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When Ray stepped off the gray Department of Corrections bus he’d ridden from Lorton to freedom, he didn’t feel very free. Released in front of the D.C. Jail, Ray had no money, no identification, no place to stay, and he was down to about 500 infection-fighting T cells.
The cold March air bit his dark brown skin through gray pants and a blue shirt—prison clothes, same as he’d worn for six years and two days. A corrections officer asked him why he had no coat. “I didn’t get one at Max,” he said, referring to Lorton’s maximum-security wing.
“Ah, Roach shoulda known better,” the officer replied with a smile. David Roach is the warden at Max. The officer walked inside.
Ray waited in the 8 a.m. chill for an hour, until an office opened and he could collect about $600 from his prison account. But he had little idea of what to do after that. He says no one counseled him on what would happen once he was released. All parolees, and especially HIV-positive ones like Ray, are supposed to have a parole plan, but Ray’s mandatory release date arrived with only cursory counseling.
Ray says no one in the Department of Corrections told him where he could find HIV medications, housing for people with HIV or AIDS, or food banks that serve hard-hit residents with the virus or the disease it causes. Locating a bed for the night was a mystery—much less his next round of drug treatments, which Lorton had provided for six years.
“I had to fend for myself,” says Ray, who asked me not to print his real name because he says he fears reprisals from his parole officer. “It’s hard to find people that are real.”
It shouldn’t have been so hard. The corrections department had received two federal grants to pay caseworkers specifically to counsel inmates with HIV or AIDS who were nearing their discharge dates. The two caseworkers were supposed to link the inmates to the ragtag patchwork of community organizations that provide housing, food, medication, counseling, and other services to D.C. residents with HIV and AIDS.
Prisoners’ advocates and AIDS activists say the “discharge planning” never occurred. “Nothing happened for two years,” says Hank Carde, an AIDS activist who publishes a newsletter on local AIDS issues. “They had nearly $120,000 in [federal] money that they didn’t do a damn thing with.”
But what’s truly remarkable about Ray’s case is that it isn’t remarkable. Throughout the District, people with HIV and AIDS—particularly those with low or no incomes—are on their own because the government that has pledged to assist them is sicker than they are.
Think you’ve heard all this before? Maybe not. Many of the city’s other recent problems—dirty water, poor trash collection, police department shortages—stem from the much-publicized District fiscal crisis, but nearly all the money budgeted to fight the AIDS epidemic—almost four-fifths, in fact—comes from the federal government. Much of that money is available literally 24 hours a day to the city, which is supposed to transfer those funds to nonprofits that have AIDS contracts or to departments like Corrections that operate their own AIDS services. It’s supposed to be a simple, quick, interest-free process. But in the District, nothing is that simple.
For years, and particularly in the last 18 months, the District has failed to spend millions of dollars of these federal AIDS grants. Specifically, according to city figures, from 1991 to 1995 the city delayed spending $11.1 million in federal grants from the Ryan White CARE Act. That amounts to more than a third of all money given to the city under the act, Congress’ main HIV/AIDS annual funding bill. The city carried over more than $3 million in unspent Ryan White funds last year alone.
While the District eventually spends nearly all these grants—which are carried over from one city budget cycle to the next, until they are used—the delays have undoubtedly allowed the epidemic to spread more quickly. While the D.C. auditor, who recently issued a nine-month study of these grants, couldn’t determine exactly how long expenditures were delayed, anecdotal evidence suggests that some Ryan White money went unspent for nearly a year—even as D.C.’s yearly infection rate climbed higher than that of perhaps any other American city. The auditor found that the time delays broke federal law. And legalities aside, very sick people were forced to beg for services that had already been bought and paid for by the federal government.
In case all this fiscal mumbo jumbo isn’t clear, think about it this way: You’ve got a very sick child at home, but you can’t afford a long hospital stay. A crazy aunt leaves you millions of dollars in a bank account across town. But you don’t spend it, for months, because you can’t or won’t do the paper work. (It’s lots of paper work, you complain, and you don’t have the time or money to fill out all those forms.) Your kid, meanwhile, gets sicker and sicker.
AIDS activists warn that our crazy aunt—the federal government—could yank its unspent money from the city—especially as the federal budget comes under an increasingly sharp ax. Indeed, last month the feds quietly instituted what amounts to a temporary fiscal receivership for Ryan White money. Under the new arrangement, all Ryan White funds given to the District—approximately $16 million this year—are paid directly from the U.S. Department of Health and Human Services (HHS) to local contractors that provide AIDS services. HHS officials have never seized control of Ryan White checks in any city before.
But if the legal cost is high, the human cost is immeasurable. Imagine living with AIDS and knowing that federal money was available in a building downtown that could put a roof over your head or help you purchase drugs to prevent a deadly bout of pneumonia. At one point this year, some homeless and low-income AIDS patients in the city were even trading drugs on a makeshift black market, since the city’s drug-assistance program had collapsed. For these patients, the last 18 months have been a macabre eternity of terror, rage, and resignation. For an untold number of them, the spending delays have likely hastened death.
“What do you expect?” asks Ray. “You got nothing, no way to survive—sometimes people don’t even want to.”
