Click here to view the FY2011 Senate HOPWA letter.

Background

On December 17, 2009, the White House Office of National AIDS Policy (ONAP) convened a consultation on the role of housing in HIV prevention and health care. Over 70 stakeholders considered presentations by issue experts and then worked together on recommendations to inform the development of the National HIV/AIDS Strategy (NHAS).

In opening remarks, ONAP Director Jeff Crowley noted that housing had been a central theme of the fourteen community meetings held across the United States to gather input on the National AIDS Strategy, with housing repeatedly cited as a critical unmet need. He charged those present to provide concrete guidance on how housing should be reflected in the NHAS to order to advance its three primary goals: reducing HIV incidence; increasing access to care and optimizing health outcomes; and reducing HIV-related health disparities.

Click here to see the complete housing recommendations as well as the list of meeting participants.

Click Here for a copy of NAHC’s press release

Click Here for a photograph of the event that was featured in Roll Call.

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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

OXFORD, MISSISSIPPI - SEPTEMBER 24-26 2008 - JOIN A CARAVAN!
For more information go to  (www.c2ea.org) or call 1-877-ENDAIDS (363-2437)

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

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