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The Science Behind Housing

The Science Behind Housing

Summit participants Reneto Wilkens, Paul Fequiere and George Kerr

Two groundbreaking studies were presented at the North American Housing and HIV/AIDS Research Summit IV this week in Washington, D.C. A San Francisco Department of Health study showed that stable supportive housing reduced the risk of death among people with AIDS by 80 percent. And final data from the trailblazing Chicago Housing Health Partnership Study study showed people who received supportive housing were almost twice as likely to have an undetectable viral load as those in usual care.

More than 300 researchers, service providers, government officials and people living with HIV from as far away as Haiti and Uganda gathered for the Summit, which is sponsored by the National AIDS Housing Coalition (NAHC) and the Ontario HIV Treatment Network.

In his presentation, Josh Bamberger of the San Francisco Department of Health showed that even a three year old can understand the benefits of housing for people living with AIDS. “Housing is good,” Bamberger said, quoting his own three-year old child. Bamberger’s study, “Impact of housing on the survival of persons with AIDS” examined the health outcomes of people enrolled in San Francisco’s Direct Access to Housing (DAH), which has provided supportive housing for homeless people with chronic medical conditions since 1999, versus those who did not enroll and were homeless.

There were 80 percent less deaths among those enrolled in DAH, which offered intensive case management with a case manager-to-client ratio of 15 to 1.

“This is the first time we’ve been able to see housing’s stark effect on death outcomes,” said Ginny Shubert, a prominent housing researcher with Shubert Botein Associates.

Final data

Results from the Chicago Housing Health Partnership Study (CHHP), the first randomized study showing the impact of health outcomes on people with chronic illnesses, were featured in the Wall Street Journal last year, but the May 2009 issue the Journal of the American Medical Association released CHHP research specifically highlighting the health outcomes of people living with AIDS and final data was presented this week at the Summit.

CHHP showed that after 18 months of being stably housed in supportive housing, 40 percent of participants had an undetectable viral load. Only 21 percent of homeless participants had an undetectable viral load.

Another interesting finding in the CHHP study was the use of nursing homes by the unstably housed people. While the CHHP study didn’t originally track nursing home use, after noticing a pattern, over the course of nine months, this usage was tracked. Unstably housed people spent a total of 4,000 more days in the nursing home than their housed cohorts—costing $2 million.

“Those are expensive, costly days,” said Laura Sadowski, one of the researchers.

Prevention works

Other prominent studies highlighted the need for housing to prevent HIV, as well as the impact of violence among women impacting stable housing. Some highlights:

  • A Housing and Health study (H & H) showed the cost-effectiveness of housing is dollar amounts—proviing that housing is a cost-effective intervention for improving health, similar to dialysis and mammograms
  • A Canadian study of HIV-positive women showed stable housing among women at high risk of HIV could allow them to escape violence situations and improve treatment outcomes.
  • In a study of street involved youth, unstable housing increased the number of sex partners among the youth.

Crowley says

The conference’s featured speaker on Thursday was Office of National AIDS Policy Director Jeff Crowley. Introducing Crowley, Housing Works President and CEO Charles King said that Crowley was a friend of people with AIDS, but “friends speak truth to friends.”

King then criticized the Obama administration for not doing enough to fight AIDS. In addition to not lifting the HIV travel and immigration ban, there is the matter of the syringe exchange funding ban still in place, as well as flat-funding for HOPWA. “I don’t believe four months is a whole lot of time, but we’ve seen when the President wants to make something happen, such as the bank bailout, he’ll make it happen,” King said.

Crowley defended the Obama administration, stating that the President “has a lot on his plate” and “it’s not that anyone sits back and says that AIDS is a low priority.”

Regarding HOPWA’s flat funding, Crowley said, “I was disappointed with HOPWA [but] this is a tight budget environment and we should be realistic about what’s do-able.”

Bailey House President and CEO Gina Quattrochi said that AIDS housing providers have had to “beg, borrow and steal” for funding, and that money needs to be allocated for tracking and researching the most effective programs. “Obama is for data-driven programs, but we don’t have the resources to make that happen,” Quattrochi said.

Crowley pressed AIDS advocates to speak with a unified voice and develop top priorities for a National AIDS Strategy, but also said that he would be traveling the country to hear grassroots opinions about what is needed.

He also said that advocates should continue to push the Obama administration. “Outside pressure can be helpful,” Crowley said. “Sometimes you’ll push the President more than he wants, but he values your input.”

Successive questioners pushed Crowley to be more proactive about including housing in U.S. AIDS policy. Quattrochi pointed out that the press release Crowley brought to the conference didn’t mention housing. “All we’ve experienced is the loss of Ryan White funding,” she said. “We need to think about housing in HIV policy.”

Posted on June 5, 2009 at 1:27 pm