Housing is Healthcare.
“Housing IS Healthcare“ was a refrain heard many times over at the 7th annual North American Housing and HIV/AIDS Summit held in downtown Montreal last week. And it’s true – there is abundant evidence that affordable, suitable housing for people living with HIV is associated with better health and wellness outcomes and less strain on the medical system.
Reflecting the importance of this issue for many people living with HIV, PositiveLite.com was there to report on the proceedings. Whilst there we took the opportunity to film video interviews with two presenters, the Ontario HIV Treatment Network (OHTN)’s Scientific and Executive Director, Sean Rourke and from the other side of the continent, Rosalind Baltzer-Turje, from The Dr Peter Centre in Vancouver. These videos interviews will appear shortly here and on the website of the OHTN, who graciously supported our attendance.
An impressively well executed conference attended by approximately 200 delegates from all parts of North America, it featured over 70 speakers. Principal organizers were the National AIDS Housing Coalition and the OHTN, with Quebec’s COCQ-SIDA the host city organizer, In fact PositiveLite.com contributor Ken Monteith gave one of the welcoming speeches.
Summit Highlights
“Closing the Housing Gap in the HIV Treatment Cascade” was the conference theme, and in fact many presentations used the treatment cascade to illustrate exactly what needs to be done to improve our collective response to HIV/AIDS (And if you are not up to speed with the treatment cascade concept, or variations thereof you really need to be, as it has become not just part of HIV jargon in relatively short time but the de facto means of measuring and tracking our performance in, amongst other things, getting people living with HIV on track to improved health and ultimately, suppressed viral load. The fact that many jurisdictions, including Ontario, do not have systems in place to properly track population health in this manner is alarming, but that’s another story.)
High ranking Keynote speaker Ronald Valdiseri from the U.S. Department of Health and Human Services painted the picture of the United States not being able to achieve its 2015 goals in its National; AIDS Strategy. However, he said the aim should be not to reinvent those goals but consider how to muster the political capital to bring the epidemic to an end. (Later we heard from the Canadians of reduced investment in housing due to high levels of public debt.) Valdiseri talked of the intersection between homelessness, housing, housing instability and HIV prevalence. He indicated that housing and food instability were the biggest predictors of health from research in to gay men in San Francisco, and in fact food stability, which this writer has seldom heard highlighted, figured prominently in several subsequent presentations.
Valdiseri noted that housing stability was associated with reduced risk behaviour and substance use and even reduced intimate partner violence. His objectives were to reduce new infections, improve health outcomes for people with HIV and reduce heath-related disparities in his country arising from race, ethnicity, location and sexual orientation.
Valdiseri ended with this: “Housing first. Housing is so fundamentally important that it must be taken care of as Job One!”
Angela Aidala of Columbia University was one of those who echoed the theme “Housing is healthcare, food is medicine.” Aidala painted the treatment cascade as part of an international (treatment as prevention?) strategy that includes test and treat. “The cascade draws attention to all those areas where there is falling off’ she said and added that “housing is often associated with those areas where people are falling off.” But so, she noted, is food instability which also impacts HIV morbidity and mortality.
The OHTN’s Sean Rourke presented findings drawn from that organization’s Positive Places, Healthy Spaces housing study, which followed 600 people living with HIV in Ontario over five years. (400 remained in the study at its end point, including as it happens, yours truly.) Alarmingly, 10% of the original cohort died during the course of the study, illustrating the true impact of unstable housing conditions. Rourke reported that age, where you live, drug use, amongst other factors, all affected mortality rates in study participants. His conclusions were that supportive housing has many beneficial and measurable outcomes including reduced prevalence of depression, improved immune functioning (CD$4counts), improved physical and mental health, reduced anxiety and better health-related quality of life. (For more details see the upcoming PositievLite.com interview with Sean Rourke)
Marjorie Bouton-Sweet, NDP MP for Hochelaga and Official Opposition Infrastructure and Housing Critic, impressed as the Day Two keynote speaker. She made the important point that providing housing is not the only solution to homelessness and pointed to spending on “homelessness prevention’ as also being necessary. She urged delegates to make sure their federal governments’ knowledge of the housing problem is up to par. As to Canada, she made the now familiar call for a National Pan-Canadian Housing Strategy. She urged that we should stress the monetary and social costs of not investing in social housing and that we should promote the notion that “housing is a right and not a privilege. Money spent on housing is cost effective” she said too.
Much of the conference thereafter was devoted to often innovative population-specific solutions that have been developed in various places in North America, fascinating and instructive in their diversity, but too numerous to detail here. Instead we will focus on one such example, the Dr. Peter Residence in downtown Vancouver which integrates housing, harm reduction and nursing care services in a nicely appointed home for people with HIV in both short- and long- stay situations. This will be the subject of a separate PositiveLite,.com post and video interview.
To be continued . .