Research & Service

Angela Aidala, PhD, of the Department of Sociomedical Sciences at the Mailman School of Public Health, was a keynote speaker at the recent conference  on HIV and Housing at the White House Office of National AIDS Policy (ONAP). The purpose of the December meeting was to inform development of housing as a priority in the national AIDS strategy. The historic gathering included more than 70 representatives of government and community groups, including HIV/AIDS housing and services experts, researchers, and organizations representing the broader low-income housing and health communities.

Dr. Aidala presented her nationally recognized research on the role of housing vis-à-vis the continuing HIV epidemic and associated health disparities.  Her research has contributed to the growing awareness of housing as a structural factor or environmental influence that affects an individual’s ability to avoid exposure to HIV, or for HIV positive individuals to gain access to healthcare.  In her presentation, Dr. Aidala showed how housing – or lack of housing -- is a manifestation of broader processes of inequality and marginalization that are fundamental drivers of HIV vulnerability and poor outcomes among the infected.

Research Presented

Evidence from her research indicates how powerfully housing is linked with risk for HIV exposure and transmission.   For example:

• Homeless or unstably housed persons are 2-6 times more likely to use drugs, use needles, share needles, and/or engage in high-risk sex than stably housed persons with the same socio-demographic, clinical, and service-use characteristics. 
• Over time, persons who receive housing assistance or otherwise improve their housing status reduce risk behaviors by half, while persons whose housing status worsens are 2-4 times as likely to increase risky behaviors.

Housing status strongly influences healthcare access and outcomes for persons living with HIV (PLWH):

• Homeless or unstably housed PLWH compared to those with stable housing have worse health and more treatment failure. The death rate among homeless PLWH is 5 times the rate for housed PLWH.  
• Lack of stable, secure, and adequate housing is a significant barrier to HIV medical care and treatment.  PLWH who receive housing assistance are 2-3 times more likely to return to care after dropping out, maintain continuous care, and receive care that meets clinical practice standards.
• Housing status is a more significant predictor of healthcare access and outcomes than are individual characteristics, insurance status, substance abuse or mental health co-morbidities, or receipt of services to address co-occurring conditions. 

Dr. Aidala and other presenters at the conference will be providing recommendations of how housing should be reflected in the forthcoming National AIDS Strategy, with implications for the president’s three primary goals: reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related disparities.