The District’s spending irregularities didn’t simply delay services for patients who already had contracted the AIDS virus. HIV testing and prevention money also went unspent for months at a time. For example, procurement delays have forced D.C.’s main public medical laboratory to drastically curtail, or even stop, testing people’s blood for HIV for a total of 10 months since November 1994. And a federal grant for AIDS prevention in D.C. went unspent for eight months last year—while Maryland and Virginia were able to implement the same grant within weeks. It doesn’t take a Ph.D. in epidemiology to understand the consequences of the District’s inability to reliably test for the disease.
Of course, every urban area has struggled with AIDS, one of the biggest public-health crises of the century. And District officials haven’t been unaware of or unsympathetic to the epidemic. The city has drafted policy goals that, had they been implemented, would have led the nation. But D.C. has not made its AIDS policy work.
The reasons for the payment delays and policy lapses are complicated, but ultimately they have contributed to a simple, stark reality: More people are probably contracting HIV faster in the District today than ever before—though the city has had trouble even gathering such statistics. “We know that many of the numbers here are just off the charts,” says Carde. Some frequently cited studies have even shown that Washington has the highest AIDS rate of any city, though the studies aren’t conclusive. What is certain is that 14 percent of all AIDS cases counted by D.C. since the epidemic began appeared last year alone. The District may have reached a tipping point in the epidemic at a time when the city seems incapable of managing even the rudiments of public health.
As AIDS service organizations now try to pick up the pieces—with the help of U.S. officials, D.C. Chief Financial Officer Anthony A. Williams, and the control board—Ray and others like him try to repair their health. But their faith in a city government that promised to help them has vanished. And for an unclear number of others, the federal rescue is just too late.
I went to see Wanda James for the same reason I met Ray: I wanted to know how the crisis in AIDS services had affected patients who rely on the city. James isn’t quite homeless, but she’s what experts call “inadequately housed”—she’s doubling up with her 62-year-old mother in Greenway, a neighborhood of Southeast. “She pays most of the bills,” James says of her mother.
Ellen Goodman, a membership coordinator at the HIV Community Coalition, had told me about James, 43, a grandmother who learned she was HIV-positive in April 1995. Like Ray, James had come to the coalition later that year seeking help; the coalition connects about 200 HIV and AIDS patients each month with nonprofits that can help them. James needed a lot of help. “She spends a lot of her time just running around trying to stay alive,” Goodman had told me.
That’s partially true, though James, who now has AIDS, doesn’t inspire pity. After she found out she was positive, she began an HIV education mission, going door-to-door in Greenway and Marshall Heights to try to raise awareness about the need for a neighborhood HIV testing program. “I felt funny telling people I’ve known for 30 years [that she has AIDS], but they ask me, ‘How you doing? You OK?’ It was overwhelming,” James says. “But, you know, a lot of them are really in denial about themselves. They’ve got the virus, too. That’s scary, isn’t it? That’s fucked up, too.”
James was so surprised about people’s ignorance about HIV and AIDS that she began working with AIDS organizations. Now she answers phones at the HIV Community Coalition and sits on a major AIDS planning council. But even James, who knows more about the city’s AIDS network than most people, couldn’t avoid the District’s crisis in AIDS services. James depends on the city’s AIDS Drug Assistance Program (ADAP) to buy her medication. In February and again in April, ADAP, which is paid for by the feds, ceased operation because the city hadn’t paid the pharmacies that sell ADAP drugs for months.
In February, the pharmacies said they would not honor ADAP cards because the city hadn’t reimbursed them since October. James heard about the shutdown and hurried to have her prescriptions filled before ADAP went under. But she knows people who couldn’t get prescriptions filled for three days.
Physicians who specialize in AIDS say that interruptions in drug treatments can be fatal for AIDS patients. Many take Bactrim, a drug that staves off pneumonia and must be taken regularly. The body can develop resistance to other, specialized HIV drugs if they aren’t taken consistently. While the February shutdown was brief, it frightened many of the 850 patients who depend on ADAP.
But February was only a prelude. By mid-March, the pharmacies were owed nearly $200,000. Some stopped honoring ADAP cards again immediately, but about half hung on until March 31. At that point, all the pharmacies withdrew from the program, and many of ADAP’s cardholders panicked.
For at least a week, AIDS activists say, no one in the city filled ADAP prescriptions. James had run out of pentamidine to fight pneumonia, so she acquired some from another AIDS patient she knows, in exchange for AZT—a trade that’s illegal under drug-control laws. “They got it from someone who passed it from someone else, and said, ‘You didn’t get this from me,’” she says. “But if that’s what you got to do to stay alive, let me tell you, you are gonna do it.”
Meanwhile, AIDS activists and nonprofits scrambled to get the federal funds to the pharmacies. But they were dealing not with the failure of a single, lazy bureaucrat but rather the entire AIDS-service delivery system—a mishmash of private, quasi-public, and city institutions built in the uncertain milieu of an epidemic whose deadliness and scope didn’t become clear for years.
The D.C. Comprehensive AIDS Resources and Education (CARE) Consortium, a nonprofit that administers the drug-assistance program, prodded the city to release the funds. But the complicated web of officials now responsible for District money couldn’t get the funds quickly “loaded” into the city’s clunky financial management system.
