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The Health Impact of Supportive Housing for HIV-Positive
Homeless Patients: A Randomized Controlled Trial
David R. Buchanan, MD, Romina Kee, MD, MPH, Laura S. Sadowski, MD, MPH, and Diana Garcia, MPH
June 2009, Vol 99, No. 6 | American Journal of Public Health
http://www.ajph.org/cgi/doi/10.2105/AJPH.2008.137810
The latest version is at Published Ahead of Print on April 16, 2009, as 10.2105/AJPH.2008.137810

ABSTRACT

Objectives. We assessed the health impact of a housing and case management program, the Chicago Housing for Health Partnership, for homeless people with HIV.
Methods. HIV-positive homeless inpatients at a public hospital (n = 105) were randomized to usual care or permanent housing with intensive case management. The primary outcome was survival with intact immunity, defined as CD4 count > 200 and viral load < 100 000. Secondary outcomes were viral loads, undetectable viral loads, and CD4 counts.
Results. Outcomes were available for 94 of 105 enrollees (90%). Of 54 intervention participants, 35 (65%) reached permanent housing in program housing agencies. After 1 year, 55% of the intervention and 34% of the usual care groups were alive and had intact immunity (P = .04). Seventeen intervention (36%) and 9 usual care (19%) participants had undetectable viral loads (P = .051). Median viral loads were 0.89 log lower in the intervention group (P = .03). There were no statistical differences in CD4 counts.
Conclusions. Homelessness is a strong predictor of poor health outcomes and
complicates the medical management of HIV. This housing intervention im-
proved the health of HIV-positive homeless people. (Am J Public Health. 2009;99:

The full article is available at: http://www.ajph.org/cgi/reprint/96/7/1278

Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults

A Randomized Trial
Laura S. Sadowski, MD, MPH; Romina A. Kee, MD, MPH; Tyler J. VanderWeele, PhD; David Buchanan, MD, MS
JAMA. 2009;301(17):1771-1778.

ABSTRACT

Context  Homeless adults, especially those with chronic medical illnesses, are frequent users of costly medical services, especially emergency department and hospital services.

Objective  To assess the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical illnesses.
Design, Setting, and Participants  Randomized controlled trial conducted at a public teaching hospital and a private, nonprofit hospital in Chicago, Illinois. Participants were 407 social worker-referred homeless adults with chronic medical illnesses (89% of referrals) from September 2003 until May 2006, with follow-up through December 2007. Analysis was by intention-to-treat.
Intervention  Housing offered as transitional housing after hospitalization discharge, followed by placement in long-term housing; case management offered on-site at primary study sites, transitional housing, and stable housing sites. Usual care participants received standard discharge planning from hospital social workers.
Main Outcome Measures  Hospitalizations, hospital days, and emergency department visits measured using electronic surveillance, medical records, and interviews. Models were adjusted for baseline differences in demographics, insurance status, prior hospitalization or emergency department visit, human immunodeficiency virus infection, current use of alcohol or other drugs, mental health symptoms, and other factors.

Results  The analytic sample (n = 405 [n = 201 for the intervention group, n = 204 for the usual care group]) was 78% men and 78% African American, with a median duration of homelessness of 30 months. After 18 months, 73% of participants had at least 1 hospitalization or emergency department visit. Compared with the usual care group, the intervention group had unadjusted annualized mean reductions of 0.5 hospitalizations (95% confidence interval [CI], -1.2 to 0.2), 2.7 fewer hospital days (95% CI, -5.6 to 0.2), and 1.2 fewer emergency department visits (95% CI, -2.4 to 0.03). Adjusting for baseline covariates, compared with the usual care group, the intervention group had a relative reduction of 29% in hospitalizations (95% CI, 10% to 44%), 29% in hospital days (95% CI, 8% to 45%), and 24% in emergency department visits (95% CI, 3% to 40%).

Conclusion  After adjustment, offering housing and case management to a population of homeless adults with chronic medical illnesses resulted in fewer hospital days and emergency department visits, compared with usual care.

The full text of the article is available at: http://jama.ama-assn.org/cgi/content/full/301/17/1771#AUTHINFO

On May 25, 2010, the U.S. House of Representatives adopted H. Con. Res. 137, expressing the sense of the Congress that the lack of adequate housing must be addressed as a barrier to effective HIV prevention, treatment and care, and that the United States should make a commitment to providing adequate funding for developing housing as a response to the AIDS pandemic.  To read the NAHC press release statement on this milestone, click here.

