Housing assistance is a powerful and cost-effective way to improve HIV health outcomes and prevent new infections.
Homelessness and unstable housing undermine HIV treatment:
- For people living with HIV, research shows that lack of stable housing is strongly linked to inadequate HIV health care, high viral load, poor health status, avoidable hospitalizations and emergency room visits, and early death.1
- Unmet subsistence needs (homelessness & hunger) have been found to have an even greater effect than antiretroviral therapy (ART) adherence on the overall physical and mental health of men and women with HIV.2
Housing instability also increases the risk of new HIV infections:
- People with HIV who are coping with homelessness are two to six times more likely than those who have stable housing to have recently engaged in drug and sexual behaviors that can transmit HIV -- after controlling for substance use, mental health issues, access to services, and other factors that contribute to risk.3
- Homeless persons with HIV are also significantly more likely to have a detectible HIV viral load, which increases the risk of transmitting the virus to others.4
Housing assistance works to improve health and reduce HIV transmission:
- Recent studies found that homeless persons with HIV randomized to receive an immediate housing placement were twice as likely as control group members who remained homeless to have an undetectable viral load after 12 months, and that placement in supportive housing reduced AIDS mortality among homeless persons by 80% over five years.5
- Improved housing status also prevents new HIV infections by reducing HIV risk behaviors by as much as half and by facilitating effective ART that lowers viral load to an undetectable level, virtually eliminating ongoing HIV transmission.6
Housing assistance is cost-effective HIV prevention and health care:
- By improving the health of people with HIV, housing assistance dramatically reduces the use of expensive emergency and in-patient services, generating "savings" in public health care spending that offset the cost of the housing -- in once case reducing annual taxpayer costs by $7,000 per person housed.7
- In addition, each new HIV infection prevented through more stable housing saves $400,000 in lifetime medical costs and countless life years -- making housing a cost-effective HIV health care intervention.8
New HIV prevention and treatment strategies will not succeed until Americans living with HIV/AIDS have a safe, stable place to call home.
The National HIV/AIDS Strategy charges responsible Federal agencies to increase housing security for people living with HIV/AIDS as a means to improve health outcomes, and the U.S. Department of Health and Human Services (HHS) recently included housing status as one of seven common core indicators for monitoring HIV prevention, treatment and care. Yet over 145,000 households living with HIV in the U.S. have unmet housing needs.
What's Needed: Evidence-Based HIV/AIDS Housing Policy
- Make safe, affordable housing available to all people living with HIV.
- Make housing assistance a top HIV prevention priority.
- Monitor housing status as an indicator of HIV treatment effectiveness.
- Aidala, A.A, et al. (2012). Housing status and the health of people living with HIV/AIDS: A systematic review. Presented at the XIX International AIDS Conference, Washington, D.C., July 2012; Kidder, D., et al. (2007). Health status, health care use, medication use, and medication adherence in homeless and housed people living with HIV/AIDS, American Journal of Public Health, 97(12): 2238-2245.
- Riley, E.D., et al. (2012). Social, structural and behavioral determinants of overall health status in a cohort of homeless and unstably housed HIV-infected men. PLoS ONE, 7(4).
- Kidder, D., et al. (2008). Housing status and HIV risk behaviors among homeless and housed persons with HIV. JAIDS, 49(4), 451-5.
- Muthulingam, D. et al. (2013). Disparities in Engagement in Care and Viral Suppression among Persons with HIV. J Acquir Immune Defic Syndr. 2013 Feb 7. [Epub ahead of print].
- Buchanan, D.R., et al. (2009). The Health Impact of Supportive Housing for HIV-Positive Homeless Patients: A Randomized Controlled Trial. AJPH, 99(S3): S675-S680; Schwarcz, S.K., et al. (2009). Impact of housing on the survival of people with AIDS. BMC Public Health, 9: 220.
- Aidala, A.A., et al. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS & Behavior, 9(3): 251-265; National Institute of Allergy and Infectious Diseases (NIAID) (2011). Treating HIV-infected people with antiretrovirals protects partners from infection: Findings result from NIH-funded international study. Bethesda, MD, May 12, 2011.
- Wolitski, R. J., et al. (2010). Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS & Behavior, 14(3): 493-503; Basu, A., et al. (2012). Comparative Cost Analysis of Housing and Case Management Program for Chronically Ill Homeless Adults Compared to Usual Care. Health Services Research, 47(1 Pt 2): 523-43.
- Holtgrave, D.R., et al. (2012). Cost-Utility Analysis of the Housing and Health Intervention for Homeless and Unstably Housed Persons Living with HIV. AIDS & Behavior. 2012 May 16. [Epub ahead of print].
- HUD (2012). Unmet HOPWA Needs PY 2010-2011.
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