CARE Consortium Executive Director Christopher Bates says the city was having trouble approving requests to shift Ryan White money from other programs into ADAP. Contract renewals for the program also had to be approved by several bureaucracies, including the D.C. Department of Human Services (DHS), the CFO’s office, and the control board.
HHS officials who administer Ryan White funds and ADAP watched the debacle with horror from their offices in suburban Maryland. “You just can’t have a problem that people can’t get their drugs, which are literally life-saving,” says Steven Young, the HHS official who oversees certain grants for this and other areas. “Clinically, it’s a medical problem. And then some people opt out of the program if it isn’t working, so then you’ve got more people getting sick. That’s a good example of one of the ways which this whole [Ryan White payments] problem manifested itself and was really doing harm to people.”
Finally, on April 16 the Whitman-Walker Clinic began filling ADAP prescriptions with a promise from the city that it would be reimbursed. Orders at the clinic’s pharmacy jumped by as many as 100 per day as beleaguered patients flooded in. “It was a grave emergency,” says clinic spokesman James R. Millner. “There was a terrible sense of panic.” Three days later, the city finally paid its bills, and people could again fill prescriptions all across the city.
City officials defend their handling of ADAP by pointing to the recent unexpected growth in the number of ADAP recipients. And they point out that the CARE Consortium had added several expensive drugs to ADAP’s formulary. (AIDS experts now worry that the new protease inhibitors—pricey drugs that can dramatically help HIV patients—may break the ADAP bank again. Just last week, the program stopped admitting new patients because ADAP’s cost has doubled in the last three months.)
But AIDS activists say the city’s talk of ADAP’s growth ignores the real issue—that the city couldn’t even spend federal money that was available. “The city just wouldn’t or couldn’t get the money through,” says Carde.
For Wanda James, of course, the precise reasons for ADAP’s collapse didn’t matter. “My life was in jeopardy,” she remembers one recent morning, sitting in the sparse HIV Community Coalition office on a battered Southeast street not far from the Navy Yard. “My T cells is down to about a hundred. I get yeast infections, I get thrush, my nose is dry, my ear is dry, my vagina is dry. You have to take your pills. I mean, this is life and death. Do you understand that?”
Nonprofits that help people like James had waited for late federal reimbursements from the city before, but the late payments had rarely threatened their very viability. Last year, however, the problem grew so acute that some of the city’s biggest AIDS contractors were owed hundreds of thousands in federal reimbursements—more than some could realistically float without drifting into bankruptcy.
“As long as I can remember, there have been payment problems in D.C., but it’s never been as bad as it was last year,” says Whitman-Walker Executive Director Jim Graham. “Last year on any given day, Whitman-Walker Clinic carried overdue payments of a million dollars. I was at wit’s end.”
Like many nonprofit AIDS-service organizations, Whitman-Walker (the city’s largest) had to curtail services last year because of the payments crisis—meaning that fewer people with HIV and AIDS could get the services they need to survive. During the last 18 months, some smaller nonprofits were forced to close temporarily. At least one that receives federal funding was forced to reorganize after declaring bankruptcy. No one is sure whether anyone died as a direct result of the shortage of services, but everyone is sure that the city got a little bit sicker—fewer people with AIDS were housed, fewer got medications, fewer were counseled about stopping the spread of the virus.
The city owed the AIDS organizations both federal and city dollars, but it was the late federal payments that particularly enraged Graham and many other nonprofit directors around town. “There is ample money—enough to take care of our needs—but the problem is the city is not spending it well. And for a while, they weren’t spending it at all,” says the HIV Community Coalition’s Goodman.
The problems began in late 1994 and were tied to the way the District manages its federal grants. Unlike 23 states (including Virginia), the city doesn’t require that federal grants be in city bank accounts before a check can be written, according to Valerie Holt, the city’s acting treasurer. Instead, the city has long paid contractors out of its own pocket and then received reimbursements from the feds.
That system works fine as long as the District has the cash to pay contractors. When it doesn’t, all hell—for lack of a bureaucratic term—breaks loose. And the victims aren’t just front-line AIDS organizations but all nonprofits with government contracts.
Holt and others say two things happened in 1994 to screw up the financial management system. First, Congress’ Cash Management Improvement Act took effect. The act required that the city be specific about when it would draw down federal money, and in precisely what amounts. “In the past, you could just estimate the disbursements,” she says. The city’s antique computers couldn’t handle the required precision. “Using our 15-year-old accounting system, we had to follow a very modern approach to managing money,” says Holt.
Second, the D.C. budget crisis hit—years of deficits were finally catching up with the city, which couldn’t afford rising interest payments and basic municipal expenses. The tax base had eroded, and revenues were down. The city, in other words, couldn’t follow the established process of fronting cash and drawing federal reimbursements later.
The result was chaos. The city mixed federal money with city money in the same account—not a problem in itself, unless you can’t say which money is which. Because of the computer and cash-flow problems, the city couldn’t. So D.C. paid whatever bills came first, meaning that some federal grants were probably used illegally for other purposes.
By early 1995, vendors were getting paid erratically—only when the city could make the system work, sometimes by manually processing hundreds of records. And even then, only when the city had the money. The painstaking work meant an unusual burden on the hundreds of budget and contracting employees throughout the city. And they weren’t up to the task.
