of substance abuse are impeded from realizing their goal of healthier living. To support clients on the road to recovery, HASA now uses a screening tool to determine if the client should be referred to a Certified Alcohol and Substance Abuse Counselor. This provides HASA with a critical opportunity to work with a client on their individualized substance abuse treatment needs. In only two short months of assessments, there has been a 50 percent increase in referrals to HASA'S onsite substance abuse counselors.

HASA clients who choose to not participate in substance abuse treatment based on an assessment's recommendation are faced with a choice: they will be offered a supportive housing placement, or they could lose the ability to receive above-enhanced rental assistance or be denied their request for rent arrears payments. This will stay in effect until proof of substance abuse treatment is established. Tough? Maybe. But New York City is serious when it comes to combating substance abuse.

It is important to note that while services provided to HASA clients cost in excess of $400 million, this does not include more than one billion dollars in Medicaid, which over 90 percent of clients receive. Illegal drugs and alcohol compromise everyone's health but they are especially dangerous and costly for those whose health is already compromised by HIV.

We want to provide clients who need help with an incentive to comply with a recommended treatment program. As we celebrate World AIDS Day, we look to the future of HASA, and remain as committed as ever to providing the highest quality of service to those living with clinical symptomatic HIV or AIDS. By shifting the focus of the program away from crisis management, we can ensure our clients lead full and rewarding lives with even greater hope.