Care, well-being, and quality of life of people living with HIV and AIDS
Abstract Format : Positive Living, Positive Homes (PLPH) is a community-based research (CBR) study examining the relationship between health and housing of adults living with HIV in British Columbia (BC), Canada. The study documented the successes and challenges of various housing-related policies, and identified best practices for HIV and housing programs, services and policies to better meet the needs of people living with HIV (PLHIV).
Methods : Using a qualitative, longitudinal, case study methodology, 99 PLHIV and 42 service providers and policy makers participated in in-depth, semi-structured interviews in Greater Vancouver, Prince George and Kamloops between June 2015 and Oct 2017. PLHIV participated in a follow-up interviews approximately one year after initial interviews. Each PLHIV participant mapped their current living space, generated a personal health/housing timeline, and answered in-depth questions on housing, HIV, overall wellbeing, access to services, social networks and relationships, substance use, mental health, and stigma during the initial interviews. Follow-up interviews reported changes over the year, and renewed timeline and mapping as needed. HIV and/or housing service providers and policy makers working in a range of community and government organizations described the work of their organizations and related successes and challenges, and provided perspectives on policies and other influencers of housing provision for PLHIV.
Results : PLHIV participants’ health and housing experiences between initial and follow-up interviews varied widely. Overall wellbeing was influenced by housing transitions that strengthened participants’ ties to community supports, facilitated good relationships with landlords and housemates, and increased autonomy. Housing transitions that negatively influenced health included those whose environments threatened sobriety, increased isolation, and risked participant exposure to physical and mental stressors. Successful practices linked to providing healthy and affordable housing included: portable housing subsidies (i.e. housing subsidies tied to individuals rather than units that give individuals choice on where they live); mixed housing that combines social and market housing units; partnerships with municipalities for land; incentives for developers to build social and affordable housing (e.g., waiving development cost charges); free electronic registry (e.g., secure platform to hold digital scans of IDs); and community voicemails for people who do not have a fixed address or phone. Challenges related to housing provision for PLHIV included: public ignorance around HIV (and the resulting stigma); lack of affordable housing along with decreased rental housing stock and increased rent; no pet policies; diminishing capital-based support from the federal government; non-centralized housing registry; policy makers and service providers working in silos; and government’s tendency to view housing as an economic opportunity rather than a health issue.
Conclusions : PLPH advanced research on visual qualitative methods, and its findings will guide the development of resources and collective advocacy directions for the HIV communities. Visual data collection methods such as the living space maps and timelines enhanced diversity and reliability of data by helping participants recall details of their housing and health history. Study findings facilitated the development of specific approaches that support PLHIV in their housing transitions, including: identifying financially, culturally, and otherwise appropriate housing; understanding HIV disclosure rights and developing skills for disclosure; supporting people in navigating their new communities; and having access to services and training that build capacity for community engagement. Study findings also highlighted the need to consider housing as a health issue, increase coordination between policy and service sectors regarding HIV and housing, and build partnerships beyond HIV and housing sectors (e.g. law enforcement, municipal governments). Ignorance around HIV transmission and substance use, and resulting stigma and NIMBY-ism, continue to dictate where and how affordable housing is built in BC. This calls for action on increasing public’s awareness of HIV and addressing HIV-related stigma.