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Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare
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Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Dec 15, 2015

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Ayanna Halman
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Page 1: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Housing and HIV/AIDSHousing is Prevention/Housing is Healthcare

Page 2: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Housing and HIV/AIDS

“It would seem like a no-brainer to me that you need a roof over your head to maintain your health.”

Cassandra AckermanHIV/AIDS Consumer Advocate &NAHC Board Member

Page 3: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Housing is HIV Prevention

Housing provides a strategic point of intervention

• Over time, studies show a strong association between change in housing status and risk behavior change

• Over time, persons who improved housing status reduced risk behaviors by half; while persons whose housing status worsened over time were 4 times as likely to exchange sex for money, food, drugs or housing.

• Access to housing also increases access to appropriate care and antiretroviral medications which lower viral load, reducing the risk of transmission.

Page 4: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Unstable housing adds to HIV risk

• Rates of HIV infection are 3 -16 x higher among persons who are homeless or unstably housed compared to similar persons with stable housing

• 3% to 14% of all homeless persons are HIV positive (10 times the rate in the general population)

• Over time studies show that among persons at high risk for HIV infection due to injecting drug use or risky sex, those without a stable home are more likely than others to become infected

• Harm reduction or other prevention interventions are much less effective for participants struggling with housing issues

Page 5: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

HIV infection- A Major Risk Factor for Housing Loss

• Up to 50% of all PLWHA report a lifetime experience of homelessness or housing instability

• 10% to 16% of all diagnosed PLWHA are literally homeless - sleeping in shelters, on the street, in a car, or in an encampment

• Twice as many have housing problems, experience housing insecurity or threat of housing loss

• Rates of housing need remain high – as some persons get their housing needs met, others develop housing problems

Page 6: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Housing & Risk Behaviors

• Research shows a direct relationship between housing status and risk behaviors

• Homeless or unstably housed persons were 2 to 6 X more likely to use hard drugs, share needles or exchange sex than stably housed persons with the same risk group, demographic, health, and service use characteristics

• There is an apparent “dose-relationship” with the homeless at greater risk than the unstably housed, and both of these groups at greater risk than the stably housed

Page 7: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Housing and Health Outcomes

• High viral load, recent opportunistic infection, and hospitalization for HIV related disease are associated with homelessness/ unstable housing

• Homeless/unstably housed PLWHA have higher rates HCV, other co-morbidities

• Mortality studies: All-cause death rate among homeless PLWHA is 5 X the death rate for housed PLWHA

• Among homeless, death rate due to HIV/AIDS is 7 - 9 X the death rate due to HIV/AIDS among the general population

Page 8: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Summary

• HIV positive persons with unstable housing are more likely to engage in sex and drug risk behaviors, are less likely to be engaged in appropriate medical care

• Overtime analyses show improvement in housing situation is associated with reduction in risk behaviors and positive change in medical care outcomes

• Findings suggest that the condition of homelessness/unstable housing, and not simply traits of individuals with housing problems, influences risk behaviors and connection to HIV medical care

• Provision of housing is a promising structural intervention to reduce the spread of HIV as well as improve the lives of infected persons

Page 9: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

CHHP preliminary results show housing saves lives & money

• Preliminary data indicate 70% of clients provided housing were housed at 18 months, compared to only 15% of the “usual care” group.

• Housed participants remained stable despite high rates of mental illness (46%), substance use (86%) & other factors thought to affect ability to stay housed.

• Housed group used half as many nursing home days as usual care counterparts & were nearly two times less likely to be hospitalized or use ER

• $12,000 average annual cost of supportive housing & coordinated care

• Preliminary cost estimates show annual medical expenses for housed group may be at least $900,000 less than usual care group, after subtracting the costs of housing intervention

Page 10: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

H&H Preliminary Results: Housing = Health

Significant improvements in housing status in both “intervention” and “customary care” study arms at 18 months

– 82% of voucher recipients stably housed - up from 4% at baseline– 52% of control group stably housed - up from 4% at baseline

Significantly, as housing improved for the group as a whole, so did health outcomes, including:

– 34% reduction in emergency room visits– 21% reduction in hospitalizations– 44% reduction in reported opportunistic infections– 40% reduction in sex trade– Significant improvement in mental health status

Page 11: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

HIV and Homelessness

In 2007:• 455,636 persons living with AIDS in the United States. In the 34 states

that report HIV, 571,378 persons were HIV infected. • According to the CDC, 56,000 people became infected with HIV in

2006 in the U.S., a 40% increase than previous estimates. • 216,624 people with HIV/AIDS with incomes of 30% of area median

income or less are in need of housing assistance.