Most of these officials were based in DHS, the largest city department. By fall, then-DHS Director Vernon Hawkins admitted that the DHS contracts office had allowed more than 500 contracts to expire without renewals. (DHS Controller Dolores Shepherd did not respond to at least 10 messages left for her.)
Many of the expired contracts were with front-line AIDS service providers who were also waiting for payments on old contracts. Sometimes they got partial payments, sometimes none. There were times when the payments didn’t seem to be authorized, and small contracts were often renewed only orally, for weeks at a time. In January 1995, AIDS organizations began to shut down temporarily to save money.
Congress’ entry into this mess didn’t improve matters—and in the beginning it slowed the system further. By the middle of last year, the Republicans who now controlled District oversight committees were demanding stricter rules. Rep. James Walsh (R-N.Y.), chairman of the Appropriations D.C. subcommittee, started talking about the Anti-Deficiency Act, an old law that could mean jail time if District officials didn’t have clear authority for all payments.
Payments got even slower—nobody was going to go to jail just so vendors could get their checks on time.
Vendors, in response, scaled back services. The HIV Community Coalition—where Wanda James and hundreds of others had found help—delayed hiring new staff last August. In April, the coalition had to close for two days, until the city paid an $80,000 bill—much of it federal Ryan White money.
Other contractors were faring no better. Koba Associates, a large provider of AIDS services, filed for Chapter 11 bankruptcy in February because it was owed $1.7 million by the city, about half of it federal money. “We routinely had payments backed up six months,” says Koba President Ford Johnson. “It reached a crescendo for the company in February, in which that was the only way we could continue providing services.” (Chapter 11 allows a company to reorganize without pressure from creditors and does not mean it has to shut its doors. Today, Koba Associates is “beginning to rebound,” Johnson says.)
Federal officials began to reproach the city for the delays. In January, an HHS official sent Hawkins a letter expressing “concern” that Ryan White dollars were not being spent in an “expeditious” manner. Verbal warnings were more direct: The city could lose some of its Ryan White funding if it did not spend the money. New Orleans lost all its supplemental Ryan White funding this year after it failed to address similar problems.
Hawkins, displaying either exceptional mendacity or utter ineffectiveness, made and broke promise after promise to fix the system. As early as March 31, 1995, he told his AIDS advisory panel that Ryan White payments would be processed within three weeks. Nothing ever changed. Earlier this summer, the control board fired Hawkins after years of lackluster performance.
But the trouble went beyond Hawkins’ inability to move money. Even new CFO Williams, who came to D.C. with massive power and congressional backing, took several weeks to begin figuring out what was wrong with federal disbursements. ADAP fell apart on Williams’ watch.
And for most of the debacle, the D.C. Council assumed its customary position on the sidelines. The council only got involved in November—and even then it simply ordered then–D.C. Auditor Russell Smith to investigate the federal grant delays.
Finally, in May, after the ADAP crisis left people without life-sustaining drugs, Williams, Ward 2 Councilmember Jack Evans (D), and others began working on the federal takeover of Ryan White payments—a move most Barry administration officials, and especially Hawkins, bitterly resisted. The change became possible after City Administrator Michael Rogers assumed responsibility for DHS contracts and the control board ousted Hawkins. With Williams’ backing, the unusual federal takeover of Ryan White payments began.
But the takeover is temporary, set to expire in November, and vendors note that long payment delays for non–Ryan White funds, and especially D.C. tax dollars, continue today. The city owed Whitman-Walker as much as $500,000 in late July, for example.
“OK, so federal dollars they are fixing, they say. I hadn’t seen the results yet, but they are fixing it. But there has been lip service on this for four months,” says Shirlene Showell, executive director of an AIDS organization that targets minorities. “And on the District-appropriated dollars—D.C. tax dollars—those are slower than ever.”
Wanda James knows what another shutdown of ADAP, or of the HIV Community Coalition, or of an organization like Showell’s, would mean. “It’s simple. People won’t get their drugs, or people won’t know where to go.”
After Ray left the D.C. jail that March morning, he holed up in a cheap hotel for two days, unsure what to do. He was taking no medication, wasn’t sure how to find a place to live, and was fast depleting his savings and T cells.
Eventually, he got in touch with Cochise Robertson, an HIV-positive friend from Lorton who had occupied the next-door cell before Robertson’s 1994 release. Robertson now runs a support group for ex-offenders with HIV, and he introduced Ray to the HIV Community Coalition staff. Now, Ray says, “they’re basically my only friends.”
Law-and-order types may think Ray deserves no better. According to court records, in 1990 Ray pleaded guilty to carnal knowledge and taking indecent liberties with a minor. Police said Ray raped an 11-year-old girl. Three times. Ray deserved to suffer.
And suffer he has. Ray’s wife has left him, and his mother died three weeks after his prison discharge. His six years in Lorton were hard, especially since he learned he had HIV shortly after being incarcerated.
For HIV/AIDS patients, life at Lorton is a hell within a hell. The prison is notorious for its failure to guarantee HIV confidentiality and for its shoddy medical treatment. (Last year, AIDS-stricken inmate Richard Johnson died after corrections officers refused to treat him for 10 days and then left him tied to a wheelchair with a sheet he’d soiled.)
