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National Housing and HIV/AIDS Research Summit

National Housing and HIV/AIDS Research Summit. Housing is the Foundation of HIV/AIDS Prevention and Care. Sponsored by the National AIDS Housing Coalition www.nationalaidshousing.org. Acknowledgements.

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National Housing and HIV/AIDS Research Summit

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  1. National Housing and HIV/AIDS Research Summit Housing is the Foundation of HIV/AIDS Prevention and Care Sponsored by the National AIDS Housing Coalition www.nationalaidshousing.org

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. 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)

  16. 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

  17. 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

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