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Housing and HIV
Stable and Safe Housing Supports Better Health for People Living With HIV

Released: December 22, 2023

Lauren Banks
Lauren Banks, MFA, MDiv
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Key Takeaways

Housing continues to be the number one unmet need of people living with HIV. Investigators who analyzed the Centers for Disease Control’s (CDC) Medical Monitoring Project data recently found that 1 in 4 people living with HIV need some form of housing assistance.

People who are unhoused are less likely to be adherent to their HIV medications for numerous reasons, including that many people who are unhoused often have their personal property stolen, their living sites are often swept by city officials, and they are sometimes afraid to have their HIV medication on their person due to stigma of having HIV.

Similarly, many unhoused persons are reticent to go into a shelter with their HIV medications because of theft and stigma.

Houselessness and Unstable Housing
When someone is unhoused, it means that they lack a residence meant for human habitation. This includes people who are living in shelters. For people who are unstably housed, meaning they have somewhere to live but are at risk of losing that living arrangement, the living conditions may be inadequate. 

These individuals carry the stress of trying to find permanent housing and/or employment, which can lead to less focus on their own health. Even people who are employed and housed can experience difficulty focusing on their health; people who are employed and rent-burdened often have to prioritize whether to pay their rent or pay for food over paying for medications or medical appointment costs.

Populations at Risk for Houselessness
LGBTQ youth are at high risk of becoming unhoused due to homophobia and lack of acceptance in their own family systems. This puts many youth in a position in which they engage in survival sex (ie, agreeing to a sexual relationship in order to have a safe place to stay) or are preyed upon for sex trafficking, thereby making them vulnerable to contracting HIV. Youth engaging in survival sex or being trafficked for sex may not know their HIV status because of choosing not to access or not having access to regular health care.

Aging persons living with HIV are increasingly becoming unhoused. In the US, as people lose their employment income, they are sometimes unable to afford the rising cost of housing.

Many aging persons living with HIV are fearful of disclosing their status in retirement homes and nursing care facilities. Staff at these locations need education and training on the science of HIV and caring for persons living with HIV to overcome stigma and discrimination that may occur in care facilities for aging persons.

Medication Adherence
When people are unhoused, medication adherence is likely not their top priority. They are likely to be more focused on finding and maintaining basic human needs like food, clean water, shelter, and security. Case managers and outreach workers are essential for helping these individuals continue to take their medication on schedule, and they can sometimes provide something similar to a secure locker so that the unhoused person can safely store their medication and any other valuables.

When people are living in unstable housing, it often means “couch surfing” at neighbors’ and friends’ houses where a person might need to hide their HIV status and their medications to remain safe and to avoid stigma associated with living with HIV. Hiding their medications may lead to missed doses.

Housing Solutions
The Housing Opportunities for Persons with HIV/AIDS (HOPWA) program provides housing to people living with HIV via many types of housing services. Unfortunately, the CDC estimates that there is only enough HOPWA funding annually to house each person living with HIV who is in need of housing for 1.24 months per year. The HOPWA program provides direct housing services for about 55,000 households, but the need is estimated to be for around 300,000 people. 

Once someone is stably housed, their likelihood of medical adherence and viral suppression is incredibly high compared to those who are not. For example, for Ryan White clients who were unstably housed, their viral suppression rate was 77.3%, whereas those who were temporarily housed had a viral suppression rate of 83.6%, and those who were stably housed had a suppression rate of 90.8%. These were individuals who were already linked to care and had case management; the underlying factor driving their health outcomes was their housing status.

In people living with HIV, other localities and housing organizations report even greater discrepancies in viral suppression rates, usually around a 20% difference, between those who are unhoused compared to those who are stably housed. 

For medication adherence to be successful and for the best chance of achieving viral suppression to undetectable levels of HIV-1 RNA, it is imperative that people living with HIV have a stable and safe place to live and thrive.

Your Thoughts? 
How often do you ask people in your care who are living with HIV about their housing needs? How do you approach that conversation? Join the conversation by posting a comment.