housing need among persons living with HIV/AIDS; 40% to 60%
of all PLWHA report a lifetime experience of homelessness or housing instability.1
Th e
▶ CDC estimates that there are currently 1.1 million people living with HIV/AIDS in the United States, and an estimated 40,000 persons become newly infected each year. AIDS housing experts estimate that about half of those people—over 500,000 households—will need some form of housing assistance during the course of their illness.
At the
▶ FY2007 funding level of $286 million, the federal Housing Opportunities for Persons with AIDS (HOPWA) program serves an estimated 67,000 households per year.
91% of these recipients of
▶ HOPWA housing assistance have
incomes of less than $1000 a month—roughly 60% less than what was needed to aff ord housing at Fair Market Rents in 2006.2
NAHC recommends a level of $454 million in FY2008 to continue supporting those who depend upon HOPWA for vital housing assistance, and to address unmet housing need across the country.
1 Aidala, A. (2005). Homelessness, Housing Instability and Housing Problems among Persons Living with HIV/AIDS. Paper presented at NAHC National Housing and HIV/AIDS Research Summit I, June 2005.
2 Based on a National Housing Wage (the amount a worker must earn to afford a 2 bedroom apartment at Fair Market Rent) of $16.31 in 2006. Out of Reach 2006, National Low Income Housing Coalition (www.nlihc.org).
the national aids housing coalition
1518 K Street NW, Suite 410 / Washington, DC 20005 / 202.347.0333 / [email protected] / www.nationalaidshousing.org
a direct link between housing and health for people living with HIV/AIDS (PLWHA): lack of housing is a barrier to care, while improved housing status increases access to treatment and adherence to anti-retroviral treatments (ART).
housing status predicts hiv treatment success or failure:
A recent
▶ CDC study found that housing status is one of the strongest predictors of treatment access and health outcomes for PLWHA. 1
Compared to stably housed
▶ PLWHA, homeless persons
experience worse overall physical and mental health, are more likely to be hospitalized and use emergency rooms, have lower CD4 counts and higher viral loads, and are less likely to receive and adhere to antiretroviral therapy.2
Stable housing remains signifi cantly associated with treatment
▶
success aft er controlling for demographics, drug and alcohol use, and receipt of medical and social services, indicating that housing itself improves the health of PLWHA.3
access to housing enables plwha to get into care and stay in care:
People with housing needs who receive any level of housing
▶
assistance are almost four times as likely to enter into medical care as those who do not receive assistance.4
1 Kidder, D.P., Wolitski, R.J., Campsmith, M.L., Nakamura, G.V. (2006). Health status, health care use, medication use, and medication adherence in homeless and housed people living with HIV/AIDS. American Journal of Public Health (in press).
2 Id.
3 Id.
4 Aidala, A., Waddell, E., Sotheran, J. (2005). Delayers, Drop-outs, the Unconnected, and
“Unmet need,” Community Health Advisory and Information Network Report 2005-3. Columbia University: Mailman School of Public Health.
Over time, homeless/unstably housed persons whose housing status
▶
improved were fi ve times more likely to report a recent HIV outpatient visit than persons who did not change their housing status.5
stable housing results in better health outcomes and reduced mortality:
Homeless/unstably housed
▶ PLWHA whose housing improved
over time were six times more likely to be receiving ART as those who remained homeless or unstably housed.6
Stable
▶ housing improves continuity of HIV care as well as ART participation, adherence and success.7
Th e number of months on
▶ ART and level of adherence are
directly related to lower viral loads, fewer opportunistic infections, and reduced mortality among extremely poor and homeless people living with HIV/AIDS.8
5 Aidala, A., Lee, G., and Siegler, A. (2007). Housing Need, Housing Assistance and Connection to Medical Care. Community Health Advisiory and Information Network Report 2006-5. Columbia University: Mailman School of Public Health. Aidala, A. (2006). Risky Persons vs. Risky Contexts- Housing as a Structural Factor Affecting HIV Prevention and HIV Care, Paper presented at the National AIDS Housing Coalition (NAHC) National Housing and HIV/AIDS Research Summit II.
