An estimated 1,122,900 adults are living with HIV in the U.S. About 0.35% of the U.S. population. It’s estimated that 15% or 162,500 of those individuals don’t know their status.
Every year the U.S. Department of Housing and Urban Development (HUD) completes a “point-in-time count” to survey people experiencing homelessness. Across the nation, volunteers go out in the evening to survey how many individuals are sleeping on the streets that night. In 2017, 10,171 reported they were living with HIV, and experiencing homelessness that night. And, that’s only those who self-reported their diagnosis.
Depending on who’s counting and where, people living with HIV and experiencing homelessness estimate from 8.5% to as high as 19.5% in the United States.
In 2017, 2,501 individuals in one night in Nebraska were experiencing some form of homelessness (on the streets, emergency shelter, etc.).
Additionally, that point-in-time count and HUD do not recognize individuals who are experiencing housing instabilities (couch surfing, near eviction, etc.).
If a person doesn’t know where they going to sleep tonight or if they’ll be safe in the morning, it’s probably difficult to prioritize health.
We can remember Maslow’s Hierarchy of Needs to show that a person’s physiological needs must be met before other needs, such as taking a medication every day.
Amanda, who does street outreach in Omaha for Nebraska AIDS Project reveals more:
“People living with HIV bring a whole new set of challenges to the already difficult time of experiencing a period of homelessness. Think about how you might take a daily medication. Perhaps you have an alarm set to take it at a specific time with a glass of water and maybe a meal. Remembering to take it is wrapped up into your daily routine usually. Now imagine you don’t have that alarm, you don’t have that glass of water easily available, you are not sure when your next meal will be, and you don’t have a clock to tell you what time of day it is. What happens if your medications are stolen and the pharmacy will not refill until 30 days have passed? Can you still take the medication if it has been exposed to extreme cold or extreme heat for long periods of time? How likely are you to take daily medications when you are constantly worried about your survival? What symptoms are you likely to experience if you do not take this medication as directed? These examples are just a few adherence barriers people face when they are HIV positive and also experiencing homelessness. Shelters do the best they can and they provide a needed service but it is wise to acknowledge that shelters are not always a good environment for everyone and shelters are often at capacity or unavailable. We often hear terrible stories of theft, violence, discrimination, sexual assault, communal illnesses, bed bugs, and unwarranted bans that take place within shelters. Some folks would rather brave the harsh weather conditions to live unsheltered instead of giving up a beloved pet, being separated from their partner, and subjected to a vulnerable position. Most people who are experiencing a period of homelessness are not the stereotypical scary criminals and drug addicts. Unless you are Warren Buffett, we are all just a few paychecks away from experiencing homelessness. Maybe you are lucky and have an extensive network of friends and family that would support you, maybe you aren’t so lucky. I simply ask you to please avoid judging those experiencing a period of homelessness. You have no idea what trauma they have lived through and what barriers may be keeping them in this position. Be kind.”
Looking at the HIV Care Continuum, we notice that there continue to be gaps in care from the time a person is diagnosed, to achieving viral suppression.
(Graphic from CDC, 2014)
- Housing instability delays HIV diagnosis and leads to increased risks of acquiring HIV.
- HIV medical care and treatment is a lifelong process, housing status is among the strongest predictor of maintain continuous HIV primary care.
- Taking medications may have competing needs, like food, hygiene, and shelter.
- Studies consistently find homelessness and housing instability are directly linked to higher viral loads and failure to achieve or sustain viral suppression, even after controlling other factors known to impact treatment effectiveness such as substance use and mental health needs (Aidala, et at. 2012; Leaver, et al. 2007; Kidder et al. 2007).
Nebraska AIDS Project is lucky to have resources like Housing Opportunities for Persons with HIV and AIDS (HOPWA). This program allows case managers to help clients apply for emergency rental assistance, or a security deposit to get them into safe housing.
Every day, case managers are working to help client avoid homelessness through wrap-around services.
If you are living with HIV and have housing or case management needs, contact us here.
Lacie is the Prevention & Support Services Supervisor for Nebraska AIDS Project in Lincoln.