Housing: The neglected first-line treatment to end HIV/AIDS

by Max Ray-Riek, for ACT UP Philadelphia

Published Dec. 4, 2015, 5:30 a.m. ET

For people with a home, HIV can be a manageable condition. But for those without stable housing, HIV remains extremely dangerous, even deadly. Now, with an end to HIV in sight, ACT UP is calling on Philadelphia to tackle its years-long waiting list for housing for people with HIV. ACT UP has a long history of working on behalf of people living with HIV. From securing the rights of those living in shelters here in Philadelphia to ensuring that Pennsylvania has one of the strongest AIDS Drug Assistance Programs in the country to fighting for the President's Emergency Fund for AIDS Relief that is bringing treatment to over 7 million people around the world, ACT UP has been fighting for fair treatment for those with HIV/AIDS for almost thirty years. We hope that ending homelessness among Philadelphians who are HIV+ will be the next victory.

We know that HIV is driven by social injustice. Globally, according to UNAIDS, "gender inequality, stigma and discrimination, lack of access to education and unstable livelihoods" all contribute to the epidemic. In the US, homophobia and transphobia, racism, mass incarceration, and poverty also worsen outcomes for those living with HIV.

Another social injustice: The lack of stable housing, which leads to a higher likelihood of using survival strategies like trading sex for shelter. Sex work is riskier when you are depending on it for survival and may not feel you can advocate for condom use. If you use drugs and don't have stable housing, it is harder to access and use clean needles -- multiple studies have shown that risky behavior is correlated with a lack of stable housing. But it gets worse. HIV infection rates are disproportionately high in communities of color, and communities of color face more structural barriers to care. Therefore, engaging in the same behavior is riskier if you aren't white.

Fully half of HIV+ people will become homeless or have unstable housing at some point during their illness, and being homeless with HIV means overcrowded shelters where weakened immune systems can turn exposure to germs into life-threatening infections.

Homelessness can also mean a denial of care. ACT UP has witnessed individuals with HIV being told: "You can't start medication until you have stable housing. Once your immune system is weak enough you'll get an AIDS diagnosis and then you'll be eligible for housing assistance." In other words, you have to risk your life to be eligible for the waitlist! This is unacceptable.

But there is a way forward. Researchers have shown that taking HIV medications lowers the amount of HIV in the bloodstream so that the chance of transmitting HIV is reduced dramatically (in some cases, it may be that there is zero chance of transmitting HIV). We can beat HIV the way we've beat other infectious diseases -- by making the amount of the virus in the population so low that no one gets sick any more. But to accomplish this, especially for the most vulnerable, we must provide stable housing to all Philadelphians.

There are two steps we can take right now to invest in housing for people with HIV. ACT UP is calling on Philadelphia to:

Put more money into the Affordable Housing Trust Fund. ACT UP is part of the Development Without Displacement campaign, fighting for funding for Philadelphia's Affordable Housing Trust Fund. The coalition's proposed anti-speculation fee on "flipping" properties (buying lots of cheap properties, and then immediately selling them at a much higher rate) would bring in more than enough money to permanently end the waiting list for housing for people with HIV in Philadelphia.
Philadelphia's AIDS Activities Coordinating Office (AACO) should apply for a social investment grant, for a comprehensive "housing-first" program with the goal of getting every HIV+ Philadelphian into stable housing. Cities from New York to Chicago to Seattle have proven that housing for people with HIV saves money by preventing new infections and by keeping people healthy. Philadelphia can take advantage of that research by attracting local, state, and private funds into investments in innovative housing-as-public-health programs. By tracking health outcomes such as lower HIV infection rates and fewer emergency room visits, we can prove that in the long run, these investments are paying for themselves. One source of new investment we should be prepared to leverage is Governor Wolf's proposed Pay for Success program that raises private capital to invest in health and housing projects. Philadelphia should be prepared to apply for a Pay for Success grant for housing for people with HIV, because all of the evidence suggests that such a program will result in long-term cost savings and improved public health.

So why is it urgent that we invest in housing for people with HIV? Because housing fights injustice, saves lives, and is a first line of treatment in ending HIV/AIDS.