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Housing = Prevention. Housing Saves Lives January 21, 2010

Posted by Anita Balan in Blogging, Environmental Health, Mental Health, Prevention, Wellness.
Tags: , , , , , , ,

If you are resident of Metro Washington, and interested in DC’s health issues, you would have come across a series of expose articles in Washington Post entitled – Wasting Away: The Squandering of D.C. AIDS dollars. Washington D.C has the nation’s highest prevalence of HIV at 3%. Currently there are over 440 homeless people living with HIV/AIDS (PLWHA) in the district. These people are on the waitlist of Housing Opportunities for People with HIV/AIDS (HOPWA) program – a federal program that was introduced in 1992 that allocates funds for subsidizing temporary and long-term stable housing for PLWHA. Affected people and their families could wait for several years before they are given a voucher. The waiting time is much longer for those who pursue public housing accommodations through section 8.  The expose articles were followed by a series of tug-of-war between the D.C. City Council, the Mayor’s office and federal department of Housing and Urban Development which manages the HOPWA program. HUD which initially threatened to withhold all of D.C. 12.2 million dollars, until D.C. got its act together, has now withdrawn its threat. But in the midst of this heated debate, what was absent was raising awareness and sharing the importance of HIV and Housing.

More after the jump

In the recent years, providing a stable long-term housing for PLWHA and their families is an important component of HIV prevention, management and care both from human rights and public health perspective. According to the National AIDS Housing Coalition since 1992, when the HOPWA program was created, numerous peer-reviewed studies have clearly shown that housing assistance over time is associated with:

  • Improved housing status and reduced HIV risk,
  • Improved access to HIV medical care and
  • Reduced associated health disparities.

These also align with the three priorities of National AIDS Strategy :

  • Reducing HIV incidence
  • Increasing access to care and optimizing health outcomes
  • Reducing HIV-related health disparities

Homeless and unstably housed people are extremely vulnerable to HIV infection. HIV infection rates among homeless or unstably housed people are three to sixteen times higher than that of the general population. Conversely, three to ten percent of all homeless people are HIV positive. People Living with HIV/AIDS (PLWHA) are also subject to discrimination, loss of income, violence, and illness due to unsanitary conditions. A staggering 70% of all PLWHA report a lifetime experience of homelessness. Randomized control trial studies have shown that housing PLWHA has led to fewer hospitalizations, fewer hospital days and fewer emergency department visits. Other studies have shown that homeless PLWHA who obtain supportive housing have an 80% reduction in mortality and are twice as likely to have an undetectable viral load within 12 months. Additionally, housing for PLWHA is an effective prevention strategy that would have a powerful impact on the entire metro Washington community. People who improved their housing status reduced risk behaviors by half, while people whose status worsened were four times as likely to exchange sex. The above statistics were pulled together from NAHC FACT sheets that can be found here .

Of course, the biggest concern for providing adequate housing for all PLWHA within a community is cost. But according to a 2007  cost and threshold analysis study conducted by Dr David Holtgrave at Johns Hopkins University showed that housing can not only be a cost-offsetting investment but also a cost-saving investment for the government. This includes $300,000 of lifetime medical costs savings for each new HIV infection prevented.  Additionally, another Harvard University multi-site evaluation study, published in AIDS and Behavior in 2005,  ‘housing is a promising structural intervention to reduce the spread of HIV’.

In the words of J’mia Edwards, an HIV positive resident of D.C., a mother of two and an outreach worker on HIV/AIDS, “…if I don’t have adequate housing, I’m not gonna worry about taking my medication…a part of my prevention is my housing.”  Housing helps positive individuals adhere to their medications, because of basic facilities like refrigeration, and protects them from opportunistic infections like Pneumocystis Pneumonia (PCP) during colder weather conditions. It is for people like J’mia, who has since found stable housing through HOPWA program, and hundreds of others in our Nation’s Capitol that we need to spread the word about HIV and housing.

Currently there are a handful of organizations in the district that are dedicated to raising awareness of housing for PLWHA: National AIDS Housing CoalitionHousing WorksDC Fights Back, and Positive Places, a committee within the Metro Washington Public Health Association, that is dedicated to advocating for ending the waitlist for the 440 people in D.C. waiting for a home.



1. Gretchen Giannelli - January 29, 2010

Anita, I find it sad and ironic that Washington DC, the capital of the free world, which some of the richest, most inflential people call home, is also the capital of the poorest and sickest.

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