HIV, COVID19 & Housing Instability

HIV, COVID19 & Housing Instability at AIDS2020: Virtual
by Hank Trout

The issue of “Housing as Healthcare” took center stage at AIDS2020: Virtual on Thursday, July 9, in a session called HIV, COVID19 and Housing Instability in High-Income Cities, organized by the University of California, San Francisco Center for AIDS Research (CFAR) and Housing Works of New York City.

Charles King and Virginia Shubert of Housing Works opened the session by acknowledging that stable, safe housing is key to preventing HIV transmission and stabilizing HIV care. In fact, housing status is the strongest predictor for HIV transmission. The people most vulnerable for HIV are also the most likely to suffer unstable, unsafe housing. Unfortunately, safe housing is out of reach for many HIV-positive people due to racism, poverty, and anti-LGBTQ prejudice. The COVID-19 pandemic has exacerbated the lack of adequate housing. Housing Works’ progress in serving the homeless and unstably housed has proven that the costs of spending on housing for HIV-positive people is offset by savings in care down the line. They have also learned that harm reduction sites are essential to controlling HIV and that medical and behavioral services are critical, as most HW clients have multiple health problems.

In 1997 in New York, the HIV/AIDS Services Administration (HASA) was codified into law. HASA has served 20,099 recipients. In emergency housing settings, 60% of people achieved viral suppression; in transitional housing, 69%; in permanent assisting living situations, 77%; and of people living independently, 80% achieved viral suppression. Housing Works has established 160 housing sites in NYC. They work with residents to enhance adherence to drug regimens, services, and viral suppression.

Darpun Sachdev of the San Francisco Department of Public Health, and Elizabeth Imbert, Matthew D Hickey, and Elise D. Riley of the University of California San Francisco discussed outreach to the homeless efforts in San Francisco. Knowing that the homeless are less likely to achieve viral suppression, UCSF and the County Health Department have set up the OPT-In program (Outreach Prevention Treatment to Improve HIV outcomes). The community-led, data-driven services include encampment health fairs (taking healthcare info to people where they are), syringe access sites, increased mobile outreach, and mobile healthcare access points. OPT-In re-engage people who have failed to adhere to their medication regimen. Of those clients, 59% were retained in the program and 50% achieved viral suppression. Often clients are found in homeless shelters. They are incentivized to access and continue care with gift cards, clothes, socks, etc.

The POP-UP program at Ward 86 of the Zuckerberg San Francisco General Hospital also provides services for those unhoused or unstably housed. In 2018, 75% of HIV-positive people in SF achieved viral suppression, but among the homeless, that number dropped to 33%. Some 79% of POP-UP clients were put on ART and 68% of those returned for follow-up services.

The presenters all agreed on one point—that housing is not only a right but is imperative in the fight against HIV/AIDS.


For more information about the University of California, San Francisco Center for AIDS Research, log on to https://www.cfar.ucsf.edu. More information about the services offered by Housing Works, check out https://www.housingworks.org/.


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.