To view H.CON.RES.137 floor proceedings, click here

The Senate also introduced S. Con. Res. 39 as S.Res.162. S. Res 162 has achieved bipartisan co-sponsorship and currently has 13 co-sponsors. S. Res. 162 has been referred to the Committee on Banking, Housing and Urban Affairs.

To view the full text S. Res. 162 as well as the complete list of co-sponsors, click here.

Preliminary Agenda- May 20, 2009

Agenda Highlights

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Hotel Information

Concept Paper

Program Brochure

Convening Organizations:

• US National AIDS Housing Coalition (NAHC)
• Johns Hopkins Bloomberg School of Health
• Ontario HIV Treatment Network (OHTN)

The United States National AIDS Housing Coalition (NAHC) will convene the fourth Housing and HIV/AIDS Research Summit June 3rdthrough 5th, 2009, in Washington, DC. NAHC will continue its collaboration with the Johns Hopkins Bloomberg School of Public Health, and will be joined for the first time by the Ontario HIV Treatment Network (OHTN) as a co-convening organization, to expand the scope of the Summit Series to bring together researchers, policy experts, consumers and providers of HIV/AIDS housing from across North America. The Housing and HIV/AIDS Research Summit Series is now established as the premiere venue for informing HIV/AIDS housing policy, and is acknowledged as an innovative and influential opportunity for the broader discussion of housing and health. Summit III brought together 225 participants, representing 25 states, the District of Columbia, and three Canadian Provinces, for presentations by over 40 experts on the relationship of housing status and HIV prevention and care. NAHC’s formal collaboration with the OHTN will make Summit IV the first regional research and policy meeting of its kind.

Increasing evidence points to the role of housing – or lack of housing – for the continuing HIV epidemic and health disparities. The theme of Summit IV is mobilizing knowledge, with a focus on building participants’ knowledge base and skills to inform housing and health policy and practice in their communities. In addition to the regular sessions, Summit IV will be preceded by a half-day training institute designed to build the capacity of consumers of HIV/AIDS housing and services to participate more actively in the design, guidance and interpretation of research.

Please visit this site for more information on the Trust Fund. http://www.nlihc.org/template/page.cfm?id=40

NAHC joined with member partners Housing Works, Inc. and the San Francisco AIDS Foundation, along with the Ontario HIV Treatment Network, to co-sponsor a housing satellite meeting at the International AIDS Conference in Mexico City, August 3. The meeting represented one of the first times that housing was highlighted in this international venue which attracted 25,000 participants. More than 150 housing summit participants learned about the state of Global HIV/AIDS housing from participants from Nepal, the US and Latin America and shared information about HIV/AIDS housing issues confronting their communities across the globe. The declaration, asserting housing for people with HIV/AIDS as a human right, was presented and discussed in a facilitated discussion with representatives, including representatives of communities from South Africa, Mexico, Peru and the US. The declaration was endorsed by meeting participants and presented to and accepted by International AIDS Society official Ron MacInnis. The meeting signaled the beginning of a week of action by HIV/AIDS housing advocates to keep housing stability and poverty and their implications for HIV/AIDS healthcare in the forefront at the International Conference. Endorsements were collected throughout the six day conference and we invite you to endorse the Declaration which will be used in our effort to continue to advance the inclusion of housing in the global discourse on healthcare for people living with HIV/AIDS.

Click Here to Endorse

The International Declaration on

Poverty, Housing Instability, and HIV/AIDS

Everyone has the right to a standard of living adequate for the health and well being of him [or her] self and of his [or her] family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his [or her] control.

- Article 25, The Universal Declaration of Human Rights

Whereas adequate and secure housing has long been recognized as a basic human right,

Whereas growing empirical evidence shows that the socioeconomic circumstances of individuals and groups are equally or even more important to health status than medical care and personal health behaviors,

Whereas in the case of HIV/AIDS, the link between poverty and disparities in HIV risk and health outcomes is well established, and new research findings demonstrate the direct relationship between inadequate housing and greater risk of HIV infection, poor health outcomes and early death,

Whereas poor living conditions, including overcrowding and in extreme cases, homelessness, undermine safety, privacy and efforts to promote self-respect, human dignity and the attendant responsible sexual behavior,

Whereas the lack of stable housing directly impacts the ability of people living in poverty to reduce HIV risk behaviors and homeless and unstably housed persons are two to six times more likely to use hard drugs, share needles or exchange sex than similar persons with stable housing,

Whereas, in spite of the evidence indicating that adequate housing has a direct positive effect on HIV prevention, treatment and health outcomes, the lack of adequate housing resources has been largely ignored in conferences and policy discussions at the international level, and

Whereas the United Nations, in both its 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS, embraced the goal of universal access to comprehensive prevention programs, treatment, care and support by 2010.

