Morning Edition; North Carolina Voices:Understanding Poverty; Making Ends Meet with HIV

People living with HIV or AIDS in North Carolina have to be poorer than those in any other state to qualify for government health paying for their medicine. A few of them become poor because of the disease, but most of them are already poor when they get infected. Many of them also struggle with mental illness and substance abuse. Treating their immune deficiencies often means assisting them with housing, transportation, and relationships too, not to mention helping them pay their bills. As part of our series North Carolina Voices Understanding Poverty, James Todd has the story of three people in Raleigh managing their HIV infections without much money. James Woodson first book out about his HIV status during a church service. The pastor was bringing me, I would stop the whole thing, give you a testimony, and that's when I got up. I said for the first time a lot of you people heard that don't know. I'm also HIV, you know, but I got faith. Man, that church went in an uproar. Woodson can testify. At age 53 he is persevered through a drug addiction, the death of a wife, and for the last 16 years

he has lived with an HIV infection he got from sex in prison. He's also poor. That's typical of people with HIV in North Carolina. A Duke University study found that 70% of HIV infected people in the South live below the federal poverty line. 90% of them were already poor when they got the disease. It's not unusual that communicable diseases impact harder and vulnerable populations, such as populations living in poverty. Evelyn Fauss heads North Carolina's HIV STD Karen Prevention Branch. You see a whole lot of behaviors in impoverished communities that help a disease that's communicable increase, such as a lot of drug use, a lot of alcohol use, lack of access to care. The poverty also means most of the estimated 25,000 people with HIV AIDS in North Carolina can't afford the medications that cost at least $10,000 a year. Okay, come in, sweetheart. James Woodson is calling for his wife, Lacania, to help explain how they manage their money. She descends the stares of their modest

two-bedroom duplex near downtown Raleigh. A muscle disease slows her steps. She says the couple lives on $150 in food stamps, housing subsidy, and two social security checks. There's one for $146. It hits the bank on the first of the month. The other check for $5.46 comes in on the third of the month. And that's when I do the bills and we'll see what we have left over by the 12th to the 15th. We're flat broke. Then they rely on friends, family, their pastor, or an AIDS service organization. Some months, they have to choose which debts to pay down. The highest bill ranges between our light bill and our free minutes account, because we got all our jury at free minutes. No, not real though. Right now, if we don't pay our water bill, they're going to cut it up. Well, yeah, I want to be right now. And we need water to take a lot of medicine. Medical expenses is one bill James doesn't have to worry about. Medicaid and

Medicare pay for all his trips to the doctor. At the pharmacy, he co-pays one to three dollars for each medication. You know it's kind of bad when you go up to the window and you got one bottle and your medicine costs is one dollar and you can't pay for it. You know what they've done at the window? I have said so many times I don't have it then don't even ask me for it no more. Medicaid is the most common form of health insurance for people being treated for HIV and North Carolina. To qualify, adults without children have to be disabled and living below the poverty line. That means people with HIV aren't eligible for Medicaid until they've been hospitalized with full-blown AIDS or are considered disabled for another reason. I can understand really with seeing your citizens go through sometimes you have to decide whether or not it's going to be food or your health. Bob was 41, recently moved to Raleigh with his partner. He cooks at this fast food

restaurant. He doesn't want to disclose his last name because he is worried he might be fired if his boss found out his HIV status. Once Bob applied for Medicaid, but the state didn't consider him disabled. Through most of his illness, he has gotten his medications through a state program for HIV patients without insurance. I had Blue Cross Blue Shield at one point and I had to let that go. I was supposed to take a certain amount every day but instead I was just like don't need to do one dosage and then you know just make it stretch out until I can figure out another plan of attack on it. Bob was able to get back into the state's AIDS drug assistance program, but even working 30 hours a week for $7.50 an hour, he could become an eligible for it. Anyone who takes home more than $12,000 a year doesn't qualify. That's the lowest cutoff level for any state AIDS drug program in the country. Even though North Carolina spends more on its program than most states, a higher proportion of its HIV population needs government assistance. Drug companies are the safety net for people with HIV in North Carolina. They provide free

medications for people who will need them for life and are unable to get them any other way. Money is not the only concern for poor people with HIV. Ruby Amagula gets by on a disability check and Medicaid, but she says having HIV can feel more isolating than being broke. I'm not contagious, you know, because I'm not having sex with anyone to be contagious, which brings up another issue of loneliness and all that other stuff too. Ruby is found friendship here at the Glory to Glory House of Refuge. It's a transitional home in Raleigh for women with HIV, but the people around her weren't always so understanding. Ruby was first diagnosed with HIV 14 years ago when she was in her 30s and living in New York City. She came home to North Carolina to live with her mother. Yeah, people that my mom, church, told my mom that she needed to put me in a high spice, because she didn't know how I was. The device was contracted,

so my mom used to have to chew food and feed it to me. And, you know, I'm grateful for my mom today because she told those three people that she went to church. I wasn't coming to my house before my daughter came out. If you don't want to get near me, don't get near me, but I'm going to take care of my mom. Ruby now works to see that people with HIV get the care they need. She helps out at AIDS service organizations, speaks at churches, and recently climbed into a van with women from her house to March in the Black HIV AIDS Awareness Rally at the State Capitol. This is something that they should be doing more up in North Carolina. HIV AIDS is no longer a descents. It's a chronic disease with a costly treatment. Paying for it if your poor requires help from government or business, support from friends and family encouraged to overcome destructive habits. For all those gifts and a chance at long life, Ruby, Bob, and James say they're grateful. For North Carolina Public Radio WNC, I'm James Todd.