Analysis of Integrated HIV Housing and Care Services. executive summary


In the United States, it is estimated that more than 1.1 million people are infected with HIV/AIDS (Centers for Disease Control and Prevention [CDC] 2013). Data indicate that individuals with HIV infection suffer far greater housing instability and homelessness than the general population: an estimated one-third to one-half are homeless or at risk of becoming homeless (Rourke et al. 2010). People living with HIV/AIDS (PLWHA) who lack stable housing are more likely to delay entering HIV care and less likely to have access to regular care, to receive anti-retroviral therapy (ART), or to adhere to their HIV medication regimen (White House Office of National AIDS Policy 2010).

The two main sources of federal housing assistance targeted specifically to PLWHA are the Housing Opportunities for Persons With AIDS program (HOPWA), provided through the U.S. Department of Housing and Urban Development (HUD); and the Ryan White HIV/AIDS Program (RWP), provided through the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). HOPWA’s primary focus is on providing housing assistance and related support services to PLWHA and their families. RWP’s is to provide HIV treatment and care: grantees can spend only a portion of funds on support services (of which housing assistance is one type).

In 2010, the Obama administration created the country’s first National HIV/AIDS Strategy (NHAS), designed to reduce the number of new HIV infections, increase access to HIV care, optimize health outcomes for PLWHA, and reduce related disparities (White House Office of National AIDS Policy 2010). Recognizing the role of housing in the HIV epidemic, the NHAS identified ways to increase federal HIV housing supports. To address the NHAS goal of greater access to HIV care, in 2011, the HUD Office of HIV/AIDS Housing awarded seven competitive Integrated HIV/AIDS Housing Plan (IHHP) grants that were designed to integrate housing assistance with HIV care and other supports at the individual service and community planning levels.

In 2012, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with the Mathematica Policy Research/Cloudburst team to analyze current federal HIV housing assistance services and study best practices integrating HIV housing and health care services. This project includes a quantitative study of the costs, utilization, and outcomes of current federal HIV housing assistance services and a qualitative study of innovative IHHP programs integrating housing assistance with HIV care.

The quantitative analysis includes significant findings: (1) a direct comparison of 2010 HOPWA and RWP data; (2) a housing assistance analysis of 2010 RWP Services Report (RSR) data, (3) a feasibility assessment of a correlational study of HOPWA and RWP housing assistance and outcomes, and (4) national, state-level, and time trend analyses. The qualitative analysis documents key features of four IHHP sites, including their site characteristics, program models, and integration of HIV housing, health care, and other supports. These IHHP grants are unique in their efforts to integrate housing and HIV care at three levels: individual client services, organizational data systems, and community-level planning processes.

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