May 8, 2012
Is housing and HIV connected? You bet it is. Photo credit: HousingWorks.org.
Hello there! This Examiner has been on a bit of a hiatus thanks to a writer's block. I am happy to report that it is over. What's new? A study from the researchers at the University of California in San Francisco about HIV and homelessness. AIDS advocates have been screaming for years that housing is treatment. Who can forget the stunning piece about a homeless HIV positive woman named Crystal that was published last year for CNN? Now yet another study has been published that further proves their point. The study was published in the April 25th issue of PLoS One.
Researchers followed a cohort of 288 HIV positive men in San Francisco who reported being homeless. They were recruited from homeless shelters, free meal programs, and single occupancy hotels for people who live on low incomes. The study lasted for six years. The researchers found that out of all the participants only 58 or one fifth of the men were actually taking their antiretroviral medications. One third of the participants reported currently having symptoms of chronic illness. The three biggest barriers to treatment that the men listed were not having stable housing (including food and hygiene), lack of family and/or social support, and drug use. Dr. Elise Riley, principal investigator and Associate Professor in the UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center, stated that the inability to meet subsistence needs has a negative effect on health. "This study shows that a simple focus on providing medications will neither effectively treat nor end HIV in inner cities. A person's ability to get needed care and take medications becomes less of a priority when they don't have food or a place to sleep. If we could improve opportunities for people to meet their basic subsistence needs, in tandem with providing antiretroviral therapy, we could improve patients' health and better realize the potential gains to public health." Medication adherence not only lowers an infected patient's viral load and prolongs their life but it also makes them less contagious and thus reduces the infection rates.
So what does this mean in terms of ending the epidemic? Simply put, if you want to make a difference in the fight against HIV, you zone in on only giving out condoms and medication. Housing, unemployment, substance abuse, mental health and many other factors must be included in an effective, comprehensive plan. Clearly there is more to this battle than safe sex practices and affordable healthcare (although those things are still very critical). Stigmatized homeless people who are infected with HIV have more pressing issues on their minds than managing medications. They need a stable place to live and regular, commensurate income. What this Examiner wants to see now is how their drug use and their mental health issues are addressed. Would effective substance abuse treatment and counseling for depression further help with medication adherence? I think it would but I am no expert. I'm just an observer advocating for treating the entire patient over the long haul and not settling for a quick fix.
For more information about this study, click here. If you want to see local AIDS housing advocacy in action, check out Housing Works and National AIDS Housing Coalition. Both organizations have offices in Northwest D.C.