Therefore, we hereby demand that policy makers address the lack of adequate housing as a barrier to effective HIV prevention, treatment, and care; and we further demand that all governments fund and develop housing as a response to the AIDS pandemic.

Click Here to Endorse

Declaración de la Cumbre Satélite sobre la Pobreza, Personas sin Hogar y el VIH/SIDA

Sommet par satellite sur la pauvreté, le sans-abrisme et le VIH/SIDA Déclaration

2008年世界艾滋病大会穷人、无家可归者与艾滋病 卫星会议声明

A Declaração Internacional sobre Pobreza, Desabrigo e HIV/AIDS

Международная декларация о бедности, трудностях с жильем и ВИЧ/СПИДе

View Endorsements

]]> http://nationalaidshousing.org/2008/07/endorseconference/feed/ 0 http://nationalaidshousing.org/2008/07/2008-international-aids-conference-satellite/ http://nationalaidshousing.org/2008/07/2008-international-aids-conference-satellite/#comments Mon, 07 Jul 2008 14:44:22 +0000 Latoya http://nationalaidshousing.org/?p=71 In conjunction with the International AIDS Conference in Mexico City this July 2008, the United States based non-governmental organizations the NAHC and Housing Works, Inc., and the San Francisco AIDS Foundation, together with the Ontario HIV Treatment Network (OHTN), have formed an international committee to convene a two- hour conference satellite event titled “International Summit on Poverty, Homelessness and HIV/AIDS.” Summit participants will work together to develop and present to the International Conference a declaration demanding adequate housing as a fundamental human right and an essential element of effective HIV prevention and health care. Going forward, the summit committee and consensus statement on housing and health will serve as valuable educational and organizing vehicles for PLWHA and their allies to build the international, national and local political will to support the development of culturally appropriate housing resources as a key element of HIV prevention and care strategies.

Click here for more details.

Senators Feingold and Collins Release Section 8 Funding Request Letter

As you know, the section 8 program is a critical component in the continuum of housing for low income people, including people with HIV/AIDS. But Section 8 but has not kept pace with need in many years. Senators Feingold (D-WI) and Collins (R-ME) are circulating the letter below for signatures. It urges the Senate THUD Appropriations subcommittee to increase funding for the tenant-based Section 8 program for FY2009. The letter closes on this Thursday, April 24.

Follow these easy steps to request that your Senator sign on:

• Call the Capitol Switchboard at (202) 225-3121 and ask to be transferred to your Senator’s office. (Don’t know who your Senator is? Visit www.senate.gov to find out.)
• Ask to speak to the staffer in your Senator’s office that handles housing issues.
• Tell the staffer about the importance of Section 8 in providing housing for people with HIV/AIDS in your community.
• Ask the Senator to sign on to the letter. If the staffer wants more information, Amanda Beaumont is staffing the letter for Sen. Feingold and Jen Capriola is staffing the letter for Sen. Collins.
• Please let NAHC know the results of your contact by emailing Latoya Thomas at latoya@nationalaidshousing.org.

Below is the letter to Appropriators requesting an increase for Section 8.

PROGRAMMATIC REQUEST LETTER

Dear Chairwoman Murray and Ranking Member Bond:

We are writing to urge you to support the highest fiscally responsible increase in funding for the Section 8 Housing Choice Voucher program in the fiscal year 2009 THUD appropriations bill. We ask that you include funding sufficient to renew existing vouchers as well as fund new vouchers in fiscal year 2009. Increasing numbers of American families are facing housing affordability challenges, whether they are renters or homeowners, and we are concerned that the current level of funding for the Section 8 program does not come close to meeting the existing rental assistance need in communities nationwide. The housing affordability burden continues to fall most heavily on low-income renters throughout the country and increased funding for the Section 8 program will help meet the affordable rental housing needs of these American families.

The Section 8 Housing Choice Voucher Program, originally created in 1974, is the largest Federal housing program in terms of HUD’s budget with approximately two million vouchers currently authorized. Yet the current number of vouchers does not come close to meeting the demand that exists in communities around our country including urban, suburban, and rural areas. We have heard from advocates in our states about the increased need for additional funding for the tenant-based program – not only to fund existing vouchers in use, but to also fund new, incremental tenant-based vouchers for low- income families currently unable to be served by the program. Advocates in our states also continue to tell us about the increasing numbers of families on waiting lists for vouchers and unfortunately, these waiting lists will only grow longer if the Section 8 program does not receive increased funding.

