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Federal Leads Explore Intersection of HIV/AIDS and Housing Insecurity or Homelessness

NHAS Meeting, 1/24/11

Participants in the Federal leads meeting included (top row, L-R): David Vos of HUD; Dr. Maggie Czarnogorski of VA; and Dr. Howard Koh of HHS and (bottom row, L-R): Dr. Ron Valdiserri of HHS; Capt. M. Shriver of the DOJ; and David Rust of SSA.

Last Monday, January 24, 2011, representatives from the six Federal agencies designated by the President as lead agencies with responsibility for implementing the National HIV/AIDS Strategy (NHAS) reconvened as part of our ongoing efforts to work toward the Strategy’s goals and achieve a more coordinated national response to the HIV epidemic in the United States. During this meeting, we focused on the issues of HIV/AIDS and homelessness and housing insecurity. We began dialogue about how the agencies could enhance collaborative efforts to address the NHAS’ charge to us to improve housing security for people living with HIV/AIDS as a means to improve health outcomes for them.  The Federal Implementation Plan directs the nation to “Support people living with HIV and co-occurring health conditions and those who have challenges meeting their basic needs, such as housing.”

Participants included representatives from the Departments of Labor, Justice, Health and Human Services, Housing and Urban Development (HUD), and Veterans Affairs and the Social Security Administration. In addition, we were joined by several colleagues from the Department of Health and Human Services who deal with homeless issues at the Centers for Disease Control and Prevention, Health Resources and Services Administration (both the Community Health Centers program and the Ryan White program), and Substance Abuse and Mental Health Services Administration.


Participants shared their deep knowledge about their agency’s relevant programs and populations served, legislative mandates, local partners, and outcome measures. Each also came to listen and learn from one another so that we can identify opportunities to strengthen existing collaborative activities or, possibly, initiate new ones that will help us work toward realizing the Strategy’s goals.

Addressing the housing needs of people living with HIV/AIDS can be seen in the bigger context of ending homelessness in America.  A Federal report issued last summer, Opening Doors: Federal Strategic Plan to Prevent and End Homelessness, calls for a coordinated Federal response to homelessness and for the creation of a national partnership at every level of government and with the private sector to reduce and end homelessness in the nation while maximizing the effectiveness of the Federal government in contributing to the end of homelessness. Also supporting our efforts are the growing efforts at HUD to better coordinate housing services with positive health outcomes for beneficiaries.

Our discussion included examinations of efforts to address the housing needs of specific HIV/AIDS sub-populations including Veterans and formerly incarcerated individuals in addition to individuals receiving or in need of housing supports.

The Federal leads have agreed to continue our dialogue on this important issue over the coming weeks and months. Among the issues for further discussion are:

  • Developing joint strategies to encourage co-location/enhanced availability of HIV-related services at housing and other nontraditional HIV care sites.
  • Identifying ways to collaborate on policies and programs that increase access for PLWH to nonmedical supportive services (e.g., housing, food, transportation) which enable people living with HIV to obtain and adhere to HIV treatment as critical elements of an effective HIV care system. This will include ideas about how to engage and incentivize our State and local partners to move in this direction.
  • Considering opportunities to adopt government-wide definitions and, possibly, measures related to homelessness and housing insecurity that would better position the agencies to share information, identify both unmet need and gaps in knowledge, and more closely coordinate planning and programs
  • Opportunities to integrate housing security into the “12 Cities” project
  • Opportunities to integrate data and measures related to client-level housing status into both the statewide HIV/AIDS plans called for in the NHAS and as requirements in relevant Federal grants to State and local agencies.
  • Identifying Federal partners and grantees at the State and local levels who are engaged in both housing services and HIV/AIDS prevention and care (i.e., recipients of Federal funds and technical assistance on both issues)

Please help inform our ongoing discussion of this important issue. How does your community support housing assistance and other services that enable people living with HIV to obtain and adhere to HIV treatment? What gaps in service or unmet need have you observed that we should consider in our cross-agency planning?  How can we do a better job of coordinating housing and other critical support services for people living with HIV/AIDS? Share your thoughts in the Comments section below.