6 Aidala, 2006; Aidala, et al., 2007.
7 Aidala, et al., 2007. Knowlton, A., Arnsten, J., Eldred, L., Wilkinson, J., Gourevitch, M., Shade, S., Dowling, K., Purcell, D., and the INSPIRE Team (2006). Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. Journal of Acquired Immunodefi ciency Diseases, 41(4): 486-492.
8 Riley, E. D., Guzman, D., Perry, S., Bangsberg, D., and Moss, A. (2005). Antiretroviral therapy, Hepatitis C, and AIDS mortality among San Francisco’s homeless and marginally housed. Journal of Acquired Immune Defi ciency Syndromes: JAIDS, 38(2): 191-5. Waldrop-Valverde, D., and Waldrop-Valverde, E. (2005). Homelessness and psychological distress as contributors to antiretroviral nonadherence in HIV-positive injecting drug users. AIDS Patient Care Stds, 19(5): 326-34.
the national aids housing coalition
1518 K Street NW, Suite 410 / Washington, DC 20005 / 202.347.0333 / [email protected] / www.nationalaidshousing.org
the NAHC housing and HIV/AIDS research summit series In June 2005 and October 2006, public health experts gathered to share research fi ndings on HIV and housing. NAHC will convene Summit III on March 5th—7th, 2008, in Baltimore, Maryland, in collaboration with the Department of Health, Behavior and Society of the Johns Hopkins Bloomberg School of Public Health. Th e goal is to develop and implement a data-driven public health response to the housing needs of persons living with HIV. Four imperatives for a sound HIV/AIDS housing policy have emerged:
1) make aff ordable housing available to persons with HIV;
2) make housing persons with HIV a top prevention priority;
3) incorporate housing as a critical element of HIV health care;
4) collect the data needed to inform HIV housing policy.
For more information on the Summit Series and the policy imperatives, read the Summit Policy Papers at www.nationalaidshousing.org.
housing need among persons with HIV/AIDS:
National research shows that housing is the greatest unmet
▶
housing need among persons living with HIV/AIDS; 40% to 60%
of all PLWHA report a lifetime experience of homelessness or housing instability.1
Th e
▶ CDC estimates that there are currently 1.1 million people living with HIV/AIDS in the United States, and an estimated 40,000 persons become newly infected each year. AIDS housing experts estimate that about half of those people—over 500,000 households—will need some form of housing assistance during the course of their illness.
At the
▶ FY2007 funding level of $286 million, the federal Housing Opportunities for Persons with AIDS (HOPWA) program serves an estimated 67,000 households per year.
91% of these recipients of
▶ HOPWA housing assistance have
incomes of less than $1000 a month—roughly 60% less than what was needed to aff ord housing at Fair Market Rents in 2006.2 a direct link between housing and health for people living with HIV/AIDS (PLWHA): lack of housing is a barrier to care, while improved housing status increases access to treatment and adherence to anti-retroviral treatments (ART).
NAHC recommends a level of $454 million in FY2008 to continue supporting those who depend upon HOPWA for vital housing assistance, and to address unmet housing need across the country.
1 Aidala, A. (2005). Homelessness, Housing Instability and Housing Problems among Persons Living with HIV/AIDS. Paper presented at NAHC National Housing and HIV/AIDS Research Summit I, June 2005.
2 Based on a National Housing Wage (the amount a worker must earn to afford a 2 bedroom apartment at Fair Market Rent) of $16.31 in 2006. Out of Reach 2006, National Low Income Housing Coalition (www.nlihc.org).
the national aids housing coalition
1518 K Street NW, Suite 410 / Washington, DC 20005 / 202.347.0333 / [email protected] / www.nationalaidshousing.org
risk behaviors among HIV positive persons with multiple behavior issues, highlighting the signifi cance of housing as an exciting new structural intervention to reduce the spread of HIV.
housing status predicts HIV risk:
Homeless persons face enormous pressures of
▶ daily survival
needs that supersede eff orts to reduce HIV risk, as well as multiple barriers to risk reduction resources.