A number of different government agencies and advocacy organizations all cite the effectiveness of Section 8 in assisting low-income families in meeting some of their housing needs. In 2002, the Government Accountability Office determined that a one-bedroom unit of housing provided through the Section 8 program costs less than it would through other federal housing programs. That same year, the Millennial Housing Commission reported to Congress that the Section 8 Housing Choice Voucher program is “flexible, cost-effective, and successful in its mission,” and that the vouchers “should continue to be the linchpin of a national policy providing very low- income renters access to the privately owned housing stock.” The Commission also called on Congress to provide a substantial investment in the tenant-based Section 8 program in the future.

In order to address the growing need for affordable housing, we urge you to include a sizeable and fiscally responsible increase for the Section 8 Housing Choice Voucher program in the fiscal year 2009 THUD appropriations bill that will not only fully fund existing vouchers, but also provide funding for new Section 8 vouchers in 2009. We commend you for the support that you provided to the Section 8 tenant-based program in the Revised Continuing Appropriations Resolution for fiscal year 2007 as well as the Consolidated Appropriations Act in fiscal year 2008. We look forward to working with you to not only boost funding for this valuable federal program that helps millions of American families secure affordable housing, but also promote responsible reforms to the Section 8 program that will allow the program to better serve the needs of American families for years to come.

Thank you for your consideration to our request. Your continued leadership on affordable housing issues is appreciated.

Sincerely,
Your Member of Congress???

Please see the below alert from the National Alliance to End Homelessness:

We have an incredible opportunity to expand funding and programs for permanent housing solutions to homelessness with the reauthorization of the McKinney-Vento Homeless Assistance Grants program. Let’s get the strongest bill we can with high priority on housing solutions to homelessness.

What To Do:

• Please call your House Member, especially those on the Financial Services Committee*, and ask him or her to contact Rep Waters** and Rep Capito*** in support of the Manager’s Amendment to the HEARTH Act.

* The House Financial Services Committee is the committee with jurisdiction over this legislation.
** Rep Maxine Waters (D-CA) is the Chair of the Subcommittee with jurisdiction over this legislation – the Subcommittee on Housing and Community Opportunity of the Committee on Financial Services.
*** Rep Shelley Moore Capito (R-WV) is the Ranking Member (highest ranking Republican.)

Why Act Now?/Current Status of the Legislation
House: The House legislation, HR 840, the HEARTH (Homeless Emergency Assistance and Rapid Transition to Housing) Act was introduced by the late Representative Julia Carson (D-IN) with lead Republican Representative Geoff Davis (R-KY) in February 2007. Two hearings were held in October. It is the intention of the Financial Services Committee to hold a markup of legislation in the next few weeks. Rep Waters, Chair of the Subcommittee with jurisdiction (Subcommittee on Housing and Community Opportunity of the Financial Services Committee), will offer a manager’s amendment making significant changes to the HEARTH Act and greatly improving its impact on the goal of ending homelessness.

Senate: S 1518, the Community Partnership to End Homelessness Act, was introduced by Senator Jack Reed (D-RI) with lead Republican Senator Wayne Allard (R-CO) in May 2007, passed the Senate Committee on Banking, Housing and Urban Affairs and awaits action on the floor of the U.S. Senate.

The goal is to ensure the two pieces of legislation are similar to enable quicker enactment and a permanent solutions focus.

What the Legislation, With the Manager’s Amendment, Will Do/The Details
It promotes permanent housing as the solution to homelessness by:
 

• Funding permanent housing renewals from the account that funds Section 8 vouchers which would provide stability for renewals as well as free up funding for other new projects.
• Makes law the practice of establishing a 30 percent set aside for permanent housing for people with disabilities, including both individuals and families.
• Requires HUD to create an incentive (probably a bonus program) for rapid rehousing programs for families.
• At least 10 percent of funding will be dedicated to permanent housing activities for homeless families regardless of disability status.
• Adds families to the definition of chronic homelessness making chronically homeless families eligible for the same permanent supportive housing programs that chronically homeless individuals are.
• Requires HUD to continue special incentives for permanent supportive housing for those who experience chronic homelessness.

Modifies the definition of homelessness to include those who are at imminent risk without expanding the definition in a way that would result in fewer resources being directed towards those who the program is intended to serve – those literally on the street, in shelters or transitional housing.

• Expands the definition to include people who couch surf – move from place to place because they can not find a stable living situation.
• Retains a targeted definition of homelessness to ensure that homeless assistance continues to focus on its mission of meeting the emergency needs of people with no place to live and help them move into permanent housing.

Does a better job of preventing homelessness by increasing assistance to families and others who are doubled up or otherwise in unstable, difficult housing situations, before they end up in shelters or on the streets.

