United States: Housing for People Living With HIV/AIDS
Part of the "More Than Just a Roof Over My Head" Booklet
The HIV/AIDS Epidemic
Approximately 1.1 million Americans are living with HIV/AIDS, with over 56,000 new HIV diagnoses each year. MSM account for 53% of PLWHA, while individuals infected through high-risk heterosexual contact and injection drug use account for 31% and 12% of PLWHA, respectively. Three men are infected for every woman infected, and AIDS is the leading cause of death for black women ages 25 to 34. Black people account for more HIV infections, AIDS cases, and HIV/AIDS related deaths than any other racial or ethnic group in the United States. While Latinos only account for 15% of the population, they represent 17% of all new HIV infections.
The Housing Crisis
AIDS housing experts estimate that about half of PLWHA in the United States -- over 500,000 households -- will need some form of housing assistance during the course of their illness. Housing is the greatest unmet service need for PLWHA. Approximately 72% of PLWHA have annual incomes below $30,000, while the National Low Income Housing Coalition's "Out of Reach 2010" reports that "assuming full-time, year-round employment, the 2010 national Housing Wage for a two-bedroom rental unit at the national average fair market rent of $959 is $18.44. This means that a household must earn the equivalent of $38,360 in annual income to afford a modest rental home." Therefore housing is simply not affordable for the vast majority of PLWHA in the United States.
Increasing evidence directs attention to the role of housing -- or lack of housing -- for the continuing HIV epidemic and associated health disparities in the United States. Housing status has been identified as a key structural factor affecting access to treatment and health behaviors among PLWHA, and research shows that receipt of housing assistance is associated over time with reduced HIV risk behaviors and improved health care outcomes. Housing is increasingly identified as strategic point of intervention to address HIV/AIDS and overlapping vulnerabilities associated with race and gender, extreme poverty, mental illness, chronic drug use, incarceration, and histories of trauma and violence.
Homelessness and unstable housing are strongly associated with greater HIV risk, inadequate health care, poor health outcomes and early death. Recent findings contribute significantly to the body of research showing strong and consistent correlations between housing status and health care access and outcomes among PLWHA. Investigators from two major multi-year studies -- the CDC's and HUD's Housing and Health (H&H) Study and the Chicago Housing for Health Partnership (CHHP) Study -- have released preliminary findings that link housing assistance to improved health outcomes for homeless and unstably housed PLWHA and other chronic health conditions, and show that public investment in housing not only improves health outcomes but actually saves taxpayer money. Findings show that homelessness and unstable housing are associated with increased rates of HIV sex and drug risk behaviors; that unstable housing increases HIV risk behaviors even among those at highest HIV risk; and that the association between lack of stable housing and greater HIV risk behaviors remains even among persons who have received risk reduction services. Significantly, persons with stable housing are less likely to engage in risky behaviors, and more likely to reduce risk behaviors, than their counterparts who are homeless/unstably housed.
Institutional Response & Solutions
The Housing Opportunities for Persons With AIDS (HOPWA) program, managed by the Department of Housing and Urban Development's Office of HIV/AIDS Housing, was established in 1992 to provide housing assistance and related supportive services for low-income persons living with HIV/AIDS and their families (earning 80% of area median incomes). Three types of grants are made under the HOPWA program:
Approximately 94% of households served by the HOPWA program achieve permanent housing stability. However, at current funding levels, HOPWA serves only about 58,000 households per year, reaching only about 30% of HOPWA-eligible households with housing needs.
On December 17, 2009, the White House Office of National AIDS Policy (ONAP) convened a consultation on the role of housing in HIV prevention and health care. In opening remarks, ONAP Director Jeff Crowley noted that housing had been a central theme of the fourteen community meetings held across the United States to gather input on the National AIDS Strategy, with housing repeatedly cited as a critical unmet need. He charged those present to provide concrete guidance on how housing should be reflected in the NHAS to order to advance its three primary goals: reducing HIV incidence; increasing access to care and optimizing health outcomes; and reducing HIV-related health disparities. Participants produced findings and recommendations that were submitted to ONAP.
"PLWHA need to be in a daily routine that includes nutrition, medication, rest and low levels of stress besides others. If these routines are not met because of housing, there is a big probability of failing treatment which may incur in developing resistance to meds, higher viral loads with increased rates of infection. Housing is a primary need for anyone, but for PLWHA it also means a public health policy concern."
Advocate testimony provided by Marcelo Maia of the Gay Men's Health Crisis. Photos provided by Kathie Hiers of AIDS Alabama and Larry Bryant of Housing Works, Inc.
Center for Disease Control and Prevention, HIV/AIDS Surveillance Report, 2007.
National AIDS Housing Coalition, Findings and Recommendations from the Office of National AIDS Policy Consultation on Housing and HIV Prevention and Care, 2010.
National AIDS Housing Coalition, Policy Paper from the Third Housing and HIV/AIDS Research Summit, 2008.
National Low Income Housing Coalition, Out of Reach 2010, 2010.
UNGASS Country Progress Report: United States, 2010.
U.S. Department of Housing and Urban Development, Office of HIV/AIDS Housing, 2010.
WHO, UNAIDS & UNICEF, Epidemiological Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response, United Kingdom, 2008.
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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