Low-income AIDS patients are living longer, thanks to medical advances - and that means less turnover of city-subsidized housing.
That's one of the reasons the Nutter administration gave for the growing list of people with AIDS who are waiting for housing in Philadelphia.
The average number of applicants on the city's waiting list has shot up in each of the last five years, jumping from 96 in 2006 to 174 this year, according to the city Health Department.
Concerned that a longer waiting list means more AIDS patients are living on the streets or in shelters where medical attention may be lacking, ACTUP Philadelphia and other advocates for people living with HIV or AIDS pressed the administration Wednesday to provide additional housing.
"People are dying in the streets because the City of Philadelphia doesn't provide adequate housing," ACTUP member Antonio Davis said. Seven homeless people with HIV died in 2009, but the Health Department said only one had applied for housing assistance.
When it comes to housing, "there should be a priority for people with HIV who are homeless or with AIDS, because you need a stable and safe place to take your medication," said Carlos Gonzales of Proyecto Sol, which advocates for Latinos with HIV or AIDS.
Activists say permanent housing helps reduce the risk of HIV transmission, makes it easier to take medication regularly, and encourages a more stable lifestyle with respect to sex and drug use.
They also argue that providing permanent housing for people with AIDS is cheaper than relying on shelters.
ACT UP and Proyecto Sol, along with Philadelphia Global AIDS Watchdogs, held a rally outside City Hall before delivering a report to the mayor's office. The group met with mayoral spokesman Doug Oliver, who promised to schedule a meeting with city officials.
According to ACTUP, other cities, including Los Angeles, New York, Chicago, San Francisco, and Seattle, spend city dollars - in addition to federal funds they receive - on housing AIDS patients. Philadelphia does not.
Last year, Philadelphia distributed more than half the $9 million it received from a federal subsidy program in the form of rental vouchers for low-income AIDS patients.
Under the program, Housing Opportunities for Persons with AIDS (HOPWA), participants pay a percentage of their income toward rent, with the rest covered by the subsidy.
A total of 487 Philadelphians and their families received some assistance through the program last year, up from the 363 vouchers distributed in 2008.
But Davis of ACTUP said the group wants Nutter to set aside an additional $3 million in the city budget to help reduce the wait list.
Oliver, in response, said it was unlikely the city would spend money beyond the federal funds it receives. Given the economic challenges of the past two years, he said, the city is doing what it can with diminishing resources.
As an explanation for the growing wait list, Oliver said that with medical improvements, "when people are getting into the permanent housing, they are remaining there longer." He also attributed the longer list to the economic downturn, saying demand is heavier for social services in general, and added that more people are being diagnosed with HIV and AIDS because of increased testing.
While the city may not be keeping pace with the need, it is providing more permanent housing units than it did.
Oliver said 65 new vouchers for rental assistance will be available in the fiscal year that begins Thursday. That is on top of 40 additional vouchers that were distributed in the last fiscal year.
All the housing vouchers were funded with grant money the city received from HOPWA. Managed by the U.S. Department of Housing and Urban Development, HOPWA is the primary source of funding nationally for government-subsidized housing for low-income AIDS patients. Most of those patients live on Supplemental Security Income or Social Security Disability Insurance.
The program allows money to be spent on the rehabilitation and new construction of units, rent, counseling, health care, and other support services.
In the cases of states and cities, the dollars are distributed by formulas based on the number of AIDS cases reported to the Centers for Disease Control and Prevention.
Nonprofits also receive funding through the program, and on Tuesday, the Asociacion Puertorriquenos en Marcha, based in North Philadelphia, was awarded a new $1.34 million grant.
The money will be used to continue providing rent and support services for 30 households citywide that include people living with AIDS, said Nilda Ruiz, the nonprofit's president and chief executive officer. Most of the families receiving the assistance are low-income or homeless Latinos.
The grant was part of a three-year, $30 million HUD award distributed nationally to 29 separate programs. Collectively they are expected to provide housing for a total of 1,232 people.