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A Home is Health

December 1, 2016

Melinda Tinsely and Renetta Boyd of HRSA's HIV/AIDS Bureau (HAB); CAPT Ilze Linda Ruditis, SAMHSA; and Kibibi Mathews-Brown, HAB
From left, Melinda Tinsely and Renetta Boyd of HRSA's HIV/AIDS Bureau (HAB); CAPT Ilze Linda Ruditis, SAMHSA; and Kibibi Mathews-Brown, HAB met on Oct. 6 to discuss outreach programs during HAB's Homeless and Housing Workgroup's Housing Awareness Month.

Whether you're serving homeless people, HIV patients or those experiencing substance abuse - and tens of thousands of Americans fall into all three populations - the likelihood of success often boils down to a single factor: Housing.

Estimates are that about half of the nation's 1.1 million people living with HIV/AIDS, for example, will experience “housing need” at some point in their lives, says Amy Palilonis, of the U.S. Department of Housing and Urban Development.

And those who are in need of housing are far more likely to fall out of treatment and become viral again, says Amy Griffin of HRSA's HIV/AIDS Bureau.

The two were among a multi-agency panel of experts who spoke Oct. 6, in recognition of Housing Awareness Month.

"Housing is health," said HUD's Palilonis, echoing a long-held axiom of safety net providers. In short, as goes one, so goes the other.

Research by multiple agencies has repeatedly found that rates of disease and addiction are much higher among those who are "unstably housed" – including HIV infections, which are estimated to be at least three times higher among homeless people, according to a 2011 HUD report at the foundation of the President's National HIV/AIDS Strategy.

"Access to affordable housing, along with care ... has been one of the chief concerns of persons living with HIV/AIDS and their advocates since the start of the epidemic," the report said, adding that demand for affordable housing by poor families, in general, had outstripped supply by a ratio of nearly 2:1.

Established in 1990, the Housing Opportunities for Persons with AIDS (HOPWA) program is the federal government's largest effort to address the shortage – with a $1.6-billion investment in the past five years alone.

But integrating the HUD program with "20 other federal prevention, care, and treatment activities" has proved challenging.

"There are gaps in service and some programs are stove-piped," observed CDR Kent Forde of HRSA's Bureau of Primary Health Care, noting that the nation's health centers serve more than a million homeless people annually.

Kent Forde of HRSA's Bureau of Primary Health Care
Kent Forde, BPHC

"We need to knock down obstacles and ensure we deliver services better" – for example, by building-in housing referral services into primary care clinics and using disease surveillance data to pinpoint areas of greatest need, as recommended by both HUD and the Centers For Disease Control and Prevention.

In 2014, the CDC awarded $9.9 million to 22 health centers for an effort called Partnerships For Care, which aims to more tightly integrate HIV services in HRSA-funded clinics in Massachusetts, New York, Maryland, and Florida.

"Housing status has been shown … to be one of the strongest predictors of health outcomes for persons living with HIV/AIDS, even after controlling for other factors,  such as drug abuse, mental health and receipt of medical and social services," the 2011 HUD report noted.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has reached the same conclusion, funding multiple efforts to reduce homelessness as part of routine behavioral health and substance abuse treatment.

A "decent, affordable place to live" matters, said SAMHSA project officer Jayme Marshall.

Learn more about HOPWA and the importance of housing in keeping people in care.

Date Last Reviewed:  April 2017