The purpose of this document is to examine the relationship between HIV/AIDS and housing instability. Adequate housing is a human right and a necessary foundation to fulfill other rights and to enjoy a decent quality of life. While poverty is linked to poorer health outcomes and creates an environment of risk across the globe, HIV infection is prevalent among all socioeconomic classes, and HIV/AIDS exacerbates poverty and inequalities across the board. HIV prevalence in urban areas is 1.7 times the prevalence in rural areas, while HIV is most prevalent in the poorest region of the world: sub-Saharan Africa, where HIV/AIDS is most experienced in rural areas and where access to information and health services is limited.
Approximately 3.49 billion people (50.6% of the world's population) live in urban areas; one third of these residents are poor, while almost a quarter (827.6 million people) live in slums. In sub-Saharan Africa, 61.7% of the urban population lives in slums, followed by South-Eastern Asia (31%), Latin America and the Caribbean (23.5%), and North Africa (13.3%). Slums are characterized by poor sanitation and hygiene, unsafe water supply, malnutrition, insecure land tenure, and lack of access to basic health, transportation, and other public services. These conditions increase the risk of HIV infection and poor health outcomes related to AIDS-related complications and mortality.
Regardless of socioeconomic status, HIV/AIDS is inextricably linked to stigma and discrimination, which can impact family and community support, income and employment, and housing security. Forced evictions and job terminations due to discovery of HIV status not only violate human rights but also disrupt access to nutrition and medical regimes, which ultimately threatens the health and well-being of HIV-positive individuals. The United Nations Development Program explains, "The devastation caused by HIV/AIDS is unique because it is depriving families, communities and entire nations of their young and most productive people. The epidemic is deepening poverty, reversing human development achievements, worsening gender inequalities, eroding the ability of governments to maintain essential services, reducing labour productivity and supply, and putting a brake on economic growth. The worsening conditions in turn make people and households even more at risk of, or vulnerable to, the epidemic, and sabotages global and national efforts to improve access to treatment and care. This cycle must be broken to ensure a sustainable solution to the HIV/AIDS crisis."
Gender inequality and homophobia impact both housing security and HIV/AIDS risk, creating a double vulnerability for HIV-positive women and sexual minorities. Intimate partner violence and gender discrimination limit the ability of women to protect themselves against HIV/AIDS. The diminished likelihood of negotiating condom use, the limited capacity to make their own sexual decisions, and the general threat of violence has led to increased infection rates among women, who represent 58% of all HIV cases. The majority of the world's poor are women, and female-headed households suffer disproportionately from inadequate housing. Women's property and inheritance rights are often ignored, and they may be excluded from wills, housing financing, and other mechanisms that ensure their housing security. In many cases widows are evicted from their homes by their in-laws following their husbands' deaths from AIDS-related causes. As the Centre on Housing Rights and Evictions (COHRE) explains, "Gender discriminatory norms and traditional practices which limit or preclude women's access to housing, land and property, both generate and sustain the dire circumstances which underlie women's disproportionate susceptibility to HIV infection."
Men who have sex with men (MSM) are the group most at-risk of HIV infection across the globe, largely due to discriminatory laws and social stigma that drive MSM underground and out of reach from prevention, treatment, and care efforts. Homophobia also puts MSM at risk of forced evictions from family homes and exclusion from housing services, which makes MSM disproportionately represented among homeless populations.
Prison, migrant, and mobile populations have also been increasingly identified as vulnerable to HIV infection due to increased risk behaviors, stigma, and discrimination. As UNAIDS explained in its background paper for the 24th Programme Coordinating Board meeting in 2009, "The conditions under which people move -- and the ways they are treated throughout the migration cycle -- pre-departure, in transit, at destinations and upon return -- that most determine their vulnerabilities, which in turn affect their risks of acquiring HIV." Prisons are high-risk environments for HIV transmission not only for the prevalence of risky behaviors but also because of the prisons themselves, which are often overcrowded and limit access to adequate nutrition and healthcare.
Rooftops Canada asserts that "Efforts to ensure adequate housing for urban slum dwellers -- to secure tenure, inheritance rights, adequate water and sanitation, economic development -- address many of the vulnerabilities that relate to HIV/AIDS." For women, sexual minorities, and other vulnerable populations, the realization of housing rights may mitigate the impact of HIV/AIDS by combating stigma and discrimination, reducing dependency, and enhancing personal autonomy and economic security. Housing security eases the burden of care and support and optimizes health outcomes.
There is an urgent need for dialogue on poverty, housing instability, slums, gender-based property and inheritance rights, the economic impact of stigma and discrimination, mobility and migration, and food security and hunger as critical issues in global policy and program responses to the continuing AIDS crisis. International HIV/AIDS and housing activists urge our colleagues to unite to demand that adequate housing be an integral part of any HIV/AIDS public policy development and that housing be treated as an urgent matter.
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