HOUSING AND HIV

 

NATIONAL AIDS HOUSING COALITION
HOUSING IS HIV PREVENTION AND HEALTHCARE

WHY HIV-SPECIFIC HOUSING RESOURCES?

The need for HIV-specific housing resources has been questioned as an example of “AIDS exceptionalism,” a term used to describe policies that differ from a traditional infectious disease control or chronic care approach.

As stated in a 2004 Institutes of Medicine (IOM) report on healthcare delivery, HIV/AIDS remains unique in that it combines an infectious agent,  potentially fatal consequences, rapid spread in vulnerable populations and the potential for the development of drug-resistant strains, while being highly treatable with anti-retroviral therapy that substantially reduces mortality & morbidity.

  • To the extent that HIV/AIDS presents lifelong care management issues, attacking HIV housing resources obscures the real problem–reforming housing and healthcare financing so that everyone with a serious, chronic illness has access to decent medical care, housing and services.
  • Successful HIV/AIDS housing supports and programs serve as a model for a modern approach to healthcare improvement in situations in which housing may have a direct impact on health risks and outcomes.

Government agencies, working in collaboration with non-profit providers of housing and services have invested in housing for persons with HIV/AIDS. By necessity, many HIV/AIDS housing programs have pioneered innovative approaches for addressing the co-occurring medical, substance use and mental health needs of the PLWHA they serve.

Research findings demonstrate overall stability and connection to care among users of these HIV-specific housing resources, providing important evidence that homeless and unstably housed persons with lifelong chronic care needs, including those who are mentally ill and/or chemically dependent:

  1. can live in independent settings if provided with necessary supports,
  2. will voluntarily access supportive services that they perceive to be relevant and respectful,
  3. and, once stably housed, will become active participants in their own medical and psychosocial care.

AREN’T HOMELESS AND UNSTABLY HOUSED PLWHA JUST
RISKY PEOPLE?

  • Research shows that the receipt of housing assistance is linked to reduction of HIV risk behaviors and positive change in medical outcomes.
  • The data show a strong relationship between housing status and HIV risk and health outcomes, controlling for other client characteristics, health status and service use variables.
  • These findings suggest that the condition of homelessness, and not simply traits of homeless individuals, influences risk behaviors and health service utilization.
  • Housing affects an individual’s ability to avoid exposure to HIV, an HIV-positive individual’s ability to avoid exposing others to HIV and the ability to access and adhere to care.
  • To end the AIDS crisis, we need to move beyond a “risky person” paradigm to a consideration of risky contexts such as housing instability and other structural factors that impact HIV risk and health outcomes.

ISN’T HOUSING TOO EXPENSIVE?

  • Studies show that supportive housing for homeless persons with HIV/AIDS and other disabilities sharply reduces their use of costly emergency and inpatient services.
  • Savings in other publicly funded services have been found to offset up to 95% of the cost of the supportive housing. These cost-offset analyses support the provision of housing even before taking into account the costs of heightened HIV risk and treatment failure among homeless PLWHA.
  • Each prevented HIV infection saves more than $300,000 in life-time medical costs.
  • Findings from an ongoing HUD/CDC study indicate that housing is a cost-saving and cost effective HIV prevention and treatment intervention.

ISN’T HEALTHCARE MORE IMPORTANT THAN HOUSING
FOR PLWHA?

  • Research shows that housing plays a critical role in effective systems of HIV/AIDS prevention and health care.
  • Housing and health care should not be viewed as competing priorities.
  • What’s needed is a more progressive and comprehensive definition of health care.

CAN’T PLWHA USE EXISTING LOW INCOME HOUSING RESOURCES?

  • The unmet housing needs of low-income people living with HIV/AIDS are part of the larger and rapidly worsening national affordable housing crisis. In 2006, 17 million American households–one in seven–were severely rent-burdened (paid more than 50% of income towards rent).
  • In not one county in the U.S. can a full-time minimum wage worker afford a 2-bedroom apartment at HUD’s Fair Market Rent.
  • Housing assistance is available to only one in four low-income households in need.
  • An estimated 750,000 persons are homeless in the U.S. each night, sleeping in shelters or on the streets, and a quarter of these persons can be considered chronically homeless, which, according to HUD’s definition, means they are homeless for long periods or repeatedly, and have a disability such as HIV/AIDS.
  • National average rents for one-bedroom and efficiency units are more than the entire monthly income of elderly and disabled persons who rely on Supplemental Security Income (SSI) ($603 in most states).
  • Funding for core federal housing programs is declining.

CAN PLWHA WITH CHRONIC SUBSTANCE USE PROBLEMS BE HOUSED?

  • In order to meet the housing needs of persons with HIV/AIDS, it is critical to employ housing models that are accessible to all homeless/unstably persons, including those who are actively using substances. Continued drug use is often a barrier to housing placement, and among former users relapse is often grounds for eviction. However, a growing body of evidence demonstrates that use-tolerant housing approaches achieve stability and service use outcomes comparable to more traditional abstinence-only housing models.
  • “Housing first” or “low-demand” housing models place persons with substance use and/or mental health issues directly into permanent housing without requiring sobriety.
  • Growing evidence shows that these programs achieve housing and service use outcomes comparable to traditional abstinence-only supportive housing.
  • Low-demand housing programs that enrolled “more challenging” consumers did not see worse housing outcomes, demonstrating that “housing readiness” is not a good predictor of outcomes.

 

From the National Housing Coalition’s “Housing is HIV Prevention and Healthcare Policy Took Kit”
http://nationalaidshousing.org/policy-toolkit/the-tools/