NAHC Summer 2010 E-Newsletter

The National AIDS Housing Coalition (NAHC) and its members of the HIV/AIDS community in the United States have long promoted the concept of "Housing as Healthcare" for people living with HIV and AIDS. The NAHC Research Summit series has become the premier venue for the presentation and discussion of data connecting research to HIV/AIDS housing policy. In addition, the cutting edge research clearly demonstrates that the critical need for housing as an intervention to address both public and individual health priorities.

In recent months, several initiatives validating the connection between housing, healthcare and HIV/AIDS have been released by three Federal agencies.

1. HUD Strategic Plan FY2010-2015

In May 2010, the U.S Department of Housing and Urban Development (HUD), released its Strategic plan for FY 2010-2015 (Plan). The Plan provides the direction and focus HUD needs to provide quality, affordable homes located in stable, sustainable, and diverse communities. It proposes to accomplish this through five core goals:

(1) Strengthen the Nation's Housing Market to Bolster the Economy and Protect Consumers; (2) Meet the Need for Quality Affordable Rental Homes; (3) Utilize Housing as a Platform for Improving Quality of Life; (4) Build Inclusive and Sustainable Communities Free From Discrimination; (5)Transform the Way HUD Does Business.

The link between housing and HIV/AIDS is addressed under Goal 3: Utilizing Housing as a Platform for Improving Quality of Life. The Strategic Plan recognizes that "Stable, healthy housing is inextricably tied to individual health. Improving health outcomes starts by increasing knowledge of health and access to health service." Stable housing, made possible through HUD assistance, would provide a platform to deliver a wide variety of health and social services to improve the education, health, economic security, and safety of its residents.

Implementation of Goal 3 as a platform to reduce the barriers to both obtaining and maintaining housing for people living with HIV/AIDS, are laid out in greater detail in subgoals 3c and 3d. Click here for more of HUD's implementation of Goal 3.

2. Opening Doors

On June 22, the United States Interagency Council on Homelessness (USICH) released the nation's first comprehensive strategy to prevent and end homelessness titled, "Opening Doors: The Federal Strategic Plan to Prevent and End Homelessness".

Opening Doors (OD) serves as a roadmap for joint action by the 19 USICH member agencies along with local and state partners in the public and private sectors. OD outlines the government's commitment to make homelessness a priority for all federal agencies and to partner with states, localities, private organizations and other stakeholders to make existing homeless programs more effective and efficient by using strategies that already have proved to be successful. Most notable among these efforts is combining housing and supportive services for the chronically homeless.

OD sets four key goals: (1) Finish the job of ending chronic homelessness in five years; (2) Prevent and end homelessness among Veterans in five years; (3) Prevent and end homelessness for families, youth, and children in ten years; and (4) Set a path to ending all types of homelessness.

As an official recognition that housing is healthcare, OD aims to increase access to stable and affordable housing as well as, improve health and stability by providing permanent supportive housing (Objective 4) along with health-related Objectives #7, 8 and 9. NAHC Executive Director Nancy Bernstine commented, "This plan encourages partnerships between housing providers and health care providers. Aligning housing and health services is the only way to successfully attack both homelessness and HIV/AIDS."

The report also calls for replenishing the nation's dwindling supply of affordable rental housing by funding the National Housing Trust Fund, which was created in 2008 as a permanent federal funding source to help construct, renovate and preserve 1.5 million units of rental housing for low-income families over 10 years.

HIV/AIDS is specifically mentioned on pages 15, 16, 17, 21, 34, 38, and 44 of the report.

3.National HIV/AIDS Strategy (NHAS)

On July 13, the White House Office of National AIDS Policy (ONAP) released the National HIV/AIDS Strategy (NHAS) and its accompanying Implementation Plan for the United States as a reaffirmation of President Obama's commitment to addressing this domestic epidemic. NAHC member organizations and supporters were among the hundreds from across the country who elevated housing as a critical need in community focus groups conducted by the Office of National AIDS Policy.

The NHAS was developed with three primary goals: (1) Reducing number of new infections, (2) Increasing access to care and optimizing health outcomes for people living with HIV, and (3) Reducing HIV-related health disparities.

Housing is prominently featured in the goal of "Increasing Access to Care and Improving Health Outcomes" which includes 3 steps to be taken to achieve success. Step 3 of this goal is: "Support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing." The anticipated result of Step 3 is that by 2015 the percentage of Ryan White HIV/AIDS Program clients with permanent housing will increase from 82 percent to 86 percent (from 434,000 to 455,800 people). This serves as a measurable proxy of efforts to expand access to HUD and other housing supports to all needy people living with HIV (page 23 of the Strategy).

The Strategy also directs HUD to "work with Congress to develop a plan (including seeking statutory changes if necessary) to shift to HIV/AIDS case reporting as a basis for formula grants for HOPWA funding" in order to increase coordination among federal agencies under the goal of "Achieving a More Coordinated National Response to the HIV Epidemic" (page 27 of the Implementation Plan).

The Strategy cites evidence featured in the Housing & HIV/AIDS Research Summit Series and refers to the US Interagency Council on Homelessness's new federal plan as a point of collaboration between housing and health agencies.

"Access to housing is an important precursor to getting many people into a stable treatment regimen. Individuals living with HIV who lack stable housing are more likely to delay HIV care, have poorer access to regular care, are less likely to receive optimal antiretroviral therapy, and are less likely to adhere to therapy... Opening Doors: Federal Strategic Plan to Prevent and End Homelessness focuses efforts to reduce homelessness and increase housing security. Planning efforts will be undertaken in collaboration with community partners to address the housing needs of vulnerable Americans who are in homeless situations or present risks of homelessness" (page 28 of the Strategy).

While the Strategy provides a roadmap for moving the nation forward in addressing the domestic HIV epidemic, it fails to acknowledge housing as prevention or the well-documented interventions to break the link between homelessness, extreme poverty and HIV/AIDS, something the HUD Strategic Plan and Opening Doors recognize. The conditions of homelessness and extreme poverty - the pressures of daily survival needs, the inability to maintain intimate relationships, and substance use as a response to stress and/or mental health problems - leave homeless and unstably housed persons extremely vulnerable to HIV infection.

"Housing is essential to the ability of people with HIV/AIDS to enter into and remain in care and to preventing the spread of the virus," said NAHC Executive Director Nancy Bernstine.

The Housing Work Group of the Federal AIDS Policy Partnership (FAPP) has created an anonymous survey to solicit broad and diverse feedback from the community relevant to the NHAS. We would like your feedback on identifying housing gaps in the NHAS as well as recommendations for implementation of the NHAS.

NAHC encourages its members to read The National HIV/AIDS Strategy, the Implementation Plan, and the President's Memorandum for the Heads of Executive Agencies and Departments for more information.