But for those who can’t come to pity Ray, there are coldly rational reasons he shouldn’t have been set adrift: Someone who receives assistance and counseling is much less likely to spread the virus than a homeless person.
“The Department of Corrections is in massive denial,” says Robertson. He and others point out that the department is squandering a perfect opportunity to educate a captive District audience about HIV before the prisoners re-enter the outside world. “And you’ve got to remember that almost everyone is released,” says Jonathan Smith, executive director of the Prisoners’ Legal Services Project.
Department of Corrections Director Margaret Moore says all parolees should have a discharge plan, and she disputes assertions that corrections provided no discharge planning with its Ryan White grant. But she admits that after an internal investigation, “I suspect that what was happening was that those individuals who had been hired [with Ryan White funds] principally to do discharge planning were getting involved in other casework activity.”
She says the department’s two caseworkers assigned to inmates with HIV/AIDS did do some counseling, though she couldn’t provide any figures. In 1994, 9,471 inmates were released from the city prison system. Experts estimate that about 10 percent of D.C. inmates are HIV-positive, meaning that about 18 HIV-positive inmates were hitting D.C. streets each week. In other words, even if the two caseworkers had spent all their time with HIV-positive dischargees, it’s unlikely they could have managed the huge load.
Though no one keeps such figures, advocates say hundreds of HIV-positive ex-offenders have ended up homeless or “inadequately housed.” Given that drugs landed many of these folks in Lorton in the first place, some are certainly returning to the shooting galleries. And on the streets, condoms aren’t a top priority.
“It’s just easier on the street—easier to get sick, easier to do what you shouldn’t be [doing],” says the Rev. Deborah Thomas, client services coordinator for Episcopal Caring Response to AIDS, an organization on 14th Street SE. Thomas worked in a shelter for several years. “I’ve seen people sharing needles, and then others have sex on the streets. It’s a survival game out there.”
Today, Ray is getting by, sort of. He lives in a spare Southeast apartment without hot water and earns a small income as a courier, which requires expensive upkeep on his 1986 Olds Calais. (He showed me one two-week paycheck for $259.) He can’t afford any of the exorbitant HIV drugs on the market (though he’s trying to sign up with ADAP), and the last time we talked (on his way to visit his parole officer last month), Ray hadn’t paid his rent lately and worried he might “lose everything and be on the street.”
He wouldn’t be there alone. While the estimates are only tentative, approximately 1,500 HIV-positive people are homeless in the District—roughly 15 percent of the total homeless population. Meanwhile, the city operates a total of just 129 housing units (a “unit” usually means a bed) for low-income people with HIV and AIDS.
“Housing is our No. 1 issue,” says James, who was told her wait for public housing would be two to five years. She is hoping that if she becomes very sick, she can find a bed at Miriam’s House, a nonprofit that provides housing for women with late-stage AIDS. But for now, she’s with her mother. “I know people who are worse off,” she says.
The three major government programs that provide public housing for District residents with HIV and AIDS are swamped. The largest, the federal Housing for People With AIDS (HOPWA) program, funds 89 units in the city. As with Ryan White, however, the city has often delayed its HOPWA payments to the nonprofits that provide the housing. “It’s all kind of the same nightmare,” says Bates of the CARE Consortium, which coordinates HOPWA here.
The two other housing programs are also struggling. The D.C. Housing Authority operates 15 HIV/AIDS units with a yearly city appropriation that hasn’t increased since its inception four years ago. And the Community Partnership for the Prevention of Homelessness has 25 units directed toward people with HIV/AIDS but has had trouble implementing a federal grant that could quadruple that number.
The remaining option, shelters, are unpleasant for anybody, but they represent a real threat to people with compromised immune systems. “Let me tell you something about us going up into those shelters,” says Leon Williford, 55, a District native and ex-offender with advanced AIDS and no steady housing. He spends nights with relatives, friends, or, sometimes, in shelters. “You’re in the midst of two to three hundred people, and everybody is coughing on you—they have no manners. They might have TB, whatever. One of them shelters is like playing Russian roulette.”
For recovering addicts who are positive, shelters can be even worse. “Those places are drug-infested. They’ve got hoodlums running around, criminals,” says the Rev. Thomas. “The worst place to put someone trying to quit is right where you can find someone nodding out [from a drug] in the hallway.” Roughly a third of D.C. residents with AIDS were exposed to HIV through injection-drug use.
Nonprofit agencies try to fill the housing gaps, but the gaps keep widening. Building Futures, which operates D.C.’s largest rental-assistance program for people with HIV and AIDS, has a waiting list of 100, which it expects to nearly double once fall applications come in.
But as with ADAP, the problem isn’t merely that the cash-strapped city can’t afford to take care of its own. Once again, people like Ray, James, and Williford might acquire housing more easily if the District had spent $11 million in two federal grants, the first of which was announced in 1993. Instead, the two grants from the U.S. Department of Housing and Urban Development (HUD) for “shelter-plus-care” housing have languished in the municipal bureaucracy for two-and-a-half years. The shelter-plus-care grants could provide as many as 100 new beds for people with HIV or AIDS.