Together, we are working to identify ways we can improve health outcomes for people living with HIV/AIDS through preventing homelessness and reducing housing insecurity. Motivated by the NHAS and Opening Doors and inspired by the innovative and caring work of our State, local, and community partners, we can make significant improvements in both housing security and health outcomes for people living with HIV/AIDS across the nation.

Comments

  1. Thank you for the hard work you do. As a HOPWA/TBRA provider, I am aware that an estimated 2,400 people in the metro-Richmond area could use long-term rent assistance. I have 28 slots. My partner agency can serve about 250 for 21 weeks each with STRMU or short-term. These programs work! Hopefully, HUD will be able to expand them, provided the funding.
    Of concern also, is the emerging incidence of dementia in long-term HIV folks. At present, it is estimated that 63% of HIV clients who have had the virus 15+ years are experiencing dementia. 3 of my 28 do. We need to look at the possibility of assisted living for these people, perhaps going back to the group-home model like the hospice houses when HOPWA first began. Not that we’re ghettoing them to die, charnal houses. Just gentle compassion… Let’s not let it hit and play catch-up like we did in the late 1980’s.
    Many thanks,
    Mike

  2. As the Project Director for 3 federally funded (SAMHSA) Substance Abuse and HIV Prevention grants in the rural N.E.Counties of Alabama, I feel strongly that this fact finding, collaboration, and similar endeavours are crucial to the success of the goals of the “Strategy”.
    Although the South does not have the large metropolitan cities (and thus the “Power”) of other cities and states, we as a nation cannot continue to ignore the crisis of HIV/AIDS in the rural South! With NO public transportation, unbelievable poverty, no affordable housing options, lack of education, and paralyzing fear, stigma and discrimination, the Persons Living with HIV/AIDS, and the front line service providers exist in a state of desperation, often patching together services with, at best, limited resources and infrastructure.
    Budgets and formularies have to be based on the number of current HIV cases, STOP counting deceased persons when considering funding and budget decisions!
    Come down on any given day to our rural agency, operating out of a modular building (we call em “trailers”), drive 2 hours one way to pick up a patient for a medical appt., then drive them back home after a half day wait, because there are NO other providiers in a 9,000 sq. mile area!
    Deal with the housing, AIDS, substance abuse crisis as we need to deal with any other human disaster in our great nation! Emergency funding, attention to the needs of each geographical area, no cookie cutter approaches, and stop putting band-aids on a gushing arterial wound!
    There are many talented and compassionate agencies, providers, consumers, coalitions and advisory groups, and advocates willing to be a part of the solution. I choose to be optimistic, and stand willing to help.

  3. Thanks for this insight. From my understanding, homeless children are at risk for sexual exploitation within 48 hours in some cities. Do you see DHHS & DOJ joining hands to protect them and reduce HIV risk?
    In addition, foster care children appear to be at highest risk until their mid twenties. What intersectoral efforts could be instigated to help them?
    Thanks for your examination of this important topic

  4. Michael Kennedy says:

    It would help to enhance coordination if the funding sources were streamlined, rather than being siloed across different agencies. HUD-directed HOPWA funding is directed toward the city while HRSA-directed Ryan White funding is handled by the County. Greater customer service and efficiencies could be attained if there were one body leveraging resources, working from one comprehensive plan.

  5. Holly Argent Tariq says:

    PLWA and HIV continue to struggle with substandard housing and housing insecurity. As providers of skilled nursing services and adult day health care services we witness the desperation of residents seeking permanent housing after a nursing home stay and ambulatory clients moving from unsuitable drug infested sro’s to inadequate aprtments.
    The casemanagers and clinicians work collaboratively to explore the best in a series of bad housing options for our clientele. The lack of qualified AIDS Housing specialists leave many clients on a treadmill of homelessness and helplessness.
    Occassionally , the pieces come together and the client is successfully housed. But all too often the issues of mold on the walls, vermin, broken appliances and unsafe living conditions result in recurring mental health issues, medication adherence problems and recuurent homelessness.

