This Tool Kit was developed by NAHC to help advocates inform national and local resource allocation, planning, and prevention and health care practice through the use of tools and strategies that employ research findings to demonstrate the link between housing and health for persons at risk of or living with HIV/AIDS.

Background

A growing body of research examines the relationship of housing status to HIV prevention and care. In 2005, The National AIDS Housing Coalition (NAHC) initiated the National Housing and HIV/AIDS Research Summit as a new forum for the presentation and discussion of research findings relevant to HIV/AIDS housing policy and practice, and the development of data-driven advocacy strategies. For more information on the Housing Research Summit Series and to purchase Summit Series products, please click here webpage.

Summit II, held in October 2006, brought together 160 researchers, policy experts, and housing providers and consumers, representing twenty-four states, the District of Columbia and two Canadian Provinces.

Summit III, held in March 2008, Baltimore, Maryland, was held in collaboration with the Department of Health, Behavior and Society of the Johns Hopkins Bloomberg School of Public Health.

Summit IV, the first North American Summit, was convened by NAHC and The Ontario HIV Treatment Network (OHTN) in June 2009 in Washington, DC. Summit IV was held in collaboration with the Department of Health, Behavior and Society of the Johns Hopkins Bloomberg School of Public Health.

Summit V was convened by NAHC and The Ontario HIV Treatment Network (OHTN) in June 2010 in Toronto, Ontario. Summit V was held in collaboration with the Department of Health, Behavior and Society of the Johns Hopkins Bloomberg School of Public Health.

Summit VI was convened by NAHC and The Ontario HIV Treatment Network (OHTN) September 21-23, 2011 in New Orleans, Louisiana. Summit VI was held in collaboration with the Johns Hopkins Bloomberg School of Public Health and the Tulane University School of Public Health and Tropical Medicine. All Summit VI material may be found here. Research findings presented at the Housing and HIV/AIDS Research Summit Series:

Show that homelessness and unstable housing are strongly linked to...

• Greater HIV risk among vulnerable populations
• Poor health outcomes for persons living with HIV/AIDS
• Early death

Studies also show strong and consistent correlations between improved housing status and…

• Reduction in HIV/AIDS risk behavior
• Better access to medical care
• Improved health outcomes
• Savings in taxpayer dollars.

This Tool Kit was developed by NAHC to help advocates inform national and local resource allocation, planning, and prevention and health care practicethrough the use of tools and strategies that employ research findings to demonstrate the link between housing and health for persons at risk of or living with HIV/AIDS.

The Tool Kit is divided into three main sections:

Why this Tool Kit?
• How to Use This Tool Kit
• The Tools




Acknowledgements

• The Policy Took Kit and the National Housing & HIV/AIDS Research Summit Series are projects of the Visioning and Advocacy Committees of the National AIDS Housing Coalition (NAHC). The National AIDS Housing Coalition (NAHC) is a 501(c)(3) organization formed in 1994 to assert the fundamental right of all persons living with HIV/AIDS to decent, safe, affordable housing and supportive services that are responsive and appropriate to their self-determined needs.
• Development of the Policy Tool Kit was made possible by a grant from the San Francisco AIDS Foundation.
• Hilary Botein and Ginny Shubert of Shubert Botein Policy Associates helped develop the Tool Kit.
• Housing Works provided assistance with graphic design.

The experiences of clients and providers of HIV/AIDS housing services are important advocacy tools, but to impact policy & funding decisions

• Science-based data on housing and HIV prevention and health outcomes is IMPORTANT, and
• Science-based data on the cost-effectiveness of HIV/AIDS housing interventions is ESSENTIAL.

Findings from rigorous research:

• “Credential” what we have known for years as HIV/AIDS housing consumers, providers and advocates;
• Provide support for the maintenance and expansion of existing HIV/AIDS housing resources; and
• Point to the importance of new housing policies and practices consciously structured and studied as public health interventions.

