National Housing and HIV/AIDS Research

Summit

Sponsored by theNational AIDS Housing Coalition

www.nationalaidshousing.org

Housing is the Foundation of HIV/AIDS Prevention and Care

Acknowledgements The National Housing & HIV/AIDS Research Summit is a project of the

Visioning Committee of the National AIDS Housing Coalition. The summit was hosted by the Emory Center for AIDS Research (

www.sph.emory.edu/CFAR), and supported by the efforts of Center Director Dr. David Holtgrave and Arnel Montenegro.

NAHC engaged Hilary Botein and Ginny Shubert from Shubert Botein Policy Associates (www.shubertbotein.com) to help plan and document the summit.

NAHC thanks the Emory University African American Alumni Association for providing meeting facilities at the Emory University Miller-Ward Alumni House.

NAHC gratefully acknowledges the financial support of the MAC AIDS Fund; Housing Works, Inc.; Broadway Cares; the Southern AIDS Coalition; the Corporation for Supportive Housing; the National Alliance to End Homelessness; the AIDS Foundation of Chicago; Gilead Pharmaceuticals; Bailey House, Inc.; Del Norte Neighborhood Development Corporation; AIDS Services of Dallas; CARES, Inc.; SAVE, Inc.; Gina Quattrochi in honor of Keith Cylar; Doorways Interfaith AIDS Residence; and Cassandra Ackerman.

Summit Background

First of its kind examination of the relationship of housing status to HIV prevention & treatment

Held June 11th & 12th, 2005 at Emory University in Atlanta, Georgia

Working session of a core group of homelessness & HIV/AIDS researchers and advocates to discuss policy implications of existing & proposed research

Community discussion among advocates, providers & consumers from across the country of the importance of policy that is informed by rigorous research

Participating Researchers

Convening Researchers: Angela Aidala, Ph. D., of the Center for Applied Public Health at

Columbia University & the Department of Sociomedical Sciences Dennis Culhane, Ph. D., of the Leonard Davis Institute of Health

Economics & the Cartographic Modeling Lab at the University of Pennsylvania School of Social Work

David Holtgrave, Ph. D., of the Rollins School of Public Health at Emory University

Participating Researchers: Martha Burt, Ph.D., of the Urban Institute’s Center on Labor,

Human Services & Population Carlos del Rio, M.D., of the Emory University School of Medicine Ernest Drucker, Ph.D., of Montefiore Medical Center/Albert

Einstein College of Medicine Elise Riley, Ph.D., M.P.H., of the University of California, San

Francisco/San Francisco General Hospital Suzanne Wenzel, Ph.D, of the Rand Corporation

Summit Result: 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.

Homelessness & HIV 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

Research refutes the “risky person model” by showing that unstable housing is more strongly associated with greater HIV risk than individual characteristics

Research shows that 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

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, violence and other public health problems

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 behavioral prevention interventions; the cost of interventions is dwarfed by the savings realized through prevented infections

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

Housing is Health Care

Provision of housing is an important structural intervention to improve access to care, ongoing engagement in care, and treatment success

Being homeless is a barrier to starting outpatient care, staying in care and starting ART

Persons who are HIV+ and outside of any medical care are 4 times more likely to enter into health care if they have housing

Housing is Health Care The all-cause death rate among homeless

HIV+ persons is 5.3-8 deaths per 100 person years compared to 1-2 for HIV+ persons who are housed

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

Access to ART by Homeless Persons

Recent research among homeless persons has found no evidence to support withholding antiretroviral treatment based on housing status Even a low level of adherence results in prolonged

life, without increasing the risk of resistant strains Importantly, however: improved housing status

improves adherence, and improved adherence is associated with improved health outcomes (including lowered viral load)

Research Gaps: Evidence We Need

Standardized definitions across fields to facilitate data collection and analyses Housing status Treatment access Health care outcomes

Demonstration of the cost effectiveness of housing as a structural intervention (comparing the cost of housing with the cost savings from improved outcomes) Housing as prevention Housing as a component of primary care and HIV

drug therapy

Research Gaps: Evidence We 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

Ongoing Challenges: Effectively “Framing” (presenting) the Evidence

Housing provides protection from “exposure” to a range of individual and public health threats, including HIV, violence, harmful drug use, incarceration

Housing is a key component of re-entry from prison or jail

Housing research refutes the “risky person” model

Housing active users is critical & effective (“low demand” housing models; “housing first” models; “harm reduction” housing)

Ongoing Challenges: Key Policy Issues

HIV/AIDS exceptionalism - the need for HIV-specific resources

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 of homelessness on the life of

communities 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

Stay Tuned!

The National AIDS Housing Coalition will release a report of the results of the National Housing and HIV/AIDS Research Summit later this summer

To read more about the Summit, make sure you get a copy of the summit report, and to find out how to get and stay involved in advocacy efforts Go to www.nationalaidshousing.org Email NAHC at

nahc@nationalaidshousing.org