Development of state and local plans to End the epidemic
Abstract Format : Lack of affordable housing is a critical problem for persons living with HIV/AIDS (PLWHA). Studies indicate the prevalence of HIV among homeless people is between 3%-20%, with some subgroups having a much higher rate. According to the 2017 Point-in-Time report for the Georgia Balance of State (BoS), there were at least 10,373 people who were homeless. Generally, people who are homeless have higher rates of chronic disease than people who are housed, due in part to the effects of lifestyle factors like substance use, exposure to extreme weather conditions, nutritional deficiencies, and being victimized by violence and abuse. Unstable housing can further affect adherence to HIV medical care amongst PLWHA. In addition, HIV-related stigma can further restrict them from seeking HIV services.
In Georgia in 2015, 22% of persons diagnosed with HIV also had an AIDS diagnosis. They were tested late. Due to HIV and homelessness, PLWHA often struggle with maintaining stable income. Housing issues, lack of income and social stigma are several social determinants of health that can affect access to HIV care. The influence of these social determinants is even higher in rural areas. The geographic area served by Georgia’s HOPWA grant is mainly rural with limited amenities, opportunities, and services in the community. When communities are not able to meet the needs of their own people it causes more social, psychological and economic problems. Limited opportunities lead to high unemployment and poverty. Unemployment can lead to other social issues, like substance abuse, which is further aggravated by undiagnosed and/or untreated mental health. A lack of transportation to travel oftentimes relatively long distances to seek HIV care causes further complications.
Methods : Considering these challenges around HIV care, especially in rural areas, the Georgia HOPWA Program has taken an Integrative Approach to coordinate additional housing and healthcare services. By collaborating with Ryan White Part B, all the HOPWA project sponsors are working closely with their local Ryan White clinics. Five of the nine HOPWA project sponsors are either local Health Departments or have Ryan White clinics on-site. This allows for the integration of Ryan White care services with HOPWA housing. The Georgia BoS Continuum of Care (CoC) covers 152 of Georgia’s 159 counties. Georgia’s HOPWA Program covers 126 of those counties. Since a majority of all HOPWA beneficiaries have been homeless, all HOPWA project sponsors are encouraged to work with their CoCs in order to access all the other homeless housing services available. The Georgia BoS CoC has implemented a Coordinated Entry System (CES) in 4 implementation sites within the BoS making them single points of entry for the persons seeking housing in those communities. With the implementation of CES, the BoS CoC is in the process of integrating all housing services, including HOPWA.
The HOPWA program is continuing to seek new partnerships to support the long-term housing needs and care services of PLWHA.
Results : An Integrative Approach to HIV housing care, including collaboration with Ryan White, accessing other HUD funded housing options, and additional local housing programs, will expand the options for PLWHA seeking comprehensive services in a non-stigmatized environment. In addition to housing through the HOPWA program, they will also benefit from other housing programs, behavioral health services, including mental health and substance abuse services, supportive services, transportation, and employment assistance.
Conclusions : The Integrative Approach with the HOPWA program is still at its initial stages. It needs continued development and evaluation to assess its impact.