HUD conditionally approved the first grant, a fiscal-year 1993 grant for $7.8 million, on Jan. 2, 1994, according to DHS records. From January to October—nearly a year—the city and HUD busied themselves working out terms.
Activists say city officials bickered during those months over which D.C. commission or agency would supervise the grants. “DHS could have implemented this in 1993 if they wanted to,” says Steve Cleghorn, deputy director of the Community Partnership, the nonprofit that runs most city homeless programs. “The delay was all on their side….I don’t know what motivates them sometimes.”
DHS spokeswoman Madelyn Andrews won’t comment. “Any response we would have would look whining and defensive,” she says, “so we’re just not going to have any comment.” But DHS sources defended themselves with background material—documents that show that the feds issued their own stream of red tape that held up the project.
“Look, it wasn’t just that we were just sitting here…on top of this stuff,” says a DHS official. The staffer points out that shelter-plus-care originated with the Kelly administration and so required reworking by Barry officials.
By January of this year, HUD and the city signed final contracts, but the shelter-plus-care grants still haven’t been implemented. No single agency is responsible for the current delays. Larded with congressional reviews atop a sticky bureaucracy, the system for moving contracts simply cannot work quickly. Everyone has to have a say. The control board, the city administrator, and the D.C. Council, among others, must sign off. Stumbling over themselves to “reform” the system, these separate fiefdoms have sometimes slowed the already glacial pace of D.C. government.
Last month, the shelter-plus-care contracts did jump through a final hoop—D.C. Council approval, which came on July 17, the last session of the council this fiscal year.
Meanwhile, James says countless people have come into the HIV Community Coalition looking for advice on where to find shelter. One, an HIV-positive single father raising young twins, had lived in an abandoned building for a few days, until his children became ill. One day at the coalition, James introduced me to him, a big guy named Michael Davis.
“I would go some place and they would say, ‘You’ve got to go five different places first,’” he says.
Until June, no city agency or nonprofit kept a list of the available HIV/AIDS housing units—another project delayed by late payments of federal money. People like Davis had to spend hours phoning the myriad groups and officials who might have the information he needed. Those who weren’t so savvy and determined—or were homeless and couldn’t always get access to telephones—were left out.
The shelter-plus-care disaster has had lasting effects; established housing providers like Building Futures decided not even to participate in shelter-plus-care. “With the complications and the timing, we just decided that it was no longer feasible for us to do it,” says Executive Director Kathryn Stephens. Officials are looking for replacements, but it’s becoming more difficult to find reliable service providers willing to deal with the city’s irregular payments.
The last time I talked to Davis, he had just found an apartment for himself and his children—after months of living in shelters and squats. Williford, the 55-year-old ex-offender with advanced AIDS, was still homeless, as he had been since he left the corrections system last October.
In the 1980s, testing was the only response to AIDS that everyone could agree on. Even squeamish, anti-gay Republicans would fund federal testing programs, which they recognized as a first line of defense. The District, on the other hand, has failed to spend even its federal testing grants quickly, leaving AIDS epidemiology to guesswork.
A little-known agency within DHS called the D.C. Bureau of Laboratories handles HIV testing for most city-run testing sites. But recent procurement snafus have meant that the bureau hasn’t always been able to buy the chemical reagents necessary for HIV tests.
The bureau ran short on reagents from November 1994 to January 1995, May 1995 to July 1995, and December 1995 to March of this year—about 10 of 17 months. During those months, according to bureau chief James B. Thomas, blood samples accumulated at the lab until he could find a temporary supply of reagents—most often from D.C. General Hospital, itself a struggling behemoth. Sometimes during those months, he couldn’t acquire any reagents.
“It was never more than a few days,” says Thomas. “We’d never get a very big backlog.” Eventually, he points out, all the tests were completed, and today the bureau is fully stocked.
But AIDS activists say the lag time was weeks for some people. The delays could be brutal for people who were suspicious of AIDS organizations and had only been tested reluctantly. “And when people finally go, to be told that their result isn’t ready could be very damaging,” says Carde. “They may not come back at all.” One study of autopsy reports of HIV-positive inner-city residents found that about half had been diagnosed after death, according to the New Republic.
Thomas wasn’t sure how many D.C. residents had to wait longer for their results. At first he said it was “maybe 10 to 15 people” each time the reagent purchases were delayed, but later he acknowledged that some weeks no testing was done, leaving as many as 150 people without timely results.
Thomas says he tried everything to get reagents more quickly, but the procurement orders had to go through DHS. “We would start yelling, ‘We’re running out!’ a good three weeks ahead of time,” he says. “And then we would always say we were out before we actually were to get pressure on people.”
The federal Centers for Disease Control and Prevention (CDC) finances the testing at the Bureau of Labs; it costs about $1.2 million a year. But the District couldn’t afford to front its own cash for reagents and wait for CDC to reimburse it. So CDC funds would sit untouched for weeks.
AIDS specialists now worry that the city’s reported HIV rates—never entirely reliable—are less accurate than ever. “We don’t trust anything we get from them,” says a Whitman-Walker official. Thomas acknowledges that the city’s “seroprevalence” surveys—designed to get a better idea of how many D.C. residents have HIV—lapsed during the reagent shortage.