With evidence to back them, policy makers can secure the resources we need to provide housing assistance and related services to people living with HIV/AIDS (PLWHA):

• As a basic human right;
• As a necessary component of systems of care to enable PLWHA to manage their disease; and
• As an exciting new mechanism to end the AIDS crisis by preventing new infections.

Get Informed

• Read the NAHC Housing and HIV/AIDS Research Summit Policy Papers
• Study the research findings (see the Summit III Briefing Book and the Policy Papers)
• Learn about NAHC’s federal legislative priorities:
• Demand full funding for programs for affordable housing for PLWHA and other disabling conditions, including HOPWA
• Urge Congress to enact the National Housing Trust Fund as a dedicated source of funding for low-income housing
• Call for passage of the Second Chance Act, to address barriers to housing for persons leaving prison and jail
• Support the Services for Ending Long Term Homelessness Act to fund services in supportive housing

Gather the Facts

• Document the results of housing programs:
• Service providers are well placed to gather evidence from program data and evaluations
• “Hard” health care markers like CD4 and viral load make it possible to track the impact of housing interventions
• Team up with researchers in your community to analyze data and report results
  • Call for standardized reporting on housing status as part of all federal and local HIV prevention and health care program reporting
  • Learn more about HIV housing need from NAHC’s HOPWA 2009 Need paper
  • Learn more about your community’s low income housing crisis
  • See housing affordability Congressional District Profiles developed by the National Low Income Housing Coalition (NLIHC).
  • See NLIHC’s Out of Reach 2007-2008 report to learn the “housing wage” in your area – the amount of money a household must earn to afford rental housing at HUD fair market rates.

Educate Decision Makers

• Members of your congressional delegation
• Don’t know who your congressional representative is? Visit www.house.gov to find out.
• Learn about key committees and about their relevance to housing and health decision-making visit including:
• Senate Appropriations Committee
• Senate Banking, Housing and Urban Affairs Committee
• Senate HELP Committee (Health, Education, Labor, and Pensions)
• House Appropriations Committee
• House Financial Services Committee (handles housing issues)
• House Energy and Commerce Committee (handles health issues)
• Learn about the Congressional timeline and opportunities for action, including the budget process (from the Center on Budget and Policy Priorities)
• Visit Washington-based and local offices of your member of Congress
  • Federal agencies
  • HUD – the Department of Housing and Urban Development
  • HHS – the Department of Health and Human Services
  • State and local elected officials
  • State and local departments of health
  • Administrators responsible for public assistance; mental health services; substance abuse services; homeless services
  • Private funders of services and research

Inform Local Planning Processes

Make sure your local housing and health planning processes are informed by the facts. Opportunities are available to use the Tool Kit to inform healthcare and housing policy at every level of government to influence the deployment of resources and affect strategies for delivery of HIV care and treatment and prevention services.

