President Barack Obama has developed three main priorities for the nation's first-ever national AIDS strategy: reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities.
Housing for people with HIV/AIDS fits squarely within these three priorities. Stable housing has been linked to lower HIV-transmission rates. People who are housed are more likely to be receiving care for their HIV. Finally, one of the greatest disparities is between the housed and the un-housed. Those of us without housing die two to five times faster than those with a home.
The issue of housing for people with HIV/AIDS is more critical in San Francisco than most other jurisdictions. According to a preliminary report from the Department of Housing and Urban Development, only 9.1 percent of people with HIV/AIDS in San Francisco are having their housing needs met. Analysis of the San Francisco Department of Public Health's Reggie database of people with HIV/AIDS shows that only 38.8 percent have permanent housing. Of those, most are paying the majority of their income to rent and are considered at risk of becoming homeless. Furthermore, the health department's latest HIV/AIDS annual report states that a full 10 percent of the total homeless population has AIDS.
People with HIV/AIDS are disproportionately the victims of homelessness and the effects of homelessness have a disparate impact on our health. The link between housing stability and HIV transmission are cause for more than alarm for the human costs to the person and their family �" each new HIV transmission has a lifetime medical cost in excess of $600,000. With up to 1,000 new HIV infections annually, San Francisco is incurring $600 million in new medical liability each and every year.
Because of this clear link between housing and the president's three main priorities, work has begun on a national AIDS housing plan to inform the national AIDS strategy.
The SF working group for a housing plan met recently to forward a set of interdisciplinary recommendations to the White House. In addition to the strongest possible call for increased funding for HIV/AIDS housing across the board, our recommendations include:
- Fostering appropriate employment opportunities for disabled people by removing the work disincentives in subsidized housing and funding supportive employment.
- Increasing access to general population affordable housing by improving outreach and marketing to the HIV community and implementing better data tracking of HIV-positive inclusion in all housing opportunities.
- Promote the San Francisco health department's Direct Access to Housing for people with medical needs as a national model. At least 17 percent of program participants in this permanent housing are HIV-positive.
- Implement legislation similar to recent laws protecting tenants in foreclosed properties. Providing increased time to find replacement housing for senior, disabled, HIV-positive, and other catastrophically ill tenants who are the victims of no-fault evictions will positively impact rates of homelessness for these vulnerable groups.
- HUD mandate a percentage of all publicly funded housing units be set-aside for HIV-positive residents using a formula based on local HIV prevalence.
- Leverage the Veterans Administration's recent commitment to ending veteran homelessness by prioritizing and setting aside housing for HIV-positive veterans.
- End discriminatory leasing practices that treat disability income disadvantageously to earned income when seeking to rent an apartment.
- HUD reinstate disability-related fair housing outreach and education programs.
- Allow Housing Opportunities for People with AIDS rental subsidy holders the same benefits as Section 8 holders, such as the ability to move to jurisdictions with less stigma and better services.
- Following the example of the Inter-Agency Council on Homelessness, facilitate federal inter-agency task force on HIV housing, including HUD, VA, Health Resources and Services Administration, and other relevant agencies.
- Allow HOPWA formula grants more flexibility. Local jurisdictions could serve more people with shallow rent subsidies, promote supportive employment for the disabled, and other creative approaches to housing stability.
- Base HOPWA funding formulas on the number of HIV-positive people in a jurisdiction. The current system of tying funding formulas to AIDS diagnosis is out of step with current reality and punishes jurisdictions like San Francisco that have invested in treating the epidemic.
We must remember that any plan, no matter how well conceived, does not reach its full potential without consistent advocacy to fuel its implementation. It is because of steady advocacy that the 2007 San Francisco Comprehensive HIV/AIDS Housing Plan has been able to meet a majority of the recommendations. While much remains to be done, much has been accomplished.
Because of this plan and continued advocacy:
1. We have prevented the loss of housing for nearly 500 people living with HIV/AIDS in Ryan White CARE subsidized units by moving costs to the general fund.
2. AIDS housing wait list policies are being updated to allow more frequent assessment and updating of list resulting in a more accurate and efficient list.
3. Residential care facilities (RCF-CI) and other project-based programs began accepting referrals from sources other than the AHWL. Also, transfers between programs based on medical need to allow movement of RCF-CI clients to more independent housing is being accomplished.
4. With Obama stimulus funds, we have recently expanded emergency eviction prevention assistance programs to serve hundreds of additional clients per year with legal assistance, one-time back rent payment, and short-term tenant-based shallow subsidies. This is a significant step toward our goal of assisting 800 additional households per year.
5. Developing marketing requirements to ensure appropriate representation in mainstream affordable housing and better track utilization by improving data is in process.
6. AIDS Housing Alliance/SF has created 12 supportive employment opportunities for people with HIV/AIDS, a small dent toward the housing plan's goal of creating 100 employment positions.
7. With the assistance of Supervisor Bevan Dufty, AIDS Housing Alliance/SF is moving forward with plans to develop housing and supportive employment for people with HIV/AIDS in the Castro and Upper Market.
8. Since the plan came out in 2007, 337 supportive housing units for homeless people with special needs have been built or are in the pipeline for clients of the Department of Public Health. Many of these are occupied by people with HIV/AIDS, helping to accomplish the plan goal of 55 additional supportive housing units for HIVers.
9. The overwhelming majority of people on the AIDS housing wait list are seeking a tenant-based rental subsidy. The plan called for the creation of 500 new subsidies. Unfortunately, the current economic climate has not allowed us to begin accomplishing this goal.
While we continue to work on the policy front, the AIDS Housing Alliance/SF invites HIV-positive folks to access our services, including: shallow rent subsidies for job training participants, move-in deposit loans and emergency assistance with back rent, and housing referrals and application assistance and landlord mediation. Our drop-in clinic is on Mondays at noon at 350 Golden Gate between Larkin and Hyde. Bring ID, letter of diagnosis, and proof of income.
Brian Basinger is director of the AIDS Housing Alliance/San Francisco.