The real casualties of the testing delays, AIDS activists say, are the people who never went for HIV tests because word got around that the testing was delayed or suspended. In 1995, the city performed 16,999 tests—26 percent fewer than it had in 1993. While the entire drop can’t be attributed to the reagent shortages, surely they were an important factor. In short, even the city’s first line of defense against AIDS was withering.
The failure of AIDS policy in the District can only be understood in the context of AIDS politics here, since the broken policy is the result of broken politics. While the city’s bureaucrats—and their elected bosses—can be blamed for the mayhem in federal AIDS grants, the city’s major AIDS and gay organizations must share culpability, along with public health reporters who didn’t do their jobs.
At the beginning of the AIDS crisis, the District showed great promise. In the early 1980s, Barry, always a friend to vote-rich lesbians and gays, signed the first contract in the nation to provide public money for an AIDS clinic—the Whitman-Walker Clinic.
“We never had reason to doubt [the city’s] commitment to this issue,” says clinic Associate Executive Director Patricia D. Hawkins. “The city has always been in the forefront of this crisis emotionally.”
The city especially paid attention when the disease broadened past the gay population. Although infection rates among white gay men declined in the late 1980s, huge waves of straight men and women—especially African-Americans—began to contract the virus around the same time, both here and nationally. The number of black Washingtonians diagnosed with AIDS was two-and-a-half times higher in 1993 than in 1988. Today, more than three-quarters of District residents with AIDS are black. And fewer than half of them contracted HIV through gay male sex.
The city was not unprepared for the increase in AIDS cases. The District’s five-year plan for HIV and AIDS, drafted in 1991, predicted a cumulative total of 8,600 AIDS cases by the end of 1995—higher than the actual figure of approximately 8,100. Liberal city officials in both the Barry and Kelly administrations tossed millions at AIDS. Pat Hawkins points out that the city has a higher per capita public contribution to HIV/AIDS than any other.
In fact, the city-appropriated yearly HIV/AIDS budget—exclusive of federal grants—has totaled about $6.4 million for several years. It’s one of very few budget items that hasn’t been slashed.
In addition, the District has an AIDS community famed for its persistent activism. Not surprisingly, Washington has drawn activists from across the country to work in national AIDS groups, and many local activists are well trained in politics.
So how could things go so wrong in the face of so much good intent?
First and most crucially, the AIDS community hasn’t held the Democratic leadership of the District accountable for its AIDS policy failures. Instead, AIDS activists have helped preserve the stale one-party system for years. When the financial system for federal grants broke down, for instance, many leftist AIDS activists were reluctant to reproach the liberal city government. “There’s blind support, and they won’t ever criticize the mayor,” says a gay activist who frequently grumbles about the Barry administration.
The Whitman-Walker Clinic is particularly entwined with the Democrat-dominated government. Clinic officials, including Hawkins, have served as officers in the Gertrude Stein Democratic Club, the city’s major lesbian and gay Democratic group. Friends and acquaintances say Executive Director Graham openly solicits donations for some of the city’s most prominent Democrats. On July 2, Graham and Hawkins helped host a fundraiser for Democratic Councilmembers Charlene Drew Jarvis (Ward 4), Harold Brazil (Ward 6), and Evans.
An advertisement for the fundraiser, which ran in the June 21 edition of the Washington Blade (the city’s premier lesbian and gay paper), was even billed to Whitman-Walker, according to the Blade. As a nonprofit, the clinic isn’t supposed to engage in partisan politics. The host committee staging the fundraiser received a substantial price cut for the ad since it ran at Whitman-Walker’s reduced rates.
Clinic spokesman Millner says the host committee requested a separate bill for the ad, but the Blade didn’t provide one. So the host committee reimbursed the clinic for the ad—but pocketed the savings from the reduced rate.
In short, there’s no question where the clinic’s support lies: Graham even backed Marion Barry in 1994, though Republican opponent Carol Schwartz has sat on the Whitman-Walker board since 1989.
To be sure, the 1994 elections preceded much of the District’s AIDS policy catastrophe, but many prominent AIDS activists muted their criticism of Barry and his administration to maintain a good relationship. (And while I spoke with many activists for this story who condemned Barry, many did not want to be quoted on the record.)
Some of them defend the administration even today. At a political forum during gay pride week in June, Whitman-Walker’s Hawkins argued that Vernon Hawkins (no relation) should not shoulder the blame for DHS malpractice. “It’s much bigger than any one person,” she said.
Well, of course it is. But as director, Vernon Hawkins was ultimately responsible—and no one forced him to make so many unrealistic, unkept promises.
Activists say Whitman-Walker supports Democrats because Democrats run Washington, and the clinic depends on government contracts. “They’ve done what they needed to do to survive,” says Carde, an administration critic.
Graham says he supports Barry because the mayor provides a voice for the city’s black majority and has always supported gay rights. As for the payments crisis of the last 18 months, Graham says Barry tried to help. “He himself was engaged along with his top staff in trying to make those payments work,” says Graham. “I know he was. And I know he was frustrated.”
But some AIDS activists believe that the Barry administration has hidden small cuts in its city-appropriated HIV/AIDS funds. (The city won’t provide a specific accounting of the money.)
