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AIDS/HIV and Homelessness
Lack of affordable housing is a critical problem facing a growing number
of people living with Acquired Immunodeficiency Syndrome (AIDS) and other
illnesses caused by the Human Immunodeficiency Virus (HIV). People with
HIV/AIDS may lose their jobs because of discrimination or because of the
fatigue and periodic hospitalization caused by HIV-related illnesses.
They may also find their incomes drained by the costs of health care.
Tragically,
individuals with HIV/AIDS may die before they are able to receive housing
assistance. Efforts to build HIV/AIDS housing often encounter chronic
funding shortfalls, bureaucratic indifference, and the stigma and fear
of AIDS. Projects to create HIV/AIDS housing may fail because of local
opposition by neighborhood or community groups.
PREVALENCE
Studies indicate that the prevalence of HIV among homeless people is between
3-20%, with some subgroups' having much higher burdens of disease:
* In a survey of the Heatlh Care for the Homeless program, a plurality
of projects reported that HIV/AIDS is increasing among the homeless population
(O'Connell, J., Lozier, J., and Gingles, K., 1997).
* 36% of people with AIDS have been homeless since learning that they
had HIV or AIDS (Robbins and Nelson, 1996).
* A Los Angeles study found that two-thirds of people with AIDS had been
homeless (Shelter Partnership, 1997).
* Up to 50% of persons living with HIV/AIDS are expected to need housing
assistance of some kind during their lifetimes (Robbins and Nelson, 1996).
Many homeless adolescents find that exchanging sex for food, clothing,
and shelter is their only chance of survival on the streets. In turn,
homeless youth are at a greater risk of contracting AIDS or HIV-related
illnesses. HIV prevalence studies anonymously performed in four cities
found a median HIV-positive rate of 2.3% for homeless persons under age
25 (Robertson, 1996).
ISSUES
To address the special considerations and challenges that primary care
providers may face in caring for homeless individuals with HIV, the Health
Care for the Homeless Clinicians' Network is undertaking a project focusing
on HIV and homelessness. The following information is taken from the Network's
September 1999 newsletter, Healing Hands.
HIV
infection exacerbated by homelessness deserves special attention for the
following reasons:
High
morbidity and mortality: HIV-infected homeless persons are believed
to be sicker than their domiciled counterparts. For example, they tend
to have higher rates and more advanced forms of TB, and higher incidence
of other illnesses such as Bartonella. Another study has demonstrated
that more homeless people die of AIDS than other HIV-infected populations.
Barriers
to care: Homeless people with HIV may face many barriers to optimal
care. Injection drug use and lack of insurance, common among homeless
people, have been shown to negatively affect health care utilization,
level of medical care and health status.
Challenges
to adherence: Adherence to complex medical regimens may be more
difficult if one does not have stable housing or access to basic subsistence
needs such as food. As it is believed that decreased adherence is the
single best predictor of protease inhibitor failure and the primary cause
of medication resistance, this problem has grave personal and public health
implications.
POLICY RECOMMENDATIONS
Homeless persons with HIV/AIDS need safe, affordable housing and supportive,
appropriate health care. Emergency housing grants should be available
for persons with HIV-related illnesses who are in danger of losing their
homes, and housing assistance should be available for those already on
the streets. Federal assistance must be provided through adequate funding
of targeted housing and health programs, and through the enforcement of
anti-discrimination laws.
RESOURCES
AIDS Housing of Washington. Second National HIV/AIDS Housing Conference,
1996. Available for $5.00 from AIDS Housing of Washington, 2025 First
Ave., Marketplace Towers, Suite 420, Seattle, WA 98121-2145; 206/448-5242.
AIDS
National Interfaith Network. The HIV/AIDS Housing Handbook, 1993. Available
for $5.00 from AIDS Housing of Washington, 2025 First Ave., Marketplace
Towers, Suite 420, Seattle, WA 98121-2145; 206/448-5242.
Health
Care for the Homeless Information Resource Center. Annotated Bibliography:
AIDS/HIV Among the Homeless Population, 1998. Available, for free, from
the Health Care for the Homeless Information Resource Center, Policy Research
Associates, 262 Delaware Avenue, Delmar, NY 12054-1123; 888/439-3300,
ext. 246.
Leiberman,
Betsy and Donald P. Chamberlain. Breaking New Ground: Developing Innovative
AIDS Care Residences, 1993. Available for $44.95 from AIDS Housing of
Washington, 2025 First Ave., Marketplace Towers, Suite 420, Seattle, WA
98121-2145; 206/448-5242.
National
Commission on AIDS. Housing and the HIV/AIDS Epidemic: Recommendations
for Action, 1992. (Order No. D-209). Available for $7.50 prepaid from
CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003;
800/458-5231. National AIDS Hotline: 800/342-AIDS.
O'Connell,
J., Lozier, J., and Gingles, K. Increased Demand and Decreased Capacity:
Challenges to the McKinney Act's Health Care for the Homeless Program,
1997. Available from the National Health Care for the Homeless Council,
P.O. Box 60427, Nashville, TN 37206-0427; 615/226-2292.
Robertson,
Marjorie. Homeless Youth on Their Own, 1996. Alcohol Research Group, 2000
Hearst Avenue, Berkeley, CA 94709; 510-642-5208. Available from author.
Robbins,
Greg and Fraser Nelson. Looking for a Place to Be: A Report on AIDS Housing
in America, 1996. Available from AIDS Housing of Washington, 2025 First
Ave., Marketplace Towers, Suite 420, Seattle WA 98121-2145; 206/448-5242.
Shelter
Partnership, Inc. A Report on Housing for Persons Living with HIV/AIDS
in the City and the County of Los Angeles, 1999. Available, for free,
from the Los Angeles City Housing Department. Fax request: 213.367.9157.
Weisfeld,
Victoria D., ed. AIDS Health Services at the Crossroads: Lessons for Community
Care, 1991. Available, for free, from the Robert Wood Johnson Foundation,
Communications Office, College Road, P.O. Box 2316, Princeton, NJ 08543-2316;
609/452-8701.
Last
updated - April 1999 - National Coalition for the Homeless
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