HIV Housing Helps End Homelessness and HIV/AIDS in the United States

  • Julie Hilvers
  • Christine C. George
  • Arturo V. Bendixen
Chapter

Abstract

This chapter addresses the syndemic relationship between HIV/AIDS and homelessness or precarious housing. We focus nationally on the United States, and conclude with a case study from the city of Chicago. This chapter reviews a wide number of studies which demonstrate that homelessness or unstable housing greatly impacts the health and overall well-being of individuals living with HIV/AIDS. Studies show an interrelationship between HIV status and housing status—people with HIV/AIDS are at risk of housing insecurity and homelessness due to a number of economic and income factors, while homelessness or housing insecurity is often associated with sex and drug use behaviors that place individual at high risk of acquiring or transmitting HIV. This chapter discusses the U.S. federal policies and strategies enacted to curb the HIV/AIDS epidemic and to support low-income individuals with HIV/AIDS. Research shows that stable housing is key to achieving the goals of strategies and is associated with improved health outcomes for those with HIV/AIDS. In addition to better health outcomes, stable housing and supportive services for low-income individuals with chronic illnesses including HIV/AIDS is associated with reduced medical costs. Finally, this chapter describes the experiences of formerly homeless individuals living with HIV/AIDS and on Medicaid who are enrolled in a supportive housing program in Chicago. Through this case study, we explore the impact of the supportive housing program on these individuals’ health behavior and status and overall well-being.

Keywords

Homelessness HIV/AIDS Homeless policy Housing and healthcare integration Permanent supportive housing Syndemics 

