Friday, May 6, 2016


By: Kathie Hiers, President & CEO, AIDS Alabama

What is the greatest unmet need for people living with HIV (PLWH)? Medical care and medications?  Transportation? Food and nutritional needs? Many, many surveys and research findings provide very a different answer: housing. When you think about it, the need for safe, decent, affordable housing is a no brainer. How can you and your family possibly succeed in medical care or in the workplace or any place else without a place to lay your head, to keep your meds, and to protect your children? I would go so far as to say housing = healthcare!

According to the National Low Income Housing Coalition’s 2015 Out of Reach Report, not a single state in our nation offers a one-room apartment that a person working full time and making minimum wage can afford. In fact, federal minimum wage has not increased since 2009 while rents have risen in almost all metropolitan areas. For PLWH, the need for housing assistance is far too commonplace. According to the National AIDS Housing Coalition, at any given time about 50% of 1.2 million PLWH in our country experience homelessness or housing instability. Additionally, research indicates that people who are unstably housed or homeless have HIV rates up to 16 times as high as persons in stable housing. Unfortunately the need substantially outstrips the resources. But here’s the bottom line: housing for PLWH improves medical outcomes, reduces new transmissions through a reduction in risky behaviors, and provides cost savings. So much research exists to confirm these results that AIDS and Behavior in 2007 dedicated an entire issue to illustrate the findings.

Report Cover for "Out of Reach 2015"
Photo Source: National Low Income Housing Coalition

The only HIV-specific funding source from the U. S. Department of Housing and Urban Development (HUD) is the legislation known as Housing Opportunities for Persons with AIDS (HOPWA). Although HOPWA is relatively small within the HUD portfolio at about $335 million, the program has been extraordinarily effective and well rated, enjoying bipartisan support. Research from New York City shows that clients assisted by HOPWA collectively have a viral load suppression of about 73%, more than double the national average of about 30%. HOPWA was created in 1992 to address the housing and service needs of PLWH. Currently, however, the statutory funding distribution methodology is based on cumulative AIDS cases and counts more deceased cases (over 650,000) than living cases. On top of the formula distribution (don’t forget: based on deceased people and AIDS only), urban areas with higher-than-national averages also receive 25% of the formula funds as a bonus, based on three-year AIDS incidence, providing disproportionate funding to these jurisdictions. As a result of this antiquated methodology, I once saw the Director of the Office of HIV/AIDS Housing, David Vos, tell a group of advocates that the per-case funding can range from $200 to $10,000. Should funding this important really be based on deceased cases and distributed in a roller coaster ride of injustice?

The National AIDS Housing Coalition (NAHC) and many other HIV organizations have been advocating for an update to this formula distribution for many years in an effort to distribute the resources in a way that better reflects the current HIV epidemic. Both the Obama Administration and HUD are working in concert with NAHC and elected officials to promote modernization that would include the following changes:
  • A shift from cumulative AIDS to living HIV/AIDS, a change that occurred within the Ryan White legislation in 2009;
  • The inclusion of an area’s housing costs and poverty rates as formula factors; and
  • A gradual implementation over a five-year period to include a provision to cap annual losses at 5% and gains at 10% (U. S. Congress, House, H.R. 3700 and H. R. 4707; and Senate, S. 2668).
These changes would provide substantial additional resources to many rural areas, small to mid-sized cities, and states, based on the jurisdiction’s burden of cases, Fair Market Rent, and poverty index.

Although funding to support stable housing may never fully meet the needs of PLWH, advocates must continue to elevate this topic and to integrate housing needs into other HIV resources, such and the Ryan White HIV/AIDS Program and other programs within the Centers for Medicare and Medicaid Services. Innovative collaborations between branches of government and funding opportunities that combine structural interventions, such as housing, with other medical and supportive services could only help to alleviate barriers to good health caused by a lack of housing for PLWH.

AIDS Alabama provides an innovative approach to the use of our state HOPWA funds. Through partnerships with all of the AIDS Service Organizations, AIDS Alabama makes HOPWA rental assistance and supportive services available in all 67 counties of the state. We believe that housing is a human right and that people in need should have access to assistance no matter what zip code they call home. But we don’t stop with HOPWA! Our agency has continued to develop HIV-specific housing across the state and in the Birmingham area that we can make affordable to our clients.  AIDS Alabama is extremely active in our local Continuum of Care to serve the area’s homeless population. We believe in HUD’s Housing First model, which gets people into safe housing and then allows us to assess and address other needs that will keep our new residents healthy and independent.  Through these homeless funds we offer substance use treatment and mental health services for our residents. We are able to access Shelter Plus Care vouchers, which work like Section 8 assistance for people with disabilities. We work especially hard to serve the chronically homeless and to get them into care. In order to do that, we provide about 20,000 legs of transportation to medical appointments each year. We are extremely excited about our newest project that will begin in October 2016, which will target young, homeless LGBTQ populations. And, of course, case management services are available to all of our clients.  Navigating the worlds of health care, housing, and insurance is hard for anyone!

At AIDS Alabama our employees, residents, and clients living with HIV play a critical role in making sure that we remember who we serve and that we serve in the most efficient and helpful way possible. Persons living with HIV must have meaningful involvement in shaping everything that we do as an agency. Hopefully one day soon we can end this epidemic in the United States.  Until that happy day we will work together toward this goal…and make sure that everyone has a place to call home while we do this work!


Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

1 comment:

Sue Saltmarsh said...

Kathie Hires is one of my heroes and it was great to read this piece!

After four years of leading Demand Universal Healthcare (DUH, as in "Does America need a New healthcare system? DUH!), one of the truths I've learned is that the basic human needs issues are woven together in a tapestry of injustice in this country. Kathie is so right to call out the intersection between housing and health-care, just as the connection between food, clean air and water, income inequality, racism,the criminal justice system and healthcare could also be acknowledged. The HIV/AIDS community has done what no other "disease group has done--through its activism and persistence it has created its very own safety net system, as well as getting the FDA and Big Pharma to keep research into better meds and even a cute prioritized at the top. But they have yet to lend their powerful voice to the fight for single-payer universal healthcare, the one thread we could pull that would evetually unravel that whole tapestry of wrongs. It will always be my hope that leaders like Kathie and others who struggle to keep ASOs like AIDS Alabama strong become louder voices in the single-payer choir. As Bernie says, when we all stand together, there's nothing we can't do!