We know housing is healthcare. Having a stable home is closely linked to successful HIV outcomes. “With safe, decent, and affordable housing, people with HIV are better able to access medical care and supportive services, get on HIV treatment, take their HIV medication consistently, and see their health care provider regularly. In short: the more stable your living situation, the better you do in care. (HIV.gov 2020)” A CDC report estimated that 3.4% of homeless people were HIV positive in 2006, compared to .4% of the general population (National Homeless 2009).
Some resources are available. Housing Opportunities for Persons With AIDS (HOPWA) is the only Federal program dedicated to the housing needs of people living with HIV/AIDS. Under the HOPWA Program, HUD makes grants to local communities, States, and nonprofit organizations for projects that benefit low-income persons living with HIV/AIDS and their families. HOPWA funds may be used for a wide range of housing, social services, program planning, and development costs. These include, but are not limited to, the acquisition, rehabilitation, or new construction of housing units and costs for facility operations, rental assistance, and short-term payments to prevent homelessness.
But these funds do not come close to covering the need for housing for those affected by HIV. Other housing programs are available, including public housing, the Section 8 Housing Choice Voucher Program, housing opportunities supported by Community Development Block Grants, the HOME Investment Partnerships Program, and the Continuum of Care Homeless Assistance Program. But many have multi-year wait lists, because anyone else in need of housing is also trying to access these programs.
Last year, Aadia Rana MD and Joe Metmowlee Garland MD did a retrospective analysis (January 2011 — December 2015) of all patients at The Miriam Hospital Immunology Center in Providence. It evaluated the housing status of all their patients — categorizing two housing factors:
- Unstably Housed: emergency shelters, sleeping in places not meant for human habitation, or relocating at least once during the year between temporary situations (staying with friends/family)
- Stably Housed: Living in apartment or house with or without supportive services
20% of patients entering into care there were unstably housed — similar to the national average. The analysis investigated those factors on two health outcomes: Retention in HIV care and Viral Suppression. In 2015, 38.5% of unstably housed people were not retained in care, compared to 13.5% of stably housed people weren’t. So stable housing clearly has a dramatic impact on whether or not someone can maintain access to care.
The analysis goes on to look at viral suppression, comparing patients that were housing stable and those that were not. Viral suppression is when people with HIV who take HIV medicine as prescribed and get tests that do not detect a significant amount of the virus in the body. And as you can see from the graphs above, not having stable housing corresponds with significant challenges to suppressing the virus.
Despite very limited resources, there is really great working being done by dedicated organizations like AIDS Project Rhode Island. We had an opportunity to chat with Anthony Faccenda Program Supervisor at APRI. Please check out the video below:
We highly recommend that you checkout AIDS Project Rhode Island’s gallery event. To commemorate World AIDS Day 2020, they invited individuals living with and affected by HIV in Rhode Island to share their feelings and stories with the community at large through creative endeavors.
