Canada: Housing for People Living With HIV/AIDS
Part of the "More Than Just a Roof Over My Head" Booklet
The HIV/AIDS Epidemic
The number of people living with HIV is continuing to increase in Canada, from approximately 57,000 people living with HIV in 2005 to approximately 65,000 people living with HIV in 2008. Although some of this increase can be attributed to the fact that people with HIV are living longer thanks to modern antiretroviral therapy, the number of new HIV infections is not decreasing. In 2008 alone, there were an estimated 2,300 to 4,300 new HIV infections. An estimated 26% of people living with HIV are unaware of their HIV status.
Although men who have sex with men (MSM) have the highest rate of new HIV infections in Canada, women, persons from endemic countries and Aboriginal persons are at high-risk of contracting HIV. Aboriginal persons and persons from endemic countries are currently over-represented in the HIV epidemic in Canada, with incidence rates of 12.5% and 16%, respectively in 2008.
The number of new HIV infections from injection drug use (IDU) increased to 17% in 2008. Among Aboriginal people, IDU is the predominant HIV exposure category, representing 66% of new HIV infections in 2008. IDU is also an increasing exposure category among women, increasing from 27% of new infections among women in 2005 to 29% in 2008.
The Housing Crisis
Over 13% of urban Canadian households were deemed to be in core housing need in 2005 (based on the definition of acceptable housing as that which is in adequate condition, of suitable size, and affordable). This problem is even more acute in the Aboriginal population, where 20.4% of Aboriginal households were in core need in 2006. Affordability, adequacy and suitability are all key issues of concern. The housing problem among Aboriginal people has led to increased susceptibility to various health concerns, such as tuberculosis and influenza.
In Ontario, almost half of people living with HIV or AIDS have problems with housing, as determined by the Positive Spaces Healthy Places (PSHP) research study. This study found that housing instability puts PHAs at risk for concerns related to safety, security and social exclusion. These issues are exacerbated by key social determinants of health that negatively impact the mental health of people living with HIV. These issues are more acutely experienced by people living with HIV of Aboriginal, African and Caribbean descent as a result of racism and the long term impacts of colonization. According to PSHP, women are also particularly vulnerable to housing instability. In the PSHP study, women living with HIV had a 15% lower monthly income then men, their housing costs were 20% higher than men, they were 40% less likely to move than men and they are three times m ore likely to be unstably housed than men.
HIV and AIDS and housing instability often go hand-in-hand. Housing discrimination within the current system is a major area of concern for people living with HIV. There is a growing consensus among AIDS service organizations, researchers, front-line workers, and policymakers that housing is a key factor affecting the health and well-being of people living with HIV. Affordable, safe, supported, and stable housing can help mitigate the effects of poverty, stigma, and illness.
Institutional Response & Solutions
Funding for supportive and rent-geared-to-income housing is a provincial jurisdiction and varies from province to province. At the provincial level, AIDS service organizations are at various stages of working with provincial housing ministries to increase the housing options available to people living with HIV. An Ontario-focused housing and health symposium identified key research priority areas. The Prairie Regional Health and Housing Symposium called for on-going research, engagement of policy and decision-makers, and increasing cooperation across sectors. Lead by COCQ-SIDA and the Canadian AIDS Society, a research initiative bringing together universities, community researchers, housing providers and AIDS service organizations is being planned in Quebec.
At the Federal level, several policy initiatives make the connection between housing and HIV and call for action. The Federal Initiative to Address HIV/AIDS in Canada calls for federal agencies and departments involved with housing to be more engaged in the national HIV/AIDS responses. Leading Together: Canada Takes Action on HIV/AIDS (2010) lists adequate and affordable housing as one of the complex needs of people living with HIV. It calls for greater government investment in this area, as well as increased partnerships within the health care system and beyond, including those individuals, organizations and agencies who are involved in housing. The Canadian Aboriginal AIDS Network is developing a five year national strategy on HIV/AIDS and housing for Aboriginal communities. Bring Me Home: The Canadian AIDS Society's Position on Housing and HIV/AIDS calls for the development of a national strategy for housing and HIV/AIDS. It has committed to reviewing national and international housing strategies to compile effective policy recommendations for a Canadian initiative.
Advocate testimony provided by Melanie Mayoh of the Ontario HIV Treatment Network.
Bekele T. et al, Direct and indirect effects of social support on health-related quality of life among persons living with HIV/AIDS: Results from the Positive Spaces Healthy Places Study (submitted), AIDS Care, 2010.
Canadian AIDS Society, Bring Me Home: The Canadian AIDS Society's Position Statement on Housing and HIV/AIDS, 2009.
Hill, Charles W, Aboriginal Housing in Canada: An Informal Background Discussion Paper, Canadian Aboriginal AIDS Network, 2010.
Public Health Agency of Canada, Surveillance and Risk Assessment Division, Summary: Estimates of HIV Prevalence and Incidence in Canada, 2008, 2009.
Rooftops Canada and Interagency Coalition on AIDS and Development, HIV, AIDS and Housing Issues, 2010.
Ticknor, Jann and Belle-Isle, Lynne, HIV and Housing: Toward a National Housing Strategy, Canadian AIDS Society, 2010.
This article was provided by National AIDS Housing Coalition. Visit NAHC's website to find out more about their activities and publications.
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