Among persons at highest
▶ HIV risk due to injecting drug use
or high-risk sex, those without a home are signifi cantly more likely than others to become HIV infected over time.1
Important new research shows a
▶ direct relationship between
housing status and risk behaviors among extremely low-income HIV+ persons with multiple behavioral issues.2
Homeless or unstably housed persons were
▶ two to six times
more likely to use hard drugs, share needles or exchange sex than stably housed persons with the same personal and service use characteristics.3
1 Song, J.Y., Safaeian, M., Strathdee, S.A., Vlahov, D., and Celentano, D. (2000). The prevalence of homelessness among injection drug users with and without HIV infection. Journal of Urban Health, 77: 678-687.
2 Aidala, A., Cross, J.E., Stall, R., Harre, D., and Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9(3): 251-265.
3 Id.
housing is hiv prevention:
Research also shows a
▶ strong association between change in housing status and HIV risk behavior change.4
Over time,
▶ persons whose housing status improved reduced risk behaviors by half; while persons whose housing status worsened over time were 4 times as likely to exchange sex.5
Access to
▶ housing also increases access to antiretroviral medications, which lower viral load and may reduce the risk of transmission.6
4 Aidala, et al., 2005. Dickson-Gomez, J. (2006), The Relationship between Housing Status and HIV Risk among Active Drug Users: A Qualitative Analysis. Paper presented at NAHC National Housing and HIV/AIDS Research Summit II.
5 Aidala, et al., 2005.
6 Holtgrave, D.R., Curran, J.W. (2006). What works, and what remains to be done, in HIV prevention in the United States. Annual Review of Public Health, 27: 261-275.
the national aids housing coalition
1518 K Street NW, Suite 410 / Washington, DC 20005 / 202.347.0333 / [email protected] / www.nationalaidshousing.org
HIV risk behaviors among HIV positive persons with multiple behavior issues, highlighting the signifi cance of housing as an exciting new structural intervention to reduce the spread of HIV.
the NAHC housing and HIV/AIDS research summit series In June 2005 and October 2006, public health experts gathered to share research fi ndings on HIV and housing. NAHC will convene Summit III on March 5th—7th, 2008, in Baltimore, Maryland, in collaboration with the Department of Health, Behavior and Society of the Johns Hopkins Bloomberg School of Public Health. Th e goal is to develop and implement a data-driven public health response to the housing needs of persons living with HIV. Four imperatives for a sound HIV/AIDS housing policy have emerged:
1) make aff ordable housing available to persons with HIV;
2) make housing persons with HIV a top prevention priority;
3) incorporate housing as a critical element of HIV health care;
4) collect the data needed to inform HIV housing policy.
For more information on the Summit Series and the policy imperatives, read the Summit Policy Papers at www.nationalaidshousing.org.
housing need among persons with HIV/AIDS:
National research shows that housing is the greatest unmet
▶
housing need among persons living with HIV/AIDS; 40% to 60%
of all PLWHA report a lifetime experience of homelessness or housing instability.1
Th e
▶ CDC estimates that there are currently 1.1 million people living with HIV/AIDS in the United States, and an estimated 40,000 persons become newly infected each year. AIDS housing experts estimate that about half of those people—over 500,000 households—will need some form of housing assistance during the course of their illness.
At the
▶ FY2007 funding level of $286 million, the federal Housing Opportunities for Persons with AIDS (HOPWA) program serves an estimated 67,000 households per year.
91% of these recipients of
▶ HOPWA housing assistance have
incomes of less than $1000 a month—roughly 60% less than what was needed to aff ord housing at Fair Market Rents in 2006.2
NAHC recommends a level of $454 million in FY2008 to continue supporting those who depend upon HOPWA for vital housing assistance, and to address unmet housing need across the country.
1 Aidala, A. (2005). Homelessness, Housing Instability and Housing Problems among Persons Living with HIV/AIDS. Paper presented at NAHC National Housing and HIV/AIDS Research Summit I, June 2005.