The National Alliance to End Homelessness estimates that without the infusion of $1.5 billion for homelessness prevention and rapid re-housing included in the American Reform and Recovery Act, an approximately 1.5 million additional Americans will become homeless in 2009 and 2010.

Page 12: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

HIV/AIDS in CT

As of December 31, 2009:•10,574 people are reported living with HIV/AIDS. •DPH estimates that approximately 13,385 people are infected in Connecticut.•In 2009 18% of newly reported HIV infections in Connecticut occurred in people between the ages of 13 -29.

Page 13: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

HIV/AIDS in CT

HIV/AIDS cases continue to be diagnosed at higher rates in Blacks and Hispanics (67%)•Sexually active young people do not get routinely tested for HIV. This means most of them were infected in their teens or early twenties.African-American men are 30.9 times more likely to die from AIDSLatino men are 20.4 times more likely to die from AIDS.

Page 14: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

AIDS Housing in CT

•Since the first program opened its doors in the mid-1980s, the agencies have housed thousands of men, women and children who otherwise would have been homeless.

•Some are actual houses, others are independent apartments, some care for the physically fragile while others care for the socially fragile.

•Each has its own personality and characteristics, but all strive to ensure that persons living with AIDS are provided with the highest quality housing and support services available.

Page 15: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Demand for and Utilization of AIDS Housing

In 2009:• The 27 AIDS housing programs provided housing and

support to 1,300 men, women and children. • 95% of the 2,500 people requesting housing were turned

away. • The Point in Time Count of people who are homeless, 6%

reported as having HIV/AIDS, and in Hartford and New Haven the percentage was 15% and 8%, respectively. Due to self-reporting, it’s likely that these figures are, in reality, much higher.

Page 16: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Barriers to affordable, supportive housing

• Long waiting lists for affordable housing, including rent subsidies.

• In CT, nearly 50,000 people applied for less than 1,500 AVAILABLE rent subsidies.

• Low vacancy rates.• Unrealistic FMRs.• Lack of assistance in finding housing, transportation and

childcare.• Source of income and other forms of discrimination.

Page 17: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

Funding Sources for AIDS Housing

Federal• The Obama administration's proposed HOPWA budget for

2011 is $340 million, a $5 million increase over last year

• NAHC strongly recommends that HOPWA be funded at $410 million in FY11

• CT receives 4 “pots” of HOPWA funds:- Hartford EMA- New Haven EMA

- Bridgeport EMA (Fairfield County)- Balance of State

Page 18: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

State Funding

State Funding

• In the Department of Social Services budget, the State of CT currently has $ allocated to “Residences for Persons with AIDS”. The breakdown of those funds is:

$ state dollars $4.187 m

$ TANF/SSBG dollars $861,555

• In CT, combined with HOPWA funds, there is nearly $7 million dollars in funds dedicated to housing for people with HIV/AIDS

• In 2008, we were able to get an increase of $750,000 which allowed the addition of over 50 new units of housing in un- or underserved areas of the state.

Page 19: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

AIDS Housing in CT

CT AIDS Housing Directory

http://www.ctaidscoalition.org/guide.htm

CSH Housing Resource Directoryhttp://www.csh.org/index.cfm?fuseaction=Page.viewPage&pageID=763

Page 20: Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare.

CT AIDS Resource Coalition

For more information:Shawn M. Lang

Director of Public PolicyCT AIDS Resource Coalition

[email protected]

Thanks to the National AIDS Housing Coalition’s Policy Toolkits for this information