References

  1. Aidala, A., Lee, G., Abramson, D., Messeri, P., & Siegler, A. (2007). Housing need, housing assistance, and connection to medical care. AIDS & Behavior, 11(6)/Supp 2, S101–S115.Google Scholar
  2. Beijer, U., Wolf, A., & Fazel, S. (2012). Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(11), 859–870.CrossRefGoogle Scholar
  3. Bendixen, A. V., & Butzen, J. (2015). Los Angeles county department of health services, housing for health program—benchmarking report. Resource document. Center for Housing and Health, AIDS Foundation of Chicago, Chicago, IL.Google Scholar
  4. Braveman, B., Levin, M., Kielhofner, G., & Finlayson, M. (2006). HIV/AIDS and return to work: A literature review one-decade post-introduction of combination therapy (HAART). Work, 27(3), 295–303.Google Scholar
  5. Buchanan, D., Romina, K., Sadowski, L. S., & Garcia, D. (2009). The health impact of supportive housing for HIV-positive homeless patients: A randomized controlled trial. American Journal of Public Health, 99(Suppl 3), S675–S680.CrossRefGoogle Scholar
  6. City of Chicago Department of Family and Supportive Services, & University of Illinois at Chicago Nathalie Voorhees Center for Neighborhood and Community Improvement. (2014). 2014 homeless point-in-time count and survey report. www.cityofchicago.org/content/dam/city/depts/fss/supp_info/Homeless/2014PITReport.pdf.
  7. Corporation for Supportive Housing. (2015). Achieving New York’s Medicaid redesign goals through supportive housing. Resource document. New York: Corporation for Supportive Housing. http://www.csh.org/wp-content/uploads/2015/06/Achieving-New-Yorks-Medicaid-Redesign-Goals-Through-Supportive-Housing.pdf.
  8. Fee, E., & Krieger, N. (1993). Thinking and rethinking AIDS: Implications for health policy. International Journal of Health Services, 23, 323–346.CrossRefGoogle Scholar
  9. Friedman, M. S., Marshal, M. P., Stall, R., Kidder, D. P., Henny, K. D., Courtenay-Quirk, C., et al. (2009). Associations between substance use, sexual risk taking and HIV treatment adherence among homeless people living with HIV. AIDS Care, 21(6), 692–700.CrossRefGoogle Scholar
  10. George, C., Hilvers, J., Greenia, A., & Byrnes, B. (2014). Evaluation of the medicaid supportive housing program. Resource document. Center for Urban Research and Learning, Loyola University, Chicago, IL. http://static1.squarespace.com/static/51e86261e4b00dfa7317c09b/t/54945da6e4b0b89b6fa3fd55/1419009446197/FINAL+MSHP+Technical+Report.pdf.
  11. Gulcur, L., Stefancic, A., Shinn, M., Tsemberis, S., & Fischer, S. N. (2003). Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programs. Journal of Community & Applied Social Psychology, 13(2), 171–186.CrossRefGoogle Scholar
  12. Hall, I., An, Q., Tang, T., Song, R., Chen, M., & Green, T., et al. (2015). Prevalence of diagnosed and undiagnosed HIV infection—United States, 2008–2012. Morbidity and Mortality Weekly Report, 64, 657–662. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6424a2.htm?s_cid=mm6424a2_e.
  13. Hawk, M., & Davis, D. (2012). The effects of a harm reduction housing program on the viral loads of homeless individuals living with HIV/AIDS. AIDS Care, 24(5), 577–582.CrossRefGoogle Scholar
  14. Kerker, B., Bainbridge, J., Li, W., Kennedy, J., Bennani, Y., & Agerton, T., et al. (2005). The health of homeless adults in New York City. Resource document. New York City Departments of Health and Mental Hygiene and Homeless Services.Google Scholar
  15. Kidder, D. P., Wolitski, R. J., Campsmith, M. L., & Nakamura, G. V. (2007). Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. American Journal of Public Health, 97(12), 2238–2245.CrossRefGoogle Scholar
  16. Kidder, D. P., Wolitski, R. J., Pals, S. L., & Campsmith, M. L. (2008). Housing status and HIV risk behaviors among homeless and housed persons with HIV. Journal of Acquired Immune Deficiency Syndromes, 49(4), 451–455.CrossRefGoogle Scholar
  17. Larimer, M. E., Malone, D. K., Garner, M. D., Atkins, D. C., Burlingham, B., Lonczak, H. S., et al. (2009). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. The Journal of the American Medical Association, 301(13), 1349–1357.CrossRefGoogle Scholar
  18. Los Angeles County Department of Health Services. (n.d.). Housing for health. http://file.lacounty.gov/dhs/cms1_217171.pdf.
  19. Marshall, B., Kerr, T., Shoveller, J. A., Patterson, T. L., Buxton, J. A., & Wood, E. (2009). Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health & Place, 15(3), 783–790.CrossRefGoogle Scholar
  20. Martinez, T., & Burt, M. (2006). Impact of permanent supportive housing on the use of acute care health services by homeless adults. Psychiatric Services, 57(7), 992–999.CrossRefGoogle Scholar
  21. Maticka-Tyndale, E., Adam, B. D., & Cohen, J. J. (2002). To work or not to work: Combination therapies and HIV. Qualitative Health Research, 12, 1353–1372.CrossRefGoogle Scholar
  22. McAllister-Hollod, L., & Rojas, J. (2013). HIV care cascade in the New York City HOPWA Program. Resource document. North American Housing and HIV/AIDS Research Summit. Montreal, Quebec. https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/key_resources/housing_and_supportive_services/hiv_care_cascade_nychopwa.pdf.
  23. Milloy, M.-J., Marshall, B. D., Montaner, J., & Wood, E. (2012). Housing status and the health of people living with HIV/AIDS. Current HIV/AIDS Reports, 9(4), 364–374.CrossRefGoogle Scholar