HOPWA grantee community-wide HIV/AIDS housing plans	While no statutory mandates exist, the Department of Housing and Urban Development encourages HOPWA grantees to develop community–wide strategies and partner with area nonprofits to provide housing assistance and supportive services for eligible persons. Many communities utilize HOPWA technical assistance funding to develop HIV/AIDS Housing plans which bring together local housing and healthcare providers and other interested stakeholders to identify HIV/AIDS housing need and devise strategies to address it. Click here for more information.
Ryan White CARE Act planning	Similar planning processes are available on the healthcare side through the Ryan White Planning Councils which operate by law all Title I Eligible Metropolitan Areas (EMAs). The Planning Councils, at least one-third of the membership of which is comprised of people living with HIV and receiving HIV services, sets priorities for funding based on identified needs. See Ryan White Care Act Amendments of 1996, P.L. 106-146.
Continuum of Care homeless housing assistance plans	The Continuum of Care is the local planning process through which interested stakeholders engage in assessing the housing and service needs of homeless people, developing a strategic plan to meet those needs, and apply for HUD funding through the McKinney Vento federal homeless assistance grant program. The Continuum of Care presents an opportunity for AIDS housing advocates not already engaged in the process to participate in identifying needs, establishing priorities and generally assuring resources are dedicated to people with HIV/AIDS. See HUD’s Guide to Continuum of Care Planning and Implementation .
10-Year plans to end homelessness	As a result of the federal government’s 2001 goal to end chronic homelessness in ten years, plans have now been adopted by over 100 states and localities across the country (click here for more information). These state and local planning processes present a unique opportunity to identify and address housing for people living with HIV/AIDS as a powerful homelessness and HIV prevention intervention. For more information visit the National Alliance to End Homelessness’s page on 10-Year plans.
Consolidated Plan (ConPlan) process for core HUD programs	The Consolidated Plan (ConPlan) combines planning and application requirements for HUD’s four block grant programs, including Housing Opportunities for Persons with AIDS (HOPWA). The ConPlan provides a key opportunity to influence deployment of federal resources at the local level for housing and housing-related services for people with HIV/AIDS. Click here for more information.
Public housing authority (PHA) 5-year plans	Local housing authorities must adopt 5 year plans (with annual updates) that include statements of housing needs, financial resources, capital improvement needs, demolition and disposition plans and conversion plans. The housing authority is required to conduct “reasonable” outreach to encourage broad public participation and conduct a public hearing. Vocal and active participation by HIV/AIDS housing advocates in the PHA planning process holds the potential for more public housing and section 8 resource set-asides for people with HIV/AIDS. See the Quality Housing and Work Responsibility Act of 1998; P.L.105-276; Oct. 21, 1998; 24 CFR 903.

Now Available

• Special issue of AIDS & Behavior November 2007.  NAHC has partnered with leading researchers to commission and prepare a special supplement of prominent journal AIDS and Behavior.  This is the first peer-reviewed academic journal ever to focus solely on the connection between housing and HIV/AIDS.  Along with compelling new research, the supplement includes policy perspectives from NAHC and former HUD Secretary, Henry Cisneros.
• HUD/CDC Housing & Health Study (H&H) – This is the first study of its kind to rigorously evaluate housing as a structural prevention & health care intervention for homeless/unstably housed PLWHA.
• Chicago Housing for Health Project (CHHP) – findings released at Summit III in March 2008.  This large-scale demonstration project examines the impact of supportive housing for homeless persons with chronic health problems.

Stay Connected

• Join NAHC – Learn more about NAHC and the Housing and HIV/AIDS Research Summit Series and find out how to get involved in advocacy efforts.
• Share your successes – to let NAHC know how you use research findings in advocacy, contact nahc@nationalaidshousing.org

• AIDS Action
• Corporation for Supportive Housing
• Housing Works
• National Alliance to End Homelessness
• National Association of People with AIDS
• National Coalition for the Homeless
• National Health Care for the Homeless Council
• National Housing Conference
• National Low Income Housing Coalition
• National Minority AIDS Council
• San Francisco AIDS Foundation
• The AIDS Institute

Were you able to convince your local Ryan White Planning Council about the importance of housing using the Took Kit PowerPoint? Get your Mayor to fund an HIV/AIDS Housing project using the fact sheet about cost-savings? The National AIDS Housing Coalition is collecting success stories from Tool Kit users to provide ideas and inspire others around the country.

Please send us your Tool Kits uses and success stories, both big and small, by emailing us at nahc@nationalaidshousing.org (subject line: Tool Kit Success).

• Capitol Hill, District of Columbia:

Use: Rep. Jerrold Nadler (8th-NY) again discussed HOPWA on the floor during appropriations consideration for FY08. The Congressman cited research presented at NAHC’s Housing and HIV/AIDS Research Summit Series. “Rates of new HIV diagnoses among the homeless are 16 times the rate in the general population,” said Mr. Nadler, “and HIV/AIDS death rates are five to seven times higher. People with AIDS who are homeless are more likely to be uninsured, use an emergency room, and be admitted to a hospital.” Click here to read the full transcript.

