According to the National AIDS Housing Coalition, there are currently more than 140,000 households across the United States in which an HIV-positive individual is struggling with unstable housing. As Philadelphia grapples with an HIV-infection rate five times the national average, the intersection of HIV and housing issues is rapidly coming to the forefront of the discussion on HIV/AIDS in the city.
NAHC cites housing as one of the key factors in ensuring those diagnosed with HIV/AIDS have access to adequate treatment, and identifies housing-assistance programs as being integral in reducing long-term behavior risks for HIV.
Max Ray, an ACT UP activist who’s been involved in the group’s effort to press for funding for HIV housing opportunities, explained that stable housing is essential to proper treatment of the disease, especially considering the conditions that exist at some homeless shelters.
“If you have a weakened immune system, shelters, which are often dangerous, can become just deadly,” Ray said. “I know people who have gotten scarlet fever, PCP pneumonia — things people weren’t getting before but are now because they’re living on the streets and in shelters with weakened immune systems.”
Ray noted that even getting bed-bug bites from shelters can throw the body of an HIV-positive person “into chaos.”
Access to medication also becomes a challenge when HIV-positive individuals enter the shelter system, Ray said.
“The regimen of medicines is often very complex and in a lot of shelters the medicines are confiscated. So people often have to disclose their HIV status to get their medicines and sometimes may not be able to get them at the times they need them,” Ray said. “Some medicines you have to take exactly every six hours or exactly half an hour after you have food, so a lot of time people can’t stick to their regimen and end up getting sicker and sicker.”
One of the largest combatants to HIV homelessness is the federal Housing Opportunities for Persons with AIDS (HOPWA), established in 1992.
HOPWA, administered in Philadelphia by the Office of Housing and Community Development, provides housing subsidies for those with the disease who pay more than 50 percent of their monthly income on rent.
OHCD spokesperson Michelle Sonsino Lewis said there are currently 229 Philadelphians on the HOPWA waiting list.
The wait for HOPWA subsidies can be up to two years, Sonsino Lewis said, although priority is given to those who are homeless, with an average one- to three-month wait for that population.
In addition to the HOPWA program, the city also administers federal programs such as Shelter Plus Care, an initiative overseen by the federal Department of Housing and Urban Development that provides housing subsidies for HIV-positive individuals and people with a history of drug or substance abuse, or who are facing a mental-health crisis. Ray noted, however, that to be eligible, individuals must be in recovery from their addiction or in treatment for their mental-health issues.
All of the city’s HIV/AIDS housing efforts are fueled by federal funds, with Philadelphia not contributing any city dollars to support housing programs for those with HIV/AIDS, Sonsino Lewis said.
While Philadelphia’s infection rate is growing more rapidly that New York City’s, the Big Apple recently contributed about $5 million to support housing efforts through its HIV/AIDS Services Administration.
Ray added that Chicago, which has about twice the total population of Philadelphia but roughly the same number of HIV infections, has been working on successful public-private partnerships to address the housing needs of the HIV/AIDS community.
Philadelphia recently issued a request for proposals for a needs-assessment to evaluate the state of homelessness and HIV in the city, an analysis that has not been done since 1996.
According to the RFP, the assessment “will be used to update, review and evaluate the effectiveness of its HOPWA program strategies and overall housing programs and policies in consideration of changing housing market forces, the real-estate foreclosure crisis and many other local, regional and national factors affecting HOPWA needs.”
The HOPWA Needs Assessment 2012-17 will evaluate the barriers to permanent housing in the region, identify the unmet housing needs of the area’s HIV/AIDS population and develop a strategy to fill gaps, which will include at least one public forum in the local community and a survey of the HIV/AIDS community.
The needs assessment will be due to the city by July 31.
An RFP briefing session will be held at 2 p.m. Nov. 28 at OHCD, 1234 Market St., 17th floor, and all applications are due by 4 p.m. Dec. 22.
The contract will begin Feb. 1.
Once the assessment is completed, Ray asserted a “centralized” AIDS housing office would be most effective in addressing the myriad needs of the community.
“There’s a lot of confusing bureaucracy right now with different agencies getting and overseeing funding and multiple providers, so we need one place where people can go and say, ‘What would it take for me to get stable housing?’ and then have those needs met,” he said.
Other options that could be addressed, Ray said, include a “shallow-rent subsidy” program, which would cover partial, but not total, housing costs, housing options for active drug users and housing that is linked with medical care.
“Once the assessment is done, the city needs to be committed to coordinating and figuring out how to be as efficient and effective as possible,” Ray said.