2 Based on a National Housing Wage (the amount a worker must earn to afford a 2 bedroom apartment at Fair Market Rent) of $16.31 in 2006. Out of Reach 2006, National Low Income Housing Coalition (www.nlihc.org).
the national aids housing coalition
1518 K Street NW, Suite 410 / Washington, DC 20005 / 202.347.0333 / [email protected] / www.nationalaidshousing.org
homelessness among persons living with HIV/AIDS (PLWHA), and deadly consequences for PLWHA from life on the streets or in shelters.
homelessness is a major risk factor for HIV:
Th e conditions of homelessness and extreme poverty—the
▶
inability to maintain intimate relationships, pressures of daily survival needs, and substance use as a response to stress and/or mental health problems—leave homeless and unstably housed persons extremely vulnerable to HIV infection.1
Rates of
▶ HIV infection are three to sixteen times higher among persons who are homeless or unstably housed, compared to similar persons who are stably housed.2
3% to 10% of all homeless persons are
▶ HIV positive—ten times
the rate of infection in the general population.3
hiv is a major risk factor for homelessness:
PLWHA
▶ are likewise extremely vulnerable to homelessness, due to discrimination, loss of income, the breakup of relationships and other factors.
As many as
▶ sixty percent of all persons living with HIV/AIDS report a lifetime experience of homelessness or housing instability. 4
1 Aidala, A. (2005). Inequality and HIV: the role of housing. Psychology and AIDS Exchange, American Psychological Association, Offi ce on AIDS, 34: 3-5.
2 Kerker, B., Bainbridge, J., Li, W., Kennedy, J., Bennani, Y., Agerton, T., Marder, D., Torian, L., Tsoi, B., Appel, K., Gutkovich, A. (2005). The Health of Homeless Adults in New York City: A report from the New York City Departments of Health and Mental Hygiene and Homeless Services.
Robertson, M.J., Clark, R., Charlebois, E.D., Tulsky, J., Bangsberg, D.R., Long, H.L., and Moss, A. (2004). HIV seroprevalence among homeless adults in San Francisco, American Journal of Public Health, 94(7): 1207-1217. Culhane, D.P., Gollub, E., Kuhn, R., and Shpaner, M. (2001).
The co-occurrence of AIDS and homelessness: Results from the integration of administrative data for AIDS surveillance and public shelter utilization in Philadelphia. Journal of Epidemiology and Community Health, 55(7): 515-520.
3 Robertson et al., 2004; Culhane et al., 2001.
4 Aidala, A. (2005). Homelessness, Housing Instability and Housing Problems among Persons Living with HIV/AIDS. Paper presented at NAHC National Housing and HIV/AIDS Research Summit I. Culhane, D. (2005). The Co-Occurrence of AIDS and Homelessness. Paper presented at NAHC National Housing and HIV/AIDS Research Summit I.
At any given time,
▶ up to 16% of all persons with HIV in some communities are homeless—sleeping in shelters, on the street, or in a car.5
housing is a matter of life or death for persons with HIV/AIDS:
Th e
▶ all-cause death rate among homeless PLWHA is fi ve times the death rate for housed PLWHA.6
Th e
▶ death rate due to HIV/AIDS is seven to nine times higher among homeless adults compared to the general population.7
Homeless
▶ PLWHA are three times as likely to be outside medical care than housed PLWHA.8
A recent
▶ CDC study found that housing status is one of the strongest predictors of health outcomes for PLWHA, aft er controlling for other factors such as drug use, mental health and receipt of medical and social services.9
Compared to stably housed
▶ PLWHA, homeless persons
experience worse overall physical and mental health, have lower CD4 counts and higher viral loads, and are less likely to receive and adhere to antiretroviral therapy.10
5 Culhane, D. (2005).
6 The study that found 5.3 deaths per 100 person years is: Riley, E. D., Guzman, D., Perry, S., Bangsberg, D., and Moss, A. (2005). Antiretroviral therapy, Hepatitis C, and AIDS mortality among San Francisco’s homeless and marginally housed. Journal of Acquired Immune Defi ciency Syndromes: JAIDS, 38(2): 191-5. The comparison is with the following study which found an overall death rate of 1-2 deaths per 100 person years: Ledergerber B, Egger M, Opravil M, et al. Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study. Swiss HIV Cohort Study. Lancet. 1999;
353(9156):863-868.
