Housing Is Cost-Effective HIV Prevention and Care
Housing for people living with HIV/AIDS saves lives and money.
HIV housing interventions prevent costly new HIV infections, improve HIV health outcomes, reduce mortality, and decrease the use of expensive emergency and hospital services.
Action to meet HIV housing needs costs far less than inaction, and is a wise use of limited public resources.
Homelessness is expensive and deadly:
- People coping with homelessness are frequent users of expensive crisis services including shelters, jails, and avoidable emergency and hospital care.1
- People living with HIV/AIDS who are unstably housed lack ongoing HIV care and rely more on emergency and acute care. They have poorer health outcomes and don't live as long.2
- People with HIV who are homeless are 2 to 3 times more likely to use an emergency room and to have a detectible viral load than those in stable housing.3
Improved housing stability reduces overall public expense:
- Housing assistance for people with HIV who are homeless improves their health outcomes and dramatically reduces emergency and inpatient health services, criminal justice involvement, and other crisis costs.4
- More stable housing for people with HIV has been shown to reduce emergency medical visits by 35% and hospitalizations by 57%.5
- Housing assistance leads to savings in avoidable health services that more than offset the costs of the housing intervention.6
Housing assistance is a cost-effective HIV health care intervention:
- Savings in health care costs support public investment in housing for people with HIV -- even before taking into account the savings associated with reducing risk and preventing new infections.7
- Each new HIV infection prevented through more stable housing saves countless life years and over $300,000 in lifetime medical costs.8
- Housing assistance is a cost-effective HIV health care intervention for people with HIV/AIDS, with a "cost per quality-adjusted life year" in the same range as widely accepted health care practices.9
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
- Include housing as a key component of HIV health care
- Continue to collect the data needed to inform HIV housing policy
- City of Toronto, Shelter, Support, and Housing Administration (2009). Cost savings analysis of the Enhanced Streets to Homes Program; Flaming, D., Matsunaga, M., & Burns, P., for the Economic Roundtable (2009). Where we sleep: The costs of housing and homelessness in Los Angeles. Prepared for the Los Angeles Homeless Services Authority.
- Wolitski, R.J., Kidder, D.P., Pals, S.L., 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; Schwarcz, S.K., Hsu, L.C., Vittinghoff, E., Vu, A., Bamberger, J.D., & Katz, M.H. (2009). Impact of housing on the survival of people with AIDS. BMC Public Health, 9: 220; Kidder, D., Wolitski, R., Campsmith, M., 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; Aidala, A., Leae, G., Abramson, D., Messeri, P., et al. (2007). Housing need, housing assistance, and connection to medical care. AIDS & Behavior, 11(6)/Supp 2: S101-S115; Parashar, S., Rhodes, C., Chan, K., et al. (2010). Effect of viral load and housing on emergency department use in a cohort of persons on antiretroviral therapy in BC. Presented at the North American Housing and HIV/AIDS Research Summit V, Toronto, Ontario, June 2010.
- Wolitski, et al, 2010.
- Wolitski, et al., 2010; Buchanan, D.R., Kee, R., Sadowski, L.S., & Garcia, D. (2009). The health impact of supportive housing for HIV-positive homeless patients: A randomized controlled trial. American Journal of Public Health, 99/Supp 3: S675-S680; Sadowski, L., Kee, R., VanderWeele, T., et al. (2009). Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of the American Medical Association, 301(17): 1771-76; Flaming, et al., 2009.
- Wolitski, et al., 2010.
- Bauer, J., Battist, A, & Bamberger, J.D. (2010). Housing the Homeless with HIV in San Francisco. Presented at the North American Housing and HIV/AIDS Research Summit V, Toronto, Ontario, June 2010; Flaming et al., 2009.
- See, e.g.: Wolitski, R., Kidder, D. & Fenton, F. (2007). HIV, homelessness, and public health: Critical Issues and a call for increased action. AIDS & Behavior. 11(6)/Supp 2: S167-S171; Holtgrave, D., Briddell, K., Little, E., et al. (2007). Cost and threshold analysis of housing as an HIV prevention intervention. AIDS & Behavior, 11(6)/Supp 2: S162-S166.
- Schackman, B.R., Gebo, K.A., Walensky, R.P., et al. (2006). The lifetime cost of current human immunodeficiency virus care in the United States. Medical Care, 44(11): 990-997.
- Holtgrave, D.R. (2009). Housing as HIV prevention and care. Presented at the White House Office of National AIDS Policy HIV and Housing Consultation, December 17, 2009; Holtgrave, et al., 2007.
- Wolitski, et al., 2007.
- U.S. Centers for Disease Control and Prevention (2010). HIV/AIDS in the United States.
- Findings and recommendations from the Office of National AIDS Policy consultation on housing and HIV prevention and care, December 17, 2009. Available from the National AIDS Housing Coalition, Washington, D.C.
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