Sending the Sick Into the Streets? How Drug Tests Will Lock Homeless New Yorkers With HIV/AIDS Out of Shelters

There is an awful trend toward drug testing for public benefits sweeping through our nation. In late 2011, Florida began drug testing for the Temporary Assistance for Needy Families (TANF) program until a federal judge overturned the policy due to questions surrounding the constitutionality of drug testing without suspicion.  Regardless, Congress has recently agreed to drug test for unemployment benefits.

Now New York City Mayor Michael Bloomberg has jumped on the bandwagon. In a surprising World AIDS Day op-ed for the Huffington Post late last year, the Mayor’s Commissioner for the Human Resources Administration (HRA), Robert Doar, announced the policy with punitive rhetoric about getting “tough” on homeless people living with HIV/AIDS who use drugs. The new policy will require drug screening for homeless people living with HIV/AIDS applying for shelter.  If they decline or do not comply with abstinence-based drug treatment programs (including failed toxicology tests), they will be denied both emergency shelter and permanent housing assistance. 

This is a shocking turnabout for a city that helped pioneer “housing first” strategies, in which homeless people were offered housing assistance regardless of whether they were using drugs or alcohol. These strategies emerged from a commitment to meeting housing needs and they are rooted in an approach that recognizes the role of stable housing in reducing public spending on emergency healthcare, corrections and shelter costs; it is also the right thing to do.

The HIV/AIDS Services Administration (HASA), a division of HRA, provides services to low-income New Yorkers who are living with HIV/AIDS. For many clients, HASA’s rental assistance is their last available option for housing. By putting more road blocks in front of this population, Commissioner Doar is ensuring that there will be a number of people living with HIV/AIDS pushed into homelessness instead of helped into secure housing.

Commissioner Doar makes his fatal mistake in his assumption that drug testing will “remove barriers to wellness” by requiring clients who fail the test to participate in drug treatment in order to continue receiving benefits. But Doar ignores the facts about the pitfalls of mandated drug treatment. Ironically, many mandated drug treatment programs do not allow for a variety of treatment options that improve the chances of sustained abstinence.

The Drug Policy Alliance’s report, “Drug Courts Are Not The Answer” examines the importance of many factors in the success of drug treatment. Traditional drug treatment programs often do not address underlying issues that contribute to substance abuse, such as the need for stable housing. By linking access to housing to abstinence, Commissioner Doar could create conditions that make it more difficult to address drug abuse.

We should also consider the effects of an abstinence-based approach to a population frequently prescribed—in states with more enlightened drug policies—medical marijuana to combat wasting, pain and nausea. Under this restrictive and punitive drug policy, New Yorkers living with HIV/AIDS who self-medicate with marijuana will be left out in the cold—literally.

A few weeks ago, VOCAL-NY, a grassroots organization of low-income New Yorkers affected by HIV/AIDS and the war on drugs, held demonstrations at the HRA commissioner’s office, pointing to Doar’s decision that may jeopardize lives. Wanda Hernandez, a member of VOCAL-NY, said that drug screening “will mean more people being placed into costly and unhealthy shelters, where they’re less likely to take their medications, go to the doctor or practice harm reduction.” At a recent public hearing, New York City Council Member Jimmy Van Bramer and his colleagues questioned whether this policy change was in the best interest of the clients HASA serves. Advocates and researchers have continually highlighted the fact that stable housing is essential in helping clients remain adherent to their treatment regimen and is the most important step towards positive health outcomes.

In a faulty attempt to “remove barriers to wellness,” Commissioner Doar has constructed a roadblock in the path to healthier lives for people living with HIV/AIDS by threatening their housing stability. Expanding the availability of voluntary substance abuse treatment for HASA clients in need of it is a good policy decision. But a stable home will do more to ensure positive health outcomes than any other intervention than Commissioner Doar’s counterproductive drug policies. 

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