Thirty years. It’s hard to believe it has been that long since the CDC first recognized what came to be known as HIV/AIDS. It’s even harder to believe how far we have come in the development of medicines to treat HIV and slow its progression so that today we can speak of HIV/AIDS as a chronic disease.
While scientists, philanthropists and politicians are offered much of the credit for how far we have come, many unsung heroes are overlooked: activists, advocates and people living with HIV/AIDS.
AIDS activists were largely responsible for much of the progress, including: pushing governments and companies to make HIV medications available; redefining clinical trials to ensure they were participatory and included people often left out (women, people of color and children); empowering people with HIV/AIDS to be seen with dignity and not as victims; fighting stigma placed on LGBTQ people (particularly gay non-trans men and trans women/men) and drug users; and advocating better prevention policies that include the controversial (but effective) use of comprehensive sex education and syringe exchanges.
The history of HIV/AIDS shows that activists are often ahead of the curve in recognizing effective treatment and prevention policies. So what are the next frontiers that we should be taking cues from current AIDS activists?
If we look here in Philadelphia, in recent years activists and advocates have been highlighting another issue that is inextricably connected to HIV/AIDS: housing.
Growing research across the country indicates that safe affordable housing is one of the strongest predictors of improved health outcomes, and reduced overall costs, for people with HIV/AIDS. Furthermore, housing helps prevent the spread of HIV as people are better able to take medications and avoid unsafe situations. In short, housing is treatment and prevention, and it saves money overall.
Here in Philadelphia we have one of the highest rates of HIV/AIDS in the country (one of the few cities to surpass us is Washington, D.C.), and we have an affordable housing and homelessness crisis. Last month Congressman Jim McDermott was in Philadelphia to speak about these joint epidemics and his landmark legislation that accounts for the vast majority of AIDS housing funding: Housing Opportunities for People With AIDS (HOPWA).
In his statement, Congressman McDermott said, “The City of Philadelphia ought to join the federal government and devote more of its own resources to this crisis. It can’t be a coincidence that Philadelphia has such an acute crisis in HIV and homelessness, yet devotes little to no resources to it.”
How bad is the crisis? The AIDS Activities Coordinating Office (AACO), of which I used to be the director, manages the citywide housing waitlist for people with AIDS and advanced HIV disease. The waitlist is currently at 231 people and has increased by nearly 70 percent in the past year, while the average wait time for most people on the list has increased from 2 years to about 2.5 years.
So what should we be doing? The city should continue recent progress, including: conducting the first HIV/AIDS housing needs assessment since 1996 and have a plan to track the ongoing need in the city, developing greater coordination among all city agencies involved in housing and HIV, and expanding AIDS “Housing First” slots (housing that does not require sobriety) that has proven to be very effective in other cities.
However, this is not nearly enough. Philadelphia, like elsewhere, is in the midst of an ongoing foreclosure crisis. Meanwhile, the Philadelphia Housing Authority has been selling hundreds of its properties. But we are doing little to find ways for these abandoned and sold properties to be used to house people most in need, including people with AIDS.
The city needs to be creative in seeking funding sources, from one-time federal grants, to cost-sharing partnerships with state agencies and private hospitals and insurers, to taxes and licensing fees on the wealthiest developers and landowners. HIV/AIDS, like mental illness, should count as a priority indicator for all housing programs, and we need to better streamline connecting people in need of housing assistance with appropriate programs. Also, HIV testing should be available at all city shelters, so we can find and get people into housing sooner (shelters/streets are awful places for people with bad immune systems).
Activists are showing us that housing is the new frontier in HIV/AIDS policy. The city needs to accept the facts and step up to find solutions to our AIDS housing crisis, and stop using the current recession or political climate as a scapegoat to avoid responsibility.
David Fair is the former director of the Philadelphia AIDS Activities Coordinating Office and of We The People Living with AIDS. He is currently the principal of David Fair Partners LL.C.