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:
- can live in independent settings if provided with necessary supports,
- will voluntarily access supportive services that they perceive to be relevant and respectful,
- and, once stably housed, will become active participants in their own medical and psychosocial care.
AREN’T HOMELESS AND UNSTABLY HOUSED PLWHA JUST
- 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
- 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”