Housing and AIDS Prevention and Health Care

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Housing and AIDS Prevention and Health Care

• National Health Care for the Homeless
• Conference
• Phoenix June 2008

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It would seem like a no-brainer to me that you
need a roof over your head to maintain your
health

• Cassandra Ackerman
• AIDS Consumer Advocate and NAHC
  Board Member

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NAHC Housing Research Summit Series

• Unique venue for presentation and discussion of
  research findings relevant to housing and health
  policy
• Regular forum to gather share what we know
  about housing and HIV/AIDS prevention and care

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Summary of Findings Summits I II III

• Research shows strong correlations of
  homelessness to greater HIV/AIDS risk, poor
  health outcomes for PLWHA, and early death

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Summary -

• The is a strong correlation between improved
  housing status and
• Reduction in HIV/AIDS risk behaviors
• Access to medical care
• Improved health outcomes
• Savings in taxpayer dollars

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Summary -

• There is a growing recognition of the role of
  structural factors, like decent housing and
  access to health care, that impact AIDS
  prevention and healthier lives

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Yet, Greatest Unmet Need

• 1.1 million PLWHA in the United States - half
  (500,000) will need housing assistance during
  their illness
• National research shows that housing and access
  to health care are the greatest unmet service
  needs of PLWHA

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Presentation

• What the research in general shows
• The Chicago HH Model of
• Supportive Housing -

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Research Findings

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Citations for Research Findings

• Not quoted in this Power Point Presentation
• Available in Workshop Handouts
• Presentation avoids information overload

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Homelessness Is a Major Risk Factor for HIV/AIDS

• Prevalence of HIV/AIDS in homeless persons is up
  to 9 times higher than for those in stable housing

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HIV/AIDS Is a Major Risk Factor for Homelessness

• Up to 60 of all PLWHA report a lifetime
  experience of homelessness or housing instability
• Up to 16 of PLWHA are homeless in some
  communities

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Housing Can Be a Matter of Life Death for PLWHA

• Death rate among homeless PLWHA is 5 times higher
  than for housed PLWHA
• Homeless PLWHA are 3 times as likely to be
  outside medical care than housed PLWHA

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Housing Status Associated with HIV/AIDS Risks

• A recent study reported reductions in rates of
  sex and drug risk behaviors among homeless and
  unstably housed PLWHA whose housing status
  improved compared to those whose housing did not
  change

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Housing Status and LowerViral Loads

• Studies with PLWHA show housing was associated
  with higher CD4 counts and lower viral loads
• Lower viral loads can reduce the risk of
  transmission

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Housing Improves Access to Health Care

• Studies show that housing stability is associated
  with improved access to health care
• Homeless or unstably housed PLWHA whose housing
  status improved
• - 5x more likely to keep medical appointments
• - 6x more likely to be receiving
  antiretrovirals

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Structural Factors Key in Prevention and Care

• Initial Findings suggest that condition of
  homelessness, and not simply personal traits and
  habits, influence risk behaviors and health
  service utilization
• Need to move beyond the risky person paradigm
  toward risky contexts in HIV/AIDS prevention
  and care

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Housing Associated withHealth Outcomes

• Stable housing for PLWHA found to be related to
  improved HAART participation and adherence
• Studies have shown that housing is associated
  with better health as indicated by CD4 counts and
  viral loads

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HUD/CDCHousing Health(HH) - Chicago
Model

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18-Month Study

• Summer 2004 to Winter 2006

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Study Goal Assess the ability of AIDS housing
to reduce the risk of HIV transmission and
improve the health of persons living with
HIV/AIDS
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Random Control Trial

• Housing Group HH funded rental assistance /
  prevention education
• Customary Care Group No HH funded rental
  assistance / usual and customary care in the
  community / prevention education

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Study Sites

• Baltimore 210 participants
• Chicago 210 participants
• Los Angeles 210 participants

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Chicago Site

• Overview of Project

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Intervention Design

• Supportive Housing
• Intensive Case Management 151
• Housing First approach
• Harm Reduction models

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Participants

• HIV and Adult
• Able to live independently
• Homeless or
• At Imminent Risk of Homelessness

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Participants
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Funding Sources

• HOPWA Formula
• HOPWA SPNS Grant
• Ryan White Part A and B
• State Dept. of Human Services

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Systems Integration

• Five supportive housing providers
• AFC as Lead Agency
• Monthly meetings of case manager and housing
  advocacy teams
• Regular meeting of agency directors

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Service Teams

• Intervention Group (105) had
• HOPWA Housing Advocate or
• Case Manager
• Agency Program Supervisor
• HOPWA LTRS voucher

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Service Teams

• Highly Vulnerable Participants were assigned
• 55 of 105
• Intensive Case Manager
• Agency Program Supervisor

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Service Teams

• More Stable Participants were assigned
• 50 of 105
• Ryan White Case Manager
• HOPWA Housing Advocate
• Agency Program Supervisor

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Outcomes

• Reached housing after voucher award (fall 2004)
• 79 - 30 to 90 days
• 22 - 91 to 120 days
• 3 - 120 days

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Outcomes

• Still housed in 2007
• 90 in rental units
• 4 living with family
• 6 deceased / 3 in prison
• 1 in half-way house
• 1 disengaged

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Challenges

• Participants using substances followed by
  disruptive behavior
• Participants with personality disorders with
  disruptive behavior

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Challenges

• Illegal and criminal activity in rental units
• Housing providers losing some landlords
• Others

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Research Outcomes - CDC

• Fall 2008
• Spring 2009

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Stay Connected!

• To learn more about the Summit Series and find
  out how to get involved in advocacy efforts
  www.nationalaidshousing.org