Positive Places: Housing for People Living with HIV/AIDS in DC

Testimony to DC Department of Housing and Community Development on Thursday November 19, 2009

Good evening. I am Anita Balan, a member of the Metro Washington Public Health Association (MWPHA). I would like to thank Director Leila Edmunds and the entire committee of Department of Housing and Community Development for this opportunity. My colleague Sarah Peterson and I are here today to advocate for long term, secure housing for People Living with HIV/AIDS in the District. As you may already know, currently there are over 440 homeless people in the district living with HIV/AIDS. We are here to ask for appropriation of sufficient supplementary funding from the City Council to house all 440 people on the DC waitlist of Housing Opportunities for People with HIV/AIDS (HOPWA) program. We also ask for the committee to recommend to the City Council to introduce legislation requiring mandatory reporting of the number of people on the waitlist for HOPWA housing.

Today we have come here to stress the importance of housing from a public health and a human rights perspective. Our message is clear and simple. Housing Rights = Human Rights and Housing Saves Lives. Our nation has a long standing history in establishing guidelines and providing short and long term housing for millions of Americans such as the Housing Act of 1937 which includes the Section 8 program, American Housing Act of 1949 and the National Housing Trust Fund. But America, the wealthiest nation in the world still has over 3.5 million homeless people. As the nation’s capital, the District of Columbia should be at the forefront of resolving the crisis of homelessness.

December 10, 2008 marked the 60th anniversary of the Universal Declaration of Human Rights. On this day, residents, organizations, and the DC City Council affirmed their commitment to human rights by declaring Washington DC as a Human Rights City. It is in this spirit that we ask the committee to create a consolidated plan, for the next five years, from FY 2011- 2015.

During the National Forum on the Human Right to Housing held just 10 days ago in this very city, Fred Karnas, a senior advisor to Secretary Shaun Donovan of Housing and Urban Development, clearly stated that the department is moving in the direction of providing safe and accessible low-income and public housing. What better time than the present, for the committee to work with the Mayor and the City Council and to shift their paradigm from housing as a commodity that can only be afforded by a few, to housing as a right that is guaranteed to all.   

Now my colleague Sarah Peterson will address some of the public health benefits of housing as it pertains to people living with HIV/AIDS.

Good evening. Stable, long term housing for people with HIV/AIDS is associated with positive health outcomes. Since 1992, when the HOPWA program was created, numerous peer-reviewed studies have clearly shown that housing assistance over time is associated with:

·         Improved housing status and reduced HIV risk,

·         Improved access to HIV medical care and

·         Reduced associated health disparities.

These also align well with the three priorities of the National AIDS Strategy.

Homeless and unstably housed people are extremely vulnerable to HIV infection. HIV infection rates among homeless or unstably housed people are three to sixteen times higher than that of the general population. Conversely, three to ten percent of all homeless people are HIV positive. People Living with HIV/AIDS (PLWHA) are also subject to discrimination, loss of income, violence, and illness due to unsanitary conditions. A staggering 70% of all PLWHA report a lifetime experience of homelessness.

Randomized control trial studies have shown that housing PLWHA has led to fewer hospitalizations, fewer hospital days and fewer emergency department visits. Other studies have shown that homeless PLWHA who obtain supportive housing have an 80% reduction in mortality and are twice as likely to have an undetectable viral load within 12 months. Additionally, housing for PLWHA is an effective prevention strategy that would have a powerful impact on the entire metro Washington community.  People who improved their housing status reduced risk behaviors by half, while people whose status worsened were four times as likely to exchange sex.

We agree that affordable, accessible housing programs are investments that would require significant resources from the government. But according to a Harvard University cost-effectiveness analysis, every $1 spent on HIV housing saves the community $3 in health costs. Another study conducted by Johns Hopkins University showed that housing can not only be a cost-offsetting investment but also a cost-saving investment for the government. This includes $300,000 of lifetime medical costs savings for each new HIV infection prevented.

Recently our local government has come under scrutiny for a lack of oversight of misappropriation of funds by some community based organizations. Assistant Secretary of HUD, Mercedes Marquez, has threatened to cut off all of 12.2 million dollars of HIV housing funding for DC. While it is gratifying to note that the DC City Council and the mayor are investigating  these issues, the government of the nation’s capital should act proactively rather than reactively to find a permanent solution to housing the homeless. Thus thelegislation for mandatory reporting of PLWHA on the HOPWA waitlist would be a small but significant step in the direction of combating the District’s epidemic.

We conclude by, once again, asking for appropriation of sufficient supplementary funding from the City Council to house all 440 people on the DC waitlist of HOPWA program. We also ask that the committee recommend to the City Council to legislate mandatory reporting of the number of people on the waitlist for HOPWA housing. To demonstrate community support we have gathered 328 signatures through petition drives from Metro Washington residents.

We would like to thank The National AIDS Housing Coalition, Housing Works, Metro Washington Public Health Association, and DC Fights Back for their support. Positive Places (a committee within the MWPHA) would like to offer itself as a resource to the Department of Housing and Community Development and in the coming months we look forward to a constructive dialogue and partnership with the committee to end HIV/AIDS based homelessness in the District.