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

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Presentation on theme: "Housing and HIV/AIDS Housing is Prevention/Housing is Healthcare."— Presentation transcript:

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

2 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 Ackerman HIV/AIDS Consumer Advocate & NAHC Board Member

3 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.

4 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

5 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

6 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

7 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

8 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

9 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

10 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

11 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.

12 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.

13 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 AIDS  Latino men are 20.4 times more likely to die from AIDS.

14 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.

15 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.

16 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.

17 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

18 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.

19 AIDS Housing in CT CT AIDS Housing Directory CSH Housing Resource Directory geID=763

20 CT AIDS Resource Coalition For more information: Shawn M. Lang Director of Public Policy CT AIDS Resource Coalition 860.761.6699 Thanks to the National AIDS Housing Coalition’s Policy Toolkits for this information

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