7 Kerker, et al., 2005.
8 Aidala, A., Lee, G., and Siegler, A. (2007). Housing Need, Housing Assistance and Connection to Medical Care. Community Health Advisiory and Information Network Report 2006-5. Columbia University: Mailman School of Public Health.
9 Kidder, D.P., Wolitski, R.J., Campsmith, M.L., Nakamura, G.V. (in press). Health status, health care use, medication use, and medication adherence in homeless and housed people living with HIV/AIDS. American Journal of Public Health (in press).
10 Id.
the national aids housing coalition
1518 K Street NW, Suite 410 / Washington, DC 20005 / 202.347.0333 / [email protected] / www.nationalaidshousing.org
NAHC recommends a level of $454 million in FY2008 to continue supporting those who depend upon HOPWA for vital housing assistance, and to address unmet housing need across the country.
the NAHC housing and HIV/AIDS research summit series In June 2005 and October 2006, public health experts gathered to share research fi ndings on HIV and housing. NAHC will convene Summit III on March 5th—7th, 2008, in Baltimore, Maryland, in collaboration with the Department of Health, Behavior and Society of the Johns Hopkins Bloomberg School of Public Health. Th e goal is to develop and implement a data-driven public health response to the housing needs of persons living with HIV. Four imperatives for a sound HIV/AIDS housing policy have emerged:
1) make aff ordable housing available to persons with HIV;
2) make housing persons with HIV a top prevention priority;
3) incorporate housing as a critical element of HIV health care;
4) collect the data needed to inform HIV housing policy.
For more information on the Summit Series and the policy imperatives, read the Summit Policy Papers at www.nationalaidshousing.org.
homelessness among persons living with HIV/AIDS (PLWHA), and deadly consequences for PLWHA from life on the streets or in shelters.
housing need among persons with HIV/AIDS:
National research shows that housing is the greatest unmet
▶
housing need among persons living with HIV/AIDS; 40% to 60%
of all PLWHA report a lifetime experience of homelessness or housing instability.1
Th e
▶ CDC estimates that there are currently 1.1 million people living with HIV/AIDS in the United States, and an estimated 40,000 persons become newly infected each year. AIDS housing experts estimate that about half of those people—over 500,000 households—will need some form of housing assistance during the course of their illness.
At the
▶ FY2007 funding level of $286 million, the federal Housing Opportunities for Persons with AIDS (HOPWA) program serves an estimated 67,000 households per year.
91% of these recipients of
▶ HOPWA housing assistance have
incomes of less than $1000 a month—roughly 60% less than what was needed to aff ord housing at Fair Market Rents in 2006.2
1 Aidala, A. (2005). Homelessness, Housing Instability and Housing Problems among Persons Living with HIV/AIDS. Paper presented at NAHC National Housing and HIV/AIDS Research Summit I, June 2005.
2 Based on a National Housing Wage (the amount a worker must earn to afford a 2 bedroom apartment at Fair Market Rent) of $16.31 in 2006. Out of Reach 2006, National Low Income Housing Coalition (www.nlihc.org).
“Housing First” (Cited from the National Alliance to End Homelessness): Housing First is an approach to ending homelessness that centers on providing homeless people with housing quickly and then providing services as needed. What differentiates a Housing First approach from other strategies is that it is “housing-based,” with an immediate and primary focus on helping individuals and families quickly access and sustain permanent housing. What differentiates a Housing First approach from traditional emergency housing or transitional models is the immediate and primary focus on helping homeless people quickly access and then sustain housing—put simply, housing comes first.
“Harm Reduction” Housing: Harm reduction housing includes a continuum of housing options from non-sobriety based / low-demand housing to sobriety based housing.
“Harm reduction” Non-sobriety-based Housing: Low demand housing is supportive housing that does not require from the tenant, sobriety, substance abstinence, or medication and treatment adherence to obtain or retain housing.
“Supportive Housing” (Adapted from the Corporation for Supportive Housing): Supportive housing is a successful, cost-effective combination of affordable housing with services that helps people live more stable, productive lives. Supportive housing works well for people
“Supportive Housing” (Adapted from the Corporation for Supportive Housing): Supportive housing is a successful, cost-effective combination of affordable housing with services that helps people live more stable, productive lives. Supportive housing works well for people