Evidence Strategies and Practical tools for inclusion of social and structural interventions such as housing, employment, and food security in plans to end the epidemic
Policy, Program, Intervention or other types of research evaluation
Issues : For people with HIV/AIDS, housing is health care. It is also HIV prevention. Without housing, it is difficult to keep up the treatment regimens and physician visits that are vital for good long-term health outcomes and for the suppression of viral loads, which is key to reducing infectiousness. Numerous studies document the critical role that stable, affordable housing plays in keeping people with HIV in care and reducing rates of transmission of the virus. The National HIV/AIDS Strategy describes housing as a key component to keeping people in care and reducing infection rates. Yet stable, affordable housing is disproportionately out of reach for people with HIV/AIDS, many of whom have seen their financial resources diminished by decades of disability. San Francisco’s most recent HIV/AIDS Housing Plan, written in 2014, found that 78% of people with HIV in San Francisco are at risk of becoming homeless. Just one unanticipated expense can cause them to miss a rent payment, leaving them vulnerable to an eviction. Once a low-income person with HIV/AIDS is evicted, they face the real possibility of becoming homeless and seeing their health rapidly decline.
Description : The AIDS Legal Referral Panel (ALRP) has provided free and low-cost legal assistance to Bay Area residents living with HIV/AIDS since 1983. As treatment options improved and people with HIV/AIDS were living longer, ALRP expanded its services to meet the changing needs of its clients, and in 1998 it began its AIDS Housing Advocacy Project (AHAP). ALRP’s approach to the housing crisis for people with HIV/AIDS is to provide free, full-scope legal services for (mostly low-income, mostly LGBT) people with HIV in San Francisco. ALRP’s primary goal is to help local residents keep the affordable housing they already have by providing legal representation to tenants who are being evicted, to advocate for safe and habitable homes, and to help clients navigate complex subsidy programs. ALRP has been among several San Francisco agencies to successfully advocate for increased public funding for eviction defense attorneys.
Lessons learned : The increase in the number of eviction defense attorneys in San Francisco has made a significant difference in the number of tenants who receive full-scope representation and retain their housing. It is clear that tenants with full-scope representation in eviction lawsuits fare exponentially better than those who are unrepresented, as they are afforded the benefit of an attorney’s knowledge and expertise as well as all of the tools of litigation. Without an attorney, tenants would not be able to properly gather important evidence through the discovery process, or prepare for the complexities of a trial. The ability to take a case to trial also provides important leverage in negotiating positive settlement agreements for tenants, often enabling them to remain housed or at least affording them ample time and financial assistance to successfully transition into new housing.
For ALRP’s clients, eviction defense and advocacy for safe housing helps them to stay off the streets, and to stay connected to the local HIV-focused medical and supportive services that have enabled them to maintain their health. Legal services have proven extremely effective in preventing homelessness and keeping HIV+ tenants healthy.
Recommendations : Access to quality legal representation for tenants living with HIV/AIDS is critical to maintaining individuals’ health and reducing transmission. For communities without strong tenant rent control and eviction control protections, attorneys can help clients with issues related to fair housing, habitability and government subsidies.
Funding for legal services should continue to grow to meet the growing needs of the community, and legal services should be recognized as a crucial component of the fight to end homelessness and improve health outcomes for people with HIV/AIDS.