World AIDS Day: Looking at Housing Barriers to HIV Wellness
• December 2022 •
From Juan Navarro, Executive Director
Los Angeles Centers for Alcohol and Drug Abuse
Executive Director’s Message: World AIDS Day: Looking at Housing Barriers to HIV Wellness
On December 1st, L.A. CADA “Rocked the Red Ribbon” for World AIDS Day 2022. This year, the global awareness campaign focused on inequalities holding back progress in ending AIDS. When I think of the many barriers to care for persons living with HIV (PLWH), lack of stable housing is a big one.
In fact, homelessness is a strong predictor of poor health outcomes in the medical management of HIV. Persons experiencing homelessness present with higher rates of HIV infection, have a more difficult time staying in care and adhering to HIV medications, and they experience worse health outcomes. Dr. Julie Lifsbay of the San Francisco AIDS Foundation states, “The HIV rate among homeless people is incredibly high. And, homeless folks who are becoming infected with HIV are from more marginalized communities . . . they are more likely to be trans women, African American, people who use injection drugs, or men who have sex with men who use injection drugs”.
Here in L.A. County, sky-high rents, lack of affordable housing inventory, and behavioral health disorders are major barriers to stable housing. A substantial number of people living with HIV in the U.S. have spent time in prison or jail, including those with co-occurring substance use and mental health disorders that complicate HIV care. A criminal history makes getting good employment and housing particularly difficult, contributing to the cycle of homelessness.
To address this issue, Los Angeles Centers for Alcohol and Drug Abuse has become a specialty provider of Recovery Bridge Housing; in fact we have the largest number of RBH beds in L.A. County. Bridge housing provides a supportive place for all the needed elements of recovery to take place: HIV care, behavioral health treatment, as well as the life skills education needed to support sustained recovery and stability. Our programs also address the unique needs of many marginalized PLWH, including provision of LGBTQ+ Affirming (exclusive) and LGBTQ+ Sensitive services, programs for sex offenders, and exclusive beds for Transitional Age Youth (TAY). With more in continuous development.
This World AIDS Day, if you know some living with HIV who needs help and housing, give them our number. L.A. CADA is here for you at (562) 906-2675.
“Thanks for asking – I’m real happy to share about my journey. My name is Jamie. I’m a transwoman in recovery for over two years. Life started good, but when I came out to my family everything changed. So, we had never talked about it, but I think my moms always knew about me. But when pops and everyone else knew, she was real embarrassed. I had to leave the house, it was so much bad blood there. Since then I was basically homeless, staying here, staying there. On the street. I did use (drugs) before, but it got worse because I was really depressed. Not one single person there for me. After I got out (of prison) what helped me the most was going into treatment. Everyone there knew what I was going through. The counselors, the other residents in the house (Recovery Bridge Housing), the peers. They all had been where I was. It wasn’t just a bed I needed. With HIV, drug addiction, depression; someone like me, you need it all. Most of all, I needed someone who feels me. So, what I can say to others is to get in a program where they really understand you.”
SPOTLIGHT – THE EVIDENCE IS IN ON:
Housing First is an evidence-based practice (EBP) that can improve outcomes for homeless persons living with HIV (PLWH). This EBP allows people experiencing homelessness to quickly and successfully enter housing without preconditions and barriers. Housing First places the need for a stable home above all other needs, and uses housing as the foundation from which to access other needed care and services.
One randomized trial found that when homeless HIV-positive individuals are hospitalized and provided with intensive case management, survival with intact immunity was increased and overall viral loads were decreased.
Despite data like this, some behavioral health programs continue to maintain strict regulations that serve as barriers to wellness. When treatment requires continuous sobriety or strict service participation, or if the program lacks diversity (making some people feel unwelcome), there will inevitably be those who are left out of treatment.
That’s where Housing First comes in. Rather than imposing a one-size-fits-all rule which denies help to a client or discharges someone who, for example, fails to a drug test, Housing First keeps people housed while providing education and support for adherence to HIV regimens and behavioral health treatment. It’s not an “anything goes” practice. This EBP works to fulfill a basic human need, builds trust between the client and the provider, and makes it possible for the homeless people to take advantage of helping services.
How Housing Helps: Surviving with HIV