  6. Jonathan Cole says:

    A focus group of consumer advocates living with HIV/AIDS and served by the Wellness Academy of Friends for Life in Memphis met to discuss the questions posed in this blog post on 2/2/11. The group applauded the Peabody House as a transitional and emergency housing resource for adults living with HIV/AIDS in Memphis. The program helps residents with medication management and scheduling as well as providing coordination and scheduling of medical appointments. Peabody House also promotes A&D recovery of its residents by referring them to programs provided by Serenity House. While Peabody House provides needed housing and casework services, consumers report that capacity does not meet current community needs. Peabody House has a waiting list with documentation requirements that make it difficult to be admitted to their program. Additionally, there are barriers for long term housing for many people living at Peabody House. Since PH is a transitional housing program, residents fear they will not be eligible for other long term housing assistance programs after leaving the PH program. Many consumers say that a criminal record often creates a barrier for admission to other long term housing programs. Other consumers say that it is harder for African American gay men to access housing services to the point of outright discrimination. Many say that women with children have an easier time finding housing options in the community. The above factors point to a need for long term housing options that provide coordinated services to persons living with HIV/AIDS.
    Consumers also cite a problem with Memphis emergency shelters that charge the homeless $5-$7 per night. These admission fees promote other social problems such as solicitation, panhandling, and robbery in the community.
    Consumers in the group also cited a need for better communication about available resources that benefit consumers among agencies that serve people living with HIV/AIDS. Consumers stated that case managers at different agencies are not always aware of community resources available to persons living with HIV/AIDS.
    Many consumers recognize HIV prevention and testing as a way to improve housing and healthcare outcomes. Too many people in the community are unaware of their HIV+ status. Undocumented HIV status is detrimental to long-term individual health and to efforts to allocate adequate resources for housing and healthcare programs based on HIV infection rate data in the community. Many people fear the stigma associated testing for HIV at the local Health Department, the Memphis Gay and Lesbian Community Center, Friends for Life or other agencies where HIV testing or other support services are provided. HIV testing at places not associated with HIV or the LGBT community attract more participation. Consumers applauded successful health fairs held at area churches in the past that provided a variety of health screenings including HIV testing. Such health fairs provided grocery store gift cards as incentives for participating in each offered screening (blood pressure, cholesterol, HIV, etc.). They encouraged more health fairs like the above to be held at churches, libraries and community centers.

  7. In our region of Southwestern Pennsylvania, many housing opportunities exclude services for individuals with criminal histories, or require people living with HIV to be clean and sober prior to entry. These mandates – often driven by funders – can create additional barriers to care for an already marginalized population. Harm reduction, including needle exchange, has been shown to be effective in engaging vulnerable populations into care but is not widely funded. This represents a significant gap in care.
    We have created a housing program that serves chronically homeless people living with HIV/AIDS, which is modeled on a harm reduction approach. Since 2006, The Open Door, Inc., (www.opendoorhousing.org) has served more than thirty individuals who are living with HIV/AIDS and have significant histories of homelessness, addictions, mental health diagnoses, and criminal activities. We recently completed a study that evaluated residents’ viral loads and found a statistically significant difference between residents’ baseline and follow-up viral load counts. More than two-thirds (69%) of our participant sample achieved undetectable viral load status, which compares to previous studies examining adherence among vulnerable and homeless populations that have found adherence rates ranging from 13-32%. Moreover, after accessing stable housing through The Open Door, our residents have been able to successfully engage in clinical and supportive services through traditional providers. The harm reduction housing approach is clearly feasible and effective, and we believe it can be replicated in other regions.

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