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INCREASE PUBLIC AND PRIVATE FUNDING FOR HIV HOUSING

Increase funds for HOPWA HIV/AIDS housing programs and care coordination and support initiatives; build support at all levels of government for strong and consistently accessible AIDS housing efforts.

Housing status itself has been shown to independently predict HIV risk and health outcomes, controlling for a wide range of individual (poverty, race/ethnicity, history of substance use, mental illness) and service use (primary care, case management, substance abuse and/or mental health treatment) characteristics.

This is an important finding, as it indicates that housing itself may improve the health of people living with HIV and AIDS (PLWHA) and reduce the spread of HIV. Identifying housing instability as a vector for HIV disease affords the opportunity to use housing policy as an effective new mechanism to control the HIV epidemic in the United States.

Contextual or structural factors such as housing status directly or indirectly affect an individual's ability to avoid exposure to HIV, as well as HIV-positive individuals' ability to avoid exposing others to infection, and to access and adhere to HIV care.

Until recently, individual-focused factors have been emphasized in HIV literature and practice, but behavioral interventions based on these assumptions alone have not been sufficient to achieve articulated national goals of substantially reducing new HIV infections, and reducing racial/ethnic disparities in HIV incidence. Effectively addressing disparities in HIV risk and health outcomes requires attention to structural explanations that acknowledge the role of housing and other social/contextual factors that determine health.

Indeed, a growing body of practice-based evidence shows that housing interventions work to enable homeless and unstably housed persons to achieve and maintain stability, and that for persons living with HIV/AIDS, improved housing status is directly related to reduced risk behaviors, improved access to health care, higher levels of ART adherence, lowered viral loads, and reduced mortality. Significantly, innovative “housing first” or harm reduction housing approaches appear to be just as effective in achieving these results as more traditional abstinence-based housing models for persons with chronic mental health and/or substance use issues.

Important new cost analyses indicate that the provision of housing is also a cost-effective prevention and treatment intervention for homeless and unstably housed PLWHA.

Cost-offset analyses have repeatedly demonstrated that supportive housing substantially reduces utilization of costly emergency and inpatient health care services, before taking into account the substantial costs associated with new HIV infections and delayed or inconsistent HIV care.

Housing intervention cost-per-client estimates are now available to answer HIV-specific affordability policy questions. These analyses indicate that housing interventions for homeless and unstably housed PLWHA are both cost-effective and cost-saving, making housing a sound investment of limited public resources.

HOPWA

The U.S. Department of Housing and Urban Development's Housing Opportunities for Persons with AIDS (HOPWA) housing assistance helps prevent homelessness and creates access to medical care and support services for individuals and families affected by HIV and AIDS. It is reported that one-third to one-half of those living with HIV/AIDS are homeless, incapable of affording their current housing, or at impending risk of homelessness.

In 2007, HOPWA funds 122 formula jurisdictions. The program provides assistance for an estimated 67,000 households affected by HIV/AIDS with assistance in the form of short-term and long-term rent, mortgage and utility payments, facility-based supportive housing and supportive services

The HOPWA program was flat-funded in the FY2007 budget at $286 million despite the reality that only a fraction of those living with debilitating and impoverishing HIV/AIDS and eligible for housing assistance receive.

Links and Resources

HUD HOPWA Program: http://www.hud.gov/offices/cpd/aidshousing/programs/

National AIDS Housing Coalition: www.nationalaidshousing.org

Care and Support for HIV/AIDS: http://www.fhi.org/en/HIVAIDS/pub/fact/carsupp.htm

Resource Library: HOPWA 101: http://www.ahc.org/resource_library/hopwa_101.html

Additional prevention and advocacy resources:

American Foundation for AIDS Research (amFAR)

CDC — Division of HIV/AIDS Prevention (DHAP)

Community HIV/AIDS Mobilization Project (CHAMP)

Sexuality Information and Education Council of the United States (SEICUS)

Harm Reduction Coalition (HRC)

National AIDS Housing Coalition (NAHC)