This is the second part of a three-part blog where I am sharing what I learned from the 9th North American Housing and HIV Research Summit held in Washington DC on August 1st and 2nd. Missed the first part? Click here for a read!
All throughout the Summit, there were some great speakers and presentations – it was clear that there was no lack of passion in the room. We talked at great lengths about addressing the structural factors to effectively respond to HIV and ending the epidemic. In this second part of the blog, I will speak to three structural factors: housing, food and employment.
The Impact of Homelessness in Achieving Viral Suppression among Low-Income HIV-Infected Women Living in a Well-Resourced US City, presented by Elise Riley, is a cohort study that assessed poverty and housing influences on HIV viral suppression among 120 low-income women with a history of housing instability in San Francisco (SF). In SF, viral suppression rate is estimated to be 72% – 88%; for the study cohort, only 40% achieved viral suppression at all measured time points over three years. The study confirmed that homelessness is at the centre and is a main driver of unsuppressed viral load – homelessness increases the odds of detectable viral load by 10%.
In addition to housing, food insecurity is also an important issue for HIV prevention and care. Food as Medicine presented by Dr. Angela Aidala demonstrated that food insecurity and HIV epidemic are closely connected. Food insecurity increases the risk of HIV infection and PLHIV are more likely to be food insecure. Food insecurity also worsens health of PLHIV along the cascade of care, including being linked to poor retention in care and lower viral suppression. Adequate, appropriate and secure food increases HIV health indicators and reduces emergency room visits. Dr. Aidala urged policy and decision makers to learn about this evidence and to go beyond resolution of hunger and malnutrition.
Combining Medical and Structural Interventions to End the Epidemic: Addressing Employment Needs of PLHIV by Mark Misrok pointed out that for many, HIV diagnosis initiates or exacerbates long-term poverty. Estimated rate of unemployment of PLHIV ranges from 40% to 70% over the past 20 years. Interestingly, the study found employment services are underutilized – while 45% reported a need for more information and resources related to employment, 22% nationally reported using vocational rehabilitation. Employment is linked to treatment adherence and thus we need to take a number of actions to better support PLHIV their employment needs. We need to incorporate ongoing assessment of individuals’ needs of employment-related information, services and resources. We also need cross-sectoral linkages and capacity building; as well as for service providers to become more aware of and build a network of resources related to vocational and rehabilitation training. A three-module online training by the U.S. Department of Labor and the U.S. Department of Housing and Urban Development called Getting to Work: A Training Curriculum for HIV/AIDS Service Providers and Housing Providers is a great resource for frontline workers to strengthen their understanding of issues related to PLHIV and employment as well as to support PLHIV in achieving their employment goals.
So what do we do with all this great research? Research allows us to get our foot in the door – they become conversation starters and talking points to grab people’s attention. Research shows over and over again that housing = prevention. Research can and does impact and improve policy so we need to keep pushing this message, and do what we do best – put the issue on the platform and continue our collective advocacy.
Read Part 1. | Watch for Part 3 next week.
Questions? Feedback? Get in touch!
Please contact Mona Lee, PAN’s Evaluation Manager at [email protected].