National Housing and HIVAIDS Research Summit

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National Housing and HIV/AIDS Research Summit

• Housing is the Foundation of
• HIV/AIDS Prevention and Care
• Sponsored by
• National AIDS Housing Coalition -
  www.nationalaidshousing.org
• Emory Center for AIDS Research -
  www.sph.emory.edu/CFAR

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Goal A Re-Visioned HIV/AIDS Housing Policy
Advocacy Agenda

• Make subsidized, affordable housing - including
  supportive housing for those who need it -
  available to all low-income people living with
  HIV/AIDS.
• Make housing homeless persons a top prevention
  priority, since housing is a proven HIV
  prevention strategy.
• Establish a national commitment to decent, safe,
  affordable and adequate housing as a right of
  every American.

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Homelessness HIV are Inextricably Linked

• Homelessness is a major risk factor for HIV, and
  HIV is a major risk factor for homelessness
• Studies have shown that from 3 to 10 of
  homeless persons are HIV (10 times the rate
  among general population)
• 40 to 60 of all PLWHA have lifetime experience
  of homelessness or housing instability

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Housing works to

• Reduce HIV/AIDS transmission
• Facilitate access to medical care
• Improve health outcomes
• Reduce harmful drug use, violence, incarceration
  and other public and private harm
• Save taxpayer dollars
• Protect and stabilize individuals, families and
  communities

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Housing is HIV/AIDS Prevention

• Recent research shows a direct relationship
  between housing status and risk behaviors among
  extremely low income HIV persons with multiple
  behavioral issues
• Recent hard drug use was 4 times higher among
  homeless persons
• Sex exchange was 4 times higher among homeless
  persons
• Homeless persons were 6 times more likely to
  engage in high risk sex
• Reduction in risk with improved housing status
  increase in risk when housing status worsened
• Research involving indigent women suggests that
  housing may be protective against HIV and other
  public health problems (controlling for other
  variables)

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Housing is HIV/AIDS Prevention

• Access to housing increases access to
  antiretrovirals, which lowers viral load and may
  reduce the risk of transmission
• Analyses have demonstrated the cost-effectiveness
  of of behavioral prevention interventions the
  cost of interventions is dwarfed by the savings
  realized through prevented infections - need same
  analysis of housing intervention
• Estimated lifetime medical treatment cost of
  each new infection is 155,000 to 195,000
• 25 of persons with HIV/AIDS who do not know
  they are infected
• Are transmitting at a 8.5 to 11 rate per year -
  compared to 1.7 to 2.5 for persons who are
  aware of their status

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Housing is Health Care

• Provision of housing is an important structural
  intervention to improve access to care, ongoing
  engagement in care, and treatment success
• Persons who are HIV and outside of any medical
  care are 4 times more likely to enter into health
  care if they have housing
• There is accumulating evidence that improved
  housing is associated with improved medical
  outcomes for formerly homeless persons with HIV
• Lower viral loads
• Reduced mortality
• Improved health and social functioning

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Housing is Health Care

• There is no evidence to support withholding
  antiretroviral treatment based on housing status
• Housing improves adherence, and improved
  adherence is associated with improved health
  outcomes (including lowered viral load)
• Even a low level of adherence results in
  prolonged life, without increasing the risk of
  resistant strains

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Evidence we still need

• Standardized definitions across fields
• Housing status
• Treatment access
• Health care outcomes
• Demonstration of cost effectiveness of housing as
  a structural intervention
• Housing as prevention
• Housing as a component of primary care and HIV
  drug therapy

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Evidence we still need

• Mandatory collection of data on housing status in
  all funded research regarding HIV prevention and
  treatment and in all funded prevention and
  service interventions
• Measures of the impact of housing on individual
  and community quality of life

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Framing- data synthesis presentation

• Housing provides protection from exposure to a
  range of individual and public health threats,
  including HIV, violence, harmful drug use,
  incarceration
• Housing as a key component of re-entry
• How to counter the risky person model
• How to frame the need to house active users
• low demand
• housing first
• harm reduction housing

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Policy Challenges

• HIV/AIDS exceptionalism
• Competition for limited funding - on every level
  of government
• Refuting the predominate risky person model
• Documenting the cost-effectiveness of housing as
  a structural intervention
• Showing the impact on communities of homelessness
  
• Establishing communicating the independent
  effect or significance of housing as a
  structural intervention necessary to address
  existing priorities
• Disease prevention
• Health care treatment access and good outcomes
• Reduction of harm associated with drug use
• Successful re-entry following incarceration