September 7, 2007
WHY HOUSING EQUALS HEALTH CARE
Holtgrave explains importance
of housing at community meeting
In July when New York City Speaker Christine Quinn said she didn't believe housing was an HIV prevention tool, Housing Works, GMHC and New York City AIDS Housing Network knew they had to make clear that the evidence speaks for itself. Yesterday the advocates brought in Drs. David Holtgrave and Angela Aidala, two of America's leading experts on the importance of housing for people living with HIV/AIDS, to speak both to Quinn and the community about the prevention and health care benefits and economic benefits of housing for people with HIV. The hope is that the speaker will put her full weight behind the HASA for All Act.
Even with the new evidence, Quinn hasn't yet come down firmly for the HASA for All Act, but participants of the meeting agreed she was more receptive than she had been in the past. "I was pleased with the outcome," said Charles King, Housing Works President and CEO. "I think it would be very hard at this point for Speaker Quinn to argue, like she has in the past, that housing as prevention is a radical idea."
NYCAHN co-director Shirlene Cooper also agreed that the meeting with Quinn was well worth it. "She listened and raised good questions and it was a little more productive than the meetings we've had before," said Cooper, who told her personal story to Quinn and her staff. "While (Holtgrave and Aidala) were going through their presentations, I said 'You just told the story of my life. Each one of those studies fits me perfectly. If I hadn't had housing, I wouldn't be here in this meeting. I wouldn't be here today. I am proof that housing saves lives.'"
HASA for All would extend full HASA benefits to poor New Yorkers living with HIV. Currently, people must progress to an AIDS diagnosis to get the full benefits that could actually keep them from progressing to AIDS in the first place. The expansion of HASA benefits would potentially help some 9,000 people with HIV get the housing, transportation, nutrition and other benefits essential to their long term health, as well as limit the costs the city spends on HIV services and cut down on new infections. Yesterday Councilmember Annabel Palma introduced legislation for the HASA for All Act. (See "AIDS ADVOCATES HAIL INTRODUCTION OF HASA FOR ALL ACT IN NYC COUNCIL")
Before Holtgrave and Aidela met with Quinn and representatives for Bloomberg and the Human Resources Administration, the experts spoke to a crowd of some 40 advocates, consumers and providers who attended the 10 a.m. meeting at Borough Hall, despite delays due to a taxi strike and broken subway lines. Aidala spoke about the sociological effects of homelessness and unstable housing for HIV positive people, while Holtgrave addressed the economic benefits.
Aidala's research at Mailman School of Public Health at Columbia University of HIV positive people in New York showed that they are half as likely to use drugs if housing situation improves and one-third as likely to report unprotected sex.
Holtgrave's research at Johns Hopkins Bloomberg School of Public Health shows that every prevented HIV infection saves over $300,000 in life-time medical costs. A recent Centers for Disease Control study shows that housing status is one of the strongest predictors of treatment access and health outcomes for people living with HIV/AIDS.
Aidala spoke about the structural forces that often work against many low-income people with HIV. "By the time some people get their housing needs met, their illnesses progress. Sometimes people lose housing because their status becomes known, or their partner becomes ill. Or the landlord finds out they're HIV-positive and takes the unit." She presented the Community Health Advisory Information Network study of people with HIV/AIDS in New York, which showed, controlling for outside factors, an increased risk of drug use and unprotected sex, often because of the stress produced by being in an unstable environment.
Aidala was quick to say that housing won't solve the AIDS crisis overnight, but that housing needs to be brought into the mix when talking about health care and prevention strategies. "The availability of housing is affected by the political process," Aidala said. "There's something we can do about it."
Next Holtgrave spoke of the economic benefits of housing for HIV-positive people. "The only reason we're doing economic evaluation is because we don't have unlimited money," he said candidly. "Because we have a fixed amount of money, how do we benefit the most people possible?" Holtgrave said that his research has shown that housing for HIV-positive people prevents new infections, and thus saves funds. Evidence shows supportive housing sharply reduces costly emergency and inpatient services among the chronically ill. Such savings have been found to offset up to 95 percent of the cost of supportive housing."Every time I hear one of these presentations I just can't understand how everyone doesn't see the benefits of housing," said Ginny Shubert, director of Shubert Botein Policy Associates and a co-founder of Housing Works.
Luis Gonzalez, a Housing Works peer, knew from personal experience that being homeless encourages a vicious cycle of risky behavior. "I used to shoot drugs a few years ago and I did more drugs when I was homeless. And when you're on drugs you don't care about anything," said Gonzalez, who is now HIV-positive.
Gonzalez's wife, and fellow Housing Works peer, Felicia Carroll agreed. "It's frustrating that there are people who still don't think housing's a prevention tool," Carroll said. "Housing leads you into medical care. If you don't have stable housing, you engage in high risk behavior."
A rally will be held in support of the HASA for All Act September 25 at 12:30 p.m. on the steps of City Hall.