  24. Nardone, M., Cho, R., & Moses, K. (2012). Medicaid-finances in supportive housing for high-need homeless beneficiaries: The business case. Resource document. Center for Health Care Strategies, Inc. & Corporation for Supportive Housing. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf73141.
  25. National Alliance to End Homelessness. (2006). Fact sheet: Homelessness and HIV/AIDS. www.endhomelessness.org/library/entry/fact-sheet-homelessness-and-hiv-aids.
  26. National Alliance to End Homelessness. (2012). A dispatch from the International AIDS Conference. www.endhomelessness.org/blog/entry/a-dispatch-from-the-international-aids-conference#.Vi_8_2708hQ.
  27. National Coalition for the Homeless. (2007). HIV/AIDS and homelessness—fact sheet #9. http://www.nationalhomeless.org/publications/facts/HIV.pdf.
  28. New York Department of Health. (2011). A plan to transform the Empire State’s Medicaid Program—better care, better health, lower costs: Multi-year action plan. Resource document. New York Department of Health. https://www.health.ny.gov/health_care/medicaid/redesign/docs/mrtfinalreport.pdf.
  29. Novick, L., Berns, D., Stricof, R., Stevens, R., Pass, K., & Wethers, J. (1989). HIV seroprevalence in newborns in New York State. Journal of American Medical Association, 261(12), 1745–1750.CrossRefGoogle Scholar
  30. Palepu, A., Milloy, M., Kerr, T., Zhang, R., & Wood, E. (2011). Homelessness and adherence to antiretroviral therapy among a cohort of HIV-infected injection drug users. Journal of Urban Health, 88(3), 545–555.CrossRefGoogle Scholar
  31. Pelletiere, D., Wardrip, K., & Crowley, S. (2006). Out of reach: 2006. Resource document. National Low Income Housing Coalition. http://nlihc.org/oor/2006.
  32. Rosenheck, R., Kasprow, W., Frisman, L., & Liu-Mares, W. (2003). Cost-effectiveness of supported housing for homeless persons with mental illness. Archives of General Psychiatry, 60(9), 940–951.CrossRefGoogle Scholar
  33. Sadowski, L. S., Kee, R. A., VanderWeele, T. J., & Buchanan, D. (2009). Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of American Medical Association, 301(17), 1771–1778.CrossRefGoogle Scholar
  34. Schwarcz, S. K., Hsu, C., Vittinghoff, A., Vu, A., Bamberger, J. D., & Katz, M. H. (2009). Impact of housing on the survival of persons with AIDS. BMC Public Health, 9, 220.CrossRefGoogle Scholar
  35. Shah, N. R., Doran, K. M., & Misa, E. J. (2013). Housing as health care: New York’s boundary-crossing experiment. New England Journal of Medicine, 369(25), 2374–2377.CrossRefGoogle Scholar
  36. Singer, M. (1994). AIDS and the health crisis of the U.S. urban poor: The perspective of critical medical anthropology. Social Science Medicine, 39(7), 931–948.Google Scholar
  37. Tevendale, H. D., Lightfoot, M., & Slocum, S. L. (2009). Individual and environmental protective factors for risky sexual behavior among homeless youth: An exploration of gender differences. AIDS and Behavior, 13(1), 154–164.CrossRefGoogle Scholar
  38. Timmons, J. C., Ciulla, J., & Lynch-Fesko, L. (2004). The impact, meaning, and challenges of work: Perspectives of individuals with HIV/AIDS. Health and Social Work, 29, 137–145.CrossRefGoogle Scholar
  39. U.S. Department of Health and Human Services. (2014). Ryan White HIV/AIDS Program—program fact sheet. Resource document. Health Resources and Services Administration, U.S. Department of Health and Human Services. http://hab.hrsa.gov/abouthab/files/programoverviewfacts2014.pdf.
  40. Weir, B. W., Bard, R. S., O’Brien, K., Casciato, C. J., & Stark, M. J. (2007). Uncovering patterns of HIV risk through multiple housing measures. AIDS and Behavior, 11(2), 1131–1144.Google Scholar
  41. Wenzel, S., Tucker, J., Elliott, M., & Hambarsoomians, K. (2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS and Behavior, 11(6 Suppl), 9–20.CrossRefGoogle Scholar
  42. White House, Office of the Press Secretary. (2013). Executive Order—HIV Care Continuum Initiative. www.whitehouse.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative.
  43. White House, Office of National AIDS Policy. (2015). National HIV/AIDS strategy for the United States—updated to 2020. www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf.
  44. Wiewel, E. (2015). The HIV care continuum for housing program clients and persons living with HIV/AIDS overall, New York City, 2013. 10th International Conference on HIV Treatment and Prevention Adherence, Miami, Florida.Google Scholar
  45. Wiewel, E., & Rojas, J. (2015). Viral suppression trends among HIV+ housing clients, New York City, 2008-2013. Washington, D.C.: Housing and HIV/AIDS Research Summit.Google Scholar
  46. Wolitski, R. J., Kidder, D. P., & Fenton, K. A. (2007). HIV, homelessness, and public health: Critical issues and a call for increased action. AIDS and Behavior, 11, 167–171.CrossRefGoogle Scholar
  47. Wolitski, R. J., Kidder, D. P., Pals, S. L., Royal, S., Aidala, A., Stall, R., et al. (2010). Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS and Behavior, 14(3), 493–503.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Julie Hilvers
    • 1
  • Christine C. George
    • 2
  • Arturo V. Bendixen
    • 3
  1. 1.Policy Research CollaborativeRoosevelt UniversityChicagoUSA
  2. 2.Center for Urban Research and LearningLoyola UniversityChicagoUSA
  3. 3.AIDS Foundation of ChicagoChicagoUSA

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