National Housing and HIV/AIDS Research Summit Sponsored by the National AIDS Housing Coalition ...
Transcript of National Housing and HIV/AIDS Research Summit Sponsored by the National AIDS Housing Coalition ...
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