• Del Norte, Colorado:

Use: Denver, Colorado NAHC member Del Norte’s mission is to create and preserve housing and other opportunities for undeserved households, including those that are low and moderate income, Spanish-speaking and those with special needs. Del Norte cited information from the Policy Toolkit to successfully convince the City Council to consider approving its Juan Diego project. Homeless persons living with HIV/AIDS are more likely to thrive, remain healthy and even become employable with permanent housing. Toolkit data was also used in successful applications to the state department of housing for grant funding as well as to the state housing finance authority for tax credit funding.

• Housing Works Inc., New York City:

Use: The NAHC Toolkit and research findings were used with clients and staff in its “change the definition” campaign and will be using them for a new policy campaign with clients to be launched on better access to New York City’s HASA (HIV/AIDS Services Administration) benefits.  Cost data showing that cost savings from prevented infections will offset incremental spending on expanded housing eligibility has been a key element in this advocacy.

Outcome: The “change the definition” campaign scored a victory by getting the New York State AIDS Advisory Council to recommend changes to the New York State AIDS Institute’s HIV illness definition as it applies to housing eligibility.

• New York City AIDS Housing Network (NYCAHN):

Use: Cost analyses developed in collaboration with NAHC and its academic partners has been used in advocacy to pass state legislation to provide affordable housing protection for disabled persons living with HIV/AIDS by capping their rent contributions at 30% of disability income in the existing city/state funded HIV/AIDS rental assistance program. Cost data shows that increased housing stability will create public savings that more than offset the cost of the cap.

Outcome: The affordable housing legislation has passed both houses of the state legislature and awaits signature by the Governor. NYCAHN representatives recently had a one-hour meeting with the Governor to explain the cost implications of the bill. He told NYCAHN that the state budget office was “breaking its rule” for the first time and considering the cost offset in calculating the fiscal impact of the bill.

• DC Fights Back, Washington, District of Columbia:

Use: DC Fights Back has used the cost analysis data to support Council Members’ efforts to leverage DC government action to end the HIV/AIDS housing waiting list.

• Acadiana Cares, Lafayette, Louisiana

Use: Acadiana Cares has used Summit data to advocate and support increases in HUD HIV Housing funds and for HIV Homeless to remain a top priority in the Five Year Plan for the City of Lafayette.

Outcome:The group has been successful using the data to increase funding and ranking with Acadiana Regional Continuum for the Homeless (ARCH), the area HUD Continuum.

• Gregory House, Honolulu, Hawaii:

Use: Gregory House has consistently and vigorously used the NAHC Toolkit and Research Summit data when meeting with the Hawaii Congressional Delegation.   The use of these combined sources of information has helped cement the legitimacy and importance of Gregory House Programs in the community and the importance housing plays in keeping people living with HIV/AIDS successfully housed. 

Outcome: Using the NAHC Toolkit and Research Summit information, Gregory House heightened the awareness of its importance with its Hawaii Congressional Delegation, particularly Congressman Abercrombie (prior to his resignation). He and Senator Inouye secured Gregory House Programs a $100,000 earmark for a Homelessness Prevention Program for persons with HIV/AIDS through the Department of Health and Human Services.

• AIDS Alabama:

Use: AIDS Alabama has incorporated some of the research findings into its Alabama and Birmingham Consolidated Plans.  AIDS Alabama has disseminated some of the findings across the state for use in grant writing, and certainly uses the findings in every grant that written and submitted.  AIDS Alabama has provided the information to its local United Way, City Council, Alabama Legislature, etc., and has utilized the findings in its statewide push for an Alabama Housing Trust Fund, as well as in Birmingham’s Community Development Department in its successful effort to garner HOME funding for an HIV-specific development.  The language has become a part of almost every publication that goes out of AIDS Alabama.  Next month the CEO will do a presentation for HIV providers locally on this very topic.

Outcomes: Tool Kit and data from Research Summits garnered:

1) Alabama Legislative allocation for supportive services in the amount of $554,400.

2) HOME funding for permanent housing development in amount of $200,000.

3) Jefferson Affordable Housing Initiative grant to purchase and renovate six permanent housing units in amount of $200,000.

4) Improved ranking in local Continuum of Care.