And Whitman-Walker officials might note that despite their politicking, the city has steered money away from the clinic in recent years. Some of the shift was needed—many African-Americans simply wouldn’t seek treatment at a Northwest clinic started by white gay men. But the District has also given hundreds of thousands of dollars to Dr. Abdul Alim Muhammad and his Abundant Life Clinic, despite Muhammad’s weird conspiracy theories, his clinic’s peddling of a probably useless drug, and the clinic’s ties to the anti-gay Nation of Islam (see “Miracle Worker?,” 9/3/93).
Whitman-Walker officials aren’t alone in their devotion to the current administration. At a ceremony earlier this year for outgoing Ryan White Planning Council Chairman Ernest Hopkins, Hopkins said he believed Barry was fully committed to AIDS programs—even as the federal government was preparing to assume control of Ryan White payments.
“I don’t think anybody wants to point any fingers, and that’s the problem,” says the HIV Community Coalition’s Goodman. (But she’s guilty, too; in the same interview she said, “We probably have one of the friendliest mayors to the community in the country.”)
Barry isn’t the only one AIDS activists are letting off the hook. The D.C. Council has done little to oversee the city’s AIDS policy, yet many councilmembers enjoy enthusiastic support from the AIDS community.
The daily papers, and especially the Post, also haven’t helped. Strong, consistent AIDS reporting—the kind that creates pressure and accountability—has largely been missing. The Post, for example, entirely ignored April’s ADAP shutdown and reported the shelter-plus-care problems only after a solution was at hand. The paper published just one story about the reagent shortage at the Bureau of Labs—in June 1995. And the Post hasn’t reported the federal takeover of Ryan White payments at all—or the cataclysm that led to it.
(Washington City Paper, which published only two articles about AIDS in all of 1995, isn’t any better. Only the Blade has consistently reported AIDS stories.)
Retired Navy commander and AIDS patient Carde is probably the activist who has done most to try to publicize the AIDS policy debacle. Partly because of feeble media coverage, he began publishing a newsletter last year to detail the financial and other problems plaguing the delivery of AIDS services.
Carde’s newsletter is full of useful, rigorously reported gems. One of the best was a recent table showing how often Barry’s appointees to the Ryan White Planning Council attended council meetings. Carde found that seven of Barry’s appointees—including his pastor and political defender Willie Wilson—hadn’t even bothered to be sworn in. (Wilson was sworn in a few days later.) Carde also discovered that 27 of the 49 councilmembers had missed more than half the meetings from January to June—including Graham, Abundant Life Clinic’s Muhammad, and Gertrude Stein Democratic Club President Jeff Coudriet.
Wanda James and I are talking for the last time, once again at the HIV Community Coalition’s yellow building on L Street SE. James hopes to get a business degree from Howard, or maybe get a job at a local business, but she’s often tired and has to leave work for frequent medical appointments.
But the HIV Community Coalition, and many friends with HIV who have also muddled through the last year-and-a-half, have given her a measure of encouragement. James even won a seat on the Ryan White Planning Council (and she has missed just one meeting).
While her immediate anger toward the city has subsided, she has little faith in the system. Born in D.C. General Hospital and educated at Eastern High School and Federal City College, James was astonished that the District let down “a Southeast girl,” as she calls herself. “There’s no sincerity on the part of the government. They go up there in their suits and ties and high heels, and they don’t care about their own neighborhoods,” she says.
Ray feels the same way. Also a D.C. native, he’s surprised that the city hasn’t helped him more—especially after Barry, himself an ex-offender, made campaign promises to inmates and ex-offenders in 1994. “Sometimes I don’t even think I’ll be out here next month,” Ray says.
On a certain level, city officials recognize that AIDS policy in the District capsized last year. Mel Wilson, administrator of the Agency for HIV/AIDS and the city’s cabinet-level AIDS official, says his hands were tied in recent months by fiscal problems. Even now, he says, “there is a level of futility in our office.”
But “we are doing some serious planning,” he says. That means big projects—a new three-year master plan for tackling HIV and AIDS—and small ones—ensuring that the new discharge-planning program for inmates is expanded. The Ryan White discharge-planning contract has been transferred from the Department of Corrections to a nonprofit.
Barry, meanwhile, has appointed yet another board to study public health. The federal takeover of Ryan White payments and the firing of Vernon Hawkins, along with the commitment of Anthony Williams and the control board to reforming AIDS policy, should help more. Last week, Williams appointed a new deputy to fix the troubled federal grant–management system.
But new AIDS policy challenges loom. The biggest will be paying for protease inhibitors for low-income residents and generally trying to narrow the gap between the rich, who now might survive HIV until an old age, and the poor, who often don’t survive long after seroconverting.
But any long-term change is unlikely without a change in the political makeup of the District. Those who care about AIDS policy must acknowledge that the Democratic establishment has repeatedly failed them.
At the International Conference on AIDS last month in Vancouver, participants discussed the mounting fear that while the industrialized world is learning to keep HIV-positive people healthy for decades, the Third World crisis continues apace. But the American participants have no farther to look than their capital to see that the fear is already a reality.CP
Art accompanying story in the printed newspaper is not available in this archive: Darrow Montgomery.