It was because of a young man we’ll call Pablo, to protect his privacy, that Latonya Dixon became a case manager on GMHC’s housing team three years ago, where she connects people who are homeless and living with HIV to their own apartment, HIV treatment, and needed supportive services.
Before joining GMHC, Dixon spent a decade working for New York City’s Department of Homeless Services (DHS), where she grew increasingly troubled at seeing homeless people living with HIV get lost in the system. They’d come into the shelter with not much beyond their personal identification—no money, extra clothing or medication, she said, and at times they had not seen a doctor in years.
“A shelter can be very intimidating, very dangerous. It can be overwhelming. I noticed that there were a lot of homeless clients coming into DHS who were HIV positive, but there was very little assistance for them,” she said.
“When someone comes in living with HIV, they are already down and out,” Dixon explained. “They may be very sick and suffering from depression and mental health issues. Substance use is also a big issue, as some in the HIV community go to substances for comfort instead of medication.”
NYC shelters are overcrowded, and social services offices have only two case managers, a housing specialist and a program director per 500 clients, she said. They can offer referrals for services, but they’re often too overtaxed to do much follow-up.
What’s more, conditions aren’t always sanitary, Dixon added. “That can be very stressful for a client living with HIV, who has no medication, no doctor—and no Medicaid so they can see one. They’re worried about picking up germs and diseases.”
“A lot of people living with HIV would go through intake and disappear, either because of the conditions of the shelter or because they weren’t getting the one-on-one help they needed,” she said.
That’s what happened with Pablo. One day on her way to work at DHS, Dixon said, “I was coming in off the A train in Brooklyn, and it was hectic like ever. I grabbed my coffee at a bodega, and I saw a big commotion in a park about two blocks from the shelter, where DHS clients were known to hang out and use substances.”
“I saw police and an ambulance,” she said. “What? Another shooting?” Soon after she arrived at work, a client burst into her office and told her that Pablo had just overdosed and died in the park.
“He was only 26—a baby,” Dixon said. “I believe he was HIV positive. He said he was afraid to get tested, because he knew he had it.”
“It was so sad. He had such a wonderful presence,” she said. “He’d say he was going to go to social services and try again. He was really trying his hardest, but with the overwhelming number of clients we had, it was difficult to get the help.”
Stories like Pablo’s became more and more frequent, Dixon said. “It happens all the time and isn’t reported. You’ll hear on the news that someone died homeless, but not that they were also living with HIV.”
Dixon decided to make a change after his death. “I needed to work with a community that helps the homeless HIV population,” she said. “People living with HIV have nowhere to turn, nowhere to go. They need a place of their own where they can feel safe and focus on living a healthy life.”
Everything You Need
Dixon joined GMHC’s housing team, which operates two supportive housing programs: the Housing Opportunities Program for People Living With AIDS (HOPWA) and the Rapid Rehousing Program. The latter houses families living in DHS shelters regardless of HIV status. Both are federally funded by the U.S. Department of Housing and Urban Development (HUD).
GMHC’s HOPWA program, launched in 2016, provides furnished apartments for 50 people living with HIV and AIDS. Most clients are referred from the agency’s Testing Center.
“We find them a home, but we don’t stop there,” Dixon said. The aim is to help clients achieve viral suppression and stay healthy and stably housed. “GMHC is one place where you can get everything you need—food, mental health and substance use counseling, the pharmacy, testing, and advocacy for treatment and benefits,” she said.
Because each housing case manager at GMHC works with only about 25 clients, they act as advocates to link each to Medicaid coverage, doctors, and medication. If a client feels overwhelmed, Dixon said, “we’ll make the appointment, and we’ll escort them to see doctors or for medical procedures. We don’t say: ‘Here’s a referral—let me know how it goes.’”
The case managers craft an individualized support plan with each client that covers medical adherence, supportive counseling, financial management, and independent living skills. They make monthly home visits to each one and check in regularly by phone.
“We’re that person for them. Some don’t have anybody else,” Dixon said. “We’re their support system–that ear for them or shoulder to cry on. We have their back.”
“If that had happened for Pablo, I believe he would still be with us,” she added.
Viral Suppression in COVID-19 Era
Amid the housing crisis in NYC and nationally, stable housing is the top unmet need for people living with HIV and AIDS, and it sharply increases the likelihood of adhering to HIV treatment. Of an estimated 1.2 million people living with HIV in the United States, over 100,000 are experiencing homelessness and another 300,000 are housing insecure, according to the National HIV/AIDS Housing Coalition.
Dixon is very proud that when the COVID-19 pandemic shut down NYC soon after she joined GMHC, the housing team was able to help 94% of its HOPWA clients remain virally suppressed—even though most hadn’t been so at intake.
In those early days of COVID-19, she said, the housing team lobbied hard with doctors and pharmacies to refill and deliver prescriptions to clients who couldn’t leave their apartments. They worked their social services networks to find free phones and laptops for clients and showed them how to use Zoom to stay connected when the world went virtual.
As Christmas came around that first year, Dixon, who is bilingual in Spanish, put on a Santa hat and played “Feliz Navidad” over Zoom to spread some virtual cheer to her Latinx clients who had no family.
“We saw such an increase with mental health issues for clients during that time, because they felt isolated and lonely—and it’s ongoing,” she said.
“Why Do You Call Me So Much?”
Last year, GMHC promoted Dixon to senior case manager for its Rapid Rehousing Program, which launched in 2020 with 31 units. HUD has increased that to 40 units because of the housing team’s success in transitioning families to their own apartments.
For clients in both programs, it generally takes one or two years to graduate to self-sufficiency, with stable income from employment and/or NYC HIV/AIDS Services (HASA) benefits.
Dixon doesn’t give up on her clients. She recalls one in the HOPWA program who’d already cycled through the shelter system and didn’t believe GMHC could help. “He’d been let down so much in his life. In DHS there was no help. Here, there was,” she said.
It took the client a while to believe that. He ducked her calls and avoided a monthly check-in meeting where GMHC’s HOPWA clients discuss self-care strategies, such as safer sex practices and staying COVID-free during the holidays.
“At one point he asked, ‘Why do you call me so much?’” Dixon said. “I would leave a message saying, ‘Hi, I know you’re dodging me. You don’t have to call me back immediately, but I’m going to call you again in a couple of days.’”
“He was the one who surprised us all,” she added. The client started attending housing meetings, secured HASA benefits and then employment as a security director, and he graduated from the program to independent living.
“It’s not easy work, but it’s rewarding.” Dixon said. “We do it with dedication, by making sure we stick with our clients all the way through the process. We want them to feel confident that they’re going to be OK and have the support they need.”