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Homelessness and AIDS: An L.A. Secret : Public Health: Skid Row has no AIDS clinic, despite infection among the homeless up to 40 times that of the overall rate.

<i> Madeleine R. Stoner, an associate professor at USC's School of Social Work, is on sabbatical, serving as director of social services at the Single Room Occupancy Housing Corp. on Skid Row</i>

When Magic Johnson revealed his tragic secret to the world, we learned that even a man who has everything is not immune. That same week, there was news about how the same tragedy is affecting people who have nothing--but it barely attracted media attention.

After a survey of 13 major cities, the Centers for Disease Control reported that the AIDS virus has infected the nation’s homeless people at rates up to 40 times as high as those of the general population; in some cities, 20% of the homeless are HIV-infected; and the rate among homeless teen-agers is alarmingly high.

In Los Angeles, 1,329 people on Skid Row--10% of the homeless population there--have AIDS; twice that number are HIV-positive.

It’s no secret that the lifestyles of homeless people make them susceptible to contracting the deadly virus. What’s surprising is the evidence that AIDS leads people to homelessness: As the disease progresses into repeated and more serious bouts with opportunistic infections, people become unable to work, to support themselves, to pay the rent.

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Perhaps the government report failed to attract media coverage because it’s no news that homeless people experience far more illnesses and injuries than the population as a whole. Perhaps it’s because we have become immune to hearing any news about homeless people.

Another explanation may lie in the longstanding wish of many in the homeless community to keep AIDS, and its precursor HIV, a dark secret.

There are some plausible reasons for such secretiveness. One is that homeless people fear that disclosure of their condition will prevent them from receiving even the minimal survival services available to them. Their secret comes out only when their illness becomes critical enough that they have to seek care.

Another reason for the big secret may lie in the fact that even the most supportive homeless advocates fear that publicizing the incidence of HIV and AIDS will add to the growing backlash against homeless people. Adding the presence of AIDS to the stigma of homelessness, addiction, mental illness or failure to work may cause government and philanthropic donors to withhold resources from what seems to be a lost cause.

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This secret has been so well guarded in Los Angeles that it is the only city in the nation with a substantial AIDS population that does not have a free-standing AIDS treatment center on Skid Row. Even the county Care Council, mandated to allocate up to $10 million in AIDS funds under the federal Ryan White AIDS Care Act, has failed to send any money to Skid Row.

People who are not themselves homeless cannot afford to dismiss this issue, because this problem is not only about society’s throwaways. The spread of HIV and AIDS affects more than street people. HIV-infected people are highly susceptible to tuberculosis and other contagious diseases occurring with more frequency among the homeless. It may surprise some, but homeless people do work, and many find housing. Sadly, they do not always leave their vulnerability to HIV behind.

Even if this disclosure causes further stigmatization of homeless people, the facts must be revealed, because so little is being done to stop the spread of AIDS in their community. We must know the truth so that education, prevention and treatment can follow. If we cannot achieve this for humane reasons, then we must act out of concern for public health.


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