• Changes the name of the Emergency Shelter Grants program to Emergency Solutions Grants program and requires that 20 percent of homeless assistance funding be for ESG and that at least half the ESG amount be for prevention and rehousing.
• Expands prevention activities under ESG.

Assists rural communities by creating a separate rural competition, simplifying the application and providing flexibility with regard to the eligible population and use of funds.

• Allows continuums that are entirely rural or are in rural states to apply under a simplified set of criteria and in a separate competition so that rural areas only compete against other rural areas.
• Programs could serve people who are homeless or in the worst housing situations.
• Up to 20 percent of funding could be used for capacity building activities.

Streamlines and simplifies the program.

• Consolidates the programs into a single Community Homeless Assistance Program.
• The agency applying for the grant would be called the Collaborative Applicant; communities could choose to designate the lead agency as a Unified Funding Agency with additional responsibilities including subgranting all funds to the project sponsors.
• Match requirement would be changed to a uniform 25 percent of the total grant, would be applied community-wide not project by project and could be cash or in-kind. Grants that had previously had no match requirement (SHP leasing grants) would not have to be matched.
• McKinney-Vento funding for rental subsidies, leasing, operating costs, or services would not count as a grant for the purpose of the Low Income Housing Tax Credit, which means it would not count against eligible basis.
• Operating costs would be redefined to include service coordination.
• “Reasonable amounts” could be used for staff training.
• Collaborative Applicants would be eligible to receive a 3 percent administrative fee; Unified Funding Agencies would be eligible to receive a 6 percent administrative fee.

Please see the below alert from the National Alliance to End Homelessness:
The U.S. Department of Housing and Urban Development (HUD) published its fiscal year 2008 “SuperNOFA,” an annual funding notice that makes available more than $1 billion in grants through 35 programs. This year, the SuperNOFA does not include the Homeless Assistance Grants that fund the local Continuum of Care. HUD intends to offer an additional $1.5 billion in homeless grants later in the year through a new electronic application process that will significantly streamline funding of thousands of homeless assistance programs nationwide. For the past four years, HUD has required nearly all grant applications to be submitted electronically through www.grants.gov. This year, applicants for funding through HUD’s Continuum of Care homeless assistance programs will submit their applications electronically through the HUD e-snaps system (electronic-special needs assistance programs system). The electronic grant submission process is meant to increase funding opportunities for states, local governments, and nonprofit grassroots organizations that house and serve lower income families living in their communities. Last year, more than 4,600 applicants successfully submitted their applications electronically.

Click here for more details.

HOPWA Garners Support of Nearly One Third of the Senate

Thirty-four tri-partisan members of the Senate, led by HOPWA champions Richard Durbin (D-IL) and Gordon Smith (R-OR), have written to the Chair and Ranking member of the Senate THUD Appropriations Committee supporting NAHC’s recommended level of funding of $470 million for the Housing Opportunities for Persons With AIDS program (HOPWA) for FY 2009.

The request is $170 million over the Administration’s February 2008 budget request for level funding of $300 million. Though HIV/AIDS housing need continues to grow, in nearly every region of the country, the Administration request would only support 70,500 housing units for persons with HIV/AIDS and their families.

Senators who signed the letter
Akaka, Daniel (D-HI)
Biden, Joseph (D-DE)
Bingaman, Jeff (D-NM)
Boxer, Barbara (D-CA)
Brown, Sherrod (D-OH)
Cantwell, Maria (D-WA)
Clinton, Hillary (D-NY)
Coleman, Norm (R-MN)
Collins, Susan (R-ME)
Durbin, Richard* (D-IL)
Feingold, Russ (D-WI)
Johnson, Tim (D-SD)
Kennedy, Edward (D-MA)
Kerry, John (D-MA)
Klobuchar, Amy (D-MN)
Landrieu, Mary (D-LA)
Lautenberg, Frank (D-NJ)
Leahy, Patrick (D-VT)
Levin, Carl (D-MI)
Lieberman, Joseph (I-CT)
Lincoln, Blanche (D-AR)
Menendez, Robert (D-NJ)
Mikulski, Barbara (D-MD)
Nelson, Bill (D-FL)
Obama, Barack (D-IL)
Reed, Jack (D-RI)
Salazar, Ken (D-CO)
Sanders, Bernie (I-VT)
Schumer, Chuck (D-NY)
Smith, Gordon* (R-OR)
Snowe, Olympia (R-ME)
Stabenow, Debbie (D-MI)
Whitehouse, Sheldon (D-RI)
Wyden, Ron (D-OR)