Her mother had a series of overlapping hospital stays due to severe diabetes that forced her to retire from her job, and now she lives in an affordable housing complex for seniors in the city, the only place she can afford to live on her Social Security disability insurance.
Her 17-year-old daughter, a server at a local restaurant, can’t afford to stop working, even though every shift brings her closer to someone with COVID-19.
“She makes maybe $50 a day,” she said. “Is it really worth her risking her life every day?”
But she also thinks about cost. Her father was able to keep his house but had to shed all his other assets so he could qualify for Medicare and Medicaid. Her daughter has health insurance through Medicaid, which Parkinson pays $65 out of her own pocket.
There have been tight months when Parkinson has had to make tough decisions about which bill to pay. But the premium bill always comes first “because nobody’s going to help me with that,” she told Medscape Medical News.
Time to Act
The spread of COVID-19 can be curbed by a speedy public health response, the healthcare system, a sufficient number of clinicians, and adequate personal protective equipment, said Millett. But “there’s so much that’s really variable right now.”
Parkinson’s experience with HIV could provide a potential path forward during the COVID crisis, though.
A federal program called the AIDS Drug Assistance Program offsets costs and means that Parkinson can afford to stay on her HIV medicines. Because of her access to clinics in St. Louis, she has regular care. And, when she needs it, she gets additional help from the federal Ryan White Cares Act, which provides wrap-around social services to help people living with HIV stay housed, fed, and able to focus on their health.
Of the people treated at Ryan White clinics across the country, 87.1% have suppressed viral loads, data show.
A parallel program modeled after Ryan White could help address disparities in communities like hers, said Parkinson.
There is evidence that policy makers are willing to respond to outbreaks in a science-based way. Although many states had not declared stay-at-home directives by March 22, by April 6, many had, including Florida, Georgia, Mississippi, and Tennessee. Two Ending the HIV Epidemic states, however — Oklahoma and Arkansas — continue to not have state-wide orders.The COVID-19 pandemic is very much like the HIV outbreak in Scott County, Indiana, from 2011 to 2014, said Steffanie Strathdee, PhD, from the University of California, San Diego, who has spent the past 20 years studying HIV outbreaks in people who inject drugs.
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