Once again this December 1st the world's attention turns to the global issue of HIV/AIDS. Typically media coverage focuses on the role of education and redoubling efforts to prevent transmission among at-risk groups. However one aspect of the disease that has received less attention is the extent to which housing conditions affect both the risk of infection and the wellbeing of people living with HIV/AIDS.
Rising rates of urbanisation combined with the current economic crisis have contributed to an increase in rough sleeping and statutory homelessness. According to the latest Housing Report, 44,160 people in England and Wales are considered 'homeless and in priority need', a 10 per cent rise since last year, and the number of rough sleepers is also growing fast. In the United States, over 1.59 million people have spent one night or more in emergency shelter or transitional housing.
The current housing crisis is likely to have a significant health impact particularly with regards to HIV transmission. Indeed, studies have revealed that homeless people are more likely to engage in risky behaviour such as sharing needles and unsafe sex. Providing housing assistance to previously-homeless people has been shown to reduce the incidence of such risky behaviour.
In the United States, it has been estimated that almost half of the 1.1 million people living with HIV will need some form of housing assistance during the course of their illness.
Housing difficulties can also put enormous pressure on people living with HIV/AIDS. In London, 49 per cent of people living with HIV/AIDS rent from a local authority or housing association. In the United States, it has been estimated that almost half of the 1.1 million people living with HIV will need some form of housing assistance during the course of their illness. Effective treatment means that for those diagnosed with the disease in developed countries, HIV is a long-term manageable condition. Nevertheless, despite the strides made in reducing infection rates and improving their quality of life, numerous challenges remain, in particular addressing their housing needs.
The need for a stable home
Housing, especially in urban areas, significantly affects the physical and emotional wellbeing of HIV-positive people. Inadequate shelter, which is the source of many health problems among the general population, can put enormous pressure on people living with HIV/AIDS. Damp, mould, lack of ventilation and overcrowding are all contributing factors in the spread of tuberculosis and other respiratory diseases. These infections are the most common causes of morbidity among HIV-positive people and could be reduced by introducing simple improvements to living conditions.
In addition, the demanding nature of HIV treatment means that it is most effective when the patient is living in a stable home. Evidence has shown that patients lacking permanent accommodation are more likely to miss scheduled medical appointments. HIV treatment often requires drugs to be refrigerated and taken at specific times and with certain foods. Living in unstable or shared accommodation can make it difficult to adhere to this strict medical regime. Lapses in self-medication can mean people living with HIV/AIDS risk greater exposure to life-threatening infections as well as increasing the chances of their HIV becoming drug resistant.
Housing problems can also aggravate mental health problems. Depression affects one-third of HIV-positive people, twice the rate of the wider population. Dealing with a long-term illness, demanding treatment and often discrimination can have severe consequences for the emotional wellbeing of affected people. In such circumstances, housing problems only add to anxiety and stress, which in turn have been shown to negatively impact the effectiveness of, and commitment to, taking retroviral drugs.
Catering to housing needs
In the UK local authorities take account of people's vulnerability and medical conditions when allocating housing support or social housing. however they have been inconsistent in applying these guidelines to HIV-positive applicants, sometimes denying assistance in the absence of visible signs of infection. The needs of people living with HIV/AIDS are varied and, when assessing them for housing need, cannot be reduced to evidence of visible infection.
Damp, mould, lack of ventilation and overcrowding are all contributing factors in the spread of tuberculosis and other respiratory diseases. These infections are the most common causes of morbidity among HIV-positive people ...
The fluctuating severity of the disease and the strict requirements of treatment mean HIV-positive people are in great need of decent, stable and safe accommodation. Addressing these issues is made more difficult by the stigma still attached to the disease and the fact that the needs of HIV-positive people may not be immediately obvious. For these reasons, it is necessary to devise eligibility assessment methods that, while ensuring confidentiality, are more sensitive to the mental and physical aspects of those living with this long-term condition.
People living with HIV may appear healthy at the time of application, but suffer deterioration in their condition within a short time. When this is the case, living in a decent, stable and safe home can make a significant difference to the patient's exposure to further infections. Research in the United States has found an 80 per cent reduction in hospitalisation for people living with HIV/AIDS after they were stably housed.
Particular attention should be paid to the quality of housing provision in order to minimise the risk of respiratory infections. This can be done by enforcing simple standards such as adequate ventilation, heating and reducing overcrowding. Furthermore, stable and appropriate housing has a direct positive impact on mental wellbeing, which has been shown to improve the effectiveness of treatment.
As rents in the private sector continue to rise and cuts in housing benefits deepen in the UK and elsewhere, these factors combined with the shortage of affordable homes place enormous pressure on this vulnerable group. Ignoring the critical role of housing and withdrawing support now will come at a high cost later for support services providing emergency shelter and healthcare. This year's World AIDS Day's campaign proclaims 'zero new HIV infections, zero discrimination, and zero AIDS-related deaths'. This cannot be achieved without prioritising the right to safe, stable, good-quality shelter.