Analysis of Integrated HIV Housing and Care Services. I. Introduction


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). Homelessness and unstable housing are linked to higher risk of HIV infection, inadequate health care, poor health outcomes, and early death (National AIDS Housing Coalition 2007). 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).

Unable to afford housing, some PLWHA turn to federal HIV programs for assistance. The two main sources of federal housing assistance targeted specifically for 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).

In 2010, the Obama administration created a 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, NHAS identified ways to increase federal HIV housing supports. HHS, designated as the lead agency for implementing federal activities under the NHAS, is responsible for monitoring national progress toward meeting its goals. 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, as well as a qualitative study of innovative HUD program models integrating housing assistance with HIV care. The overall goals of the project are (1) to review the current status of HIV housing programs; and (2) to document innovative, replicable program models integrating housing assistance with HIV health care.

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