Housing Is Healthcare—Demand It!

by Hank Trout

Imagine you’re a long-term survivor of HIV/AIDS in your sixties living in San Francisco. In the 1980s or ‘90s, your health forced you to quit work and live on Social Security Disability Insurance. You used to have private disability insurance through your past employer, but that insurance stopped when you turned sixty-five. You’ve been in your apartment for, say, twenty years, and so thanks to rent control, your rent is manageable, even on your limited income, even in the obscenely expensive rental market here.

One day you learn that your landlord has filed a “Notice of Intent to Withdraw Units from the Rental Market” under the Ellis Act, which enables property owners to evict all tenants and take the building off the rental market. You can fight the eviction (it has infrequently been done successfully) but you probably have neither the funds nor the energy for a long legal battle. Your home of twenty years will disappear in twelve months. Finding a new apartment, in this city where the median rental price for a one-bedroom apartment is $3,950, is not an option. Nor is leaving the city for another town because you lack the money for relocation.

There’s a frightening chance that you will join the thousands of long-term survivors who are homeless.

Given the lopsided income inequality in the US, more and more people living with or affected by HIV/AIDS across the country are losing their homes and apartments, are forced to leave homeless shelters, or lose transitional housing. According to DOORWAYS, a housing service in St. Louis, Missouri, of the estimated 3.5 million people who are homeless every year in the U.S., as many as 3.4 percent (102,000) are HIV positive, a rate three times higher than the general population. In some homeless sub-populations (African-Americans, transgender folks, seniors), the rate is estimated to be even higher. Studies have concluded that half of PLHIV are at risk of homelessness due to unaffordable housing costs, the high cost of medical care, stigma, discrimination, and limited incomes.

Knowing what we know about the link between stable housing and HIV/AIDS prevention and healthcare, this is unconscionable!

Study after study has demonstrated that stable housing is strongly linked to HIV viral load suppression rates. It makes sense——PLHIV who are in stable housing are more likely to seek HIV care, more likely to take advantage of other non-medical HIV/AIDS services, more likely to adhere consistently to their prescribed medicine, and more likely to achieve undetectable viral loads, rendering them unable to transmit the virus to others. On the other hand, PLHIV who are homeless or experiencing unstable housing are more likely to delay HIV care and less likely to access care consistently or to adhere to their HIV treatment. Housing for PLHIV is not only good healthcare, it is good prevention.

There are, of course, federal programs to help ensure that PLHIV are stably housed, such as HOPWA (Housing Opportunities for People with AIDS) but considering the Trump Administration’s slash-and-burn approach to HIV/AIDS-related funding, I wouldn’t count on it. The President’s budget for 2020 proposed cutting HOPWA funding to $380-million; only with fierce fighting did Congress boost that funding to $410-million. The President’s proposed budget for 2021 again calls for cutting HOPWA funding by twenty percent. Conservatives whine that HOPWA is too expensive, ignoring the fact that getting PLHIV into supportive housing sharply reduces their use of costly emergency and inpatient services. Further, these savings offset up to 95% of the cost of supportive housing. A HUD/CDC study indicated that housing is an effective cost-saving and cost-effective HIV prevention and treatment tool. Each prevented HIV infection saves more than $300,000 in life-time medical costs.

I have never experienced the horrors of homeless myself, but I know more than a few long-term survivors who have only recently gained stable housing. And except for the fact that our landlord is a good friend of forty-plus years and charges us less than half of the market rate for our one-bedroom apartment, I’m not sure where we could turn. Even with his salary as a teacher and my Social Security income, there is no way my husband Rick and I could afford $3,950 in rent! But for now, I am blessed with stable housing.

So, what can we do to ensure that our long-term survivors are never discarded, forced out onto the streets? For starters, write to your Senators, your Representative in the House, and HUD Secretary Ben Carson and demand that funding for HOPWA and other programs for PLHIV be increased even more. If we are serious about ending the HIV/AIDS pandemic, stable housing for PLHIV is imperative. Demand it!


Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick. Follow him on Twitter @HankTroutWriter.