Reprinted with the permission of the National Coalition for the Homeless http://www.nationalhomeless.org/publications/facts.html

ARTICLE #1: HIV/AIDS and Homelessness

NCH Fact Sheet #9
Published by the National Coalition for the Homeless, August 2007

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 illness. 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

ISSUES

A 2000 study by Columbia University showed that the greatest need for HIV or AIDS treatment after medication was stable housing. As a direct result of the lack of housing, many homeless people with HIV or AIDS are unable to receive adequate health care, treatment, and education about the disease. Therefore, there are special considerations and challenges when caring for homeless individuals with HIV or AIDS.

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