'Housing is health care,' goes the mantra of AIDS housing program advocates. And a recent New York City study backs up that assertion. People receiving supportive housing services were more than twice as likely to remain in proper medical care. Other research suggests that providing housing to HIVers can reduce transmission of the virus, minimize criminal activity, and save taxpayer dollars.
But efforts to provide assistance to the one third to one half of all HIVers whom advocates estimate are either homeless or at risk of losing their housing are becoming increasingly hampered by such obstacles as scarce funding, including cuts in the federal Housing Opportunities for Persons With AIDS program, community opposition, and the complexity of serving a population with highly diverse needs.
Meeting these challenges requires a blend of ingenuity, creative fund-raising, and--above all else--a fierce dedication to the cause of helping HIVers learn to help themselves. And several AIDS housing organizations around the country are emerging as leaders in this crucial and ever-more-complicated undertaking.
When it comes to innovative fund-raising, New York City's Housing Works leads the pack. Andrew Coamey, senior vice president for housing development and operations, says the organization--which operates 123 housing units, three HIV primary care clinics, 18 case management teams, a drop-in center, a needle-exchange program, and a job training program--tries hard to reduce its reliance on government money. So the agency runs for-profit thrift stores, a bookstore, a catering company, and a property management business, which together provide over one third of the organization's annual $41 million budget.
Tapping private-sector funding sources has proved to be an effective strategy for Doorways, a St. Louis housing group that has been honored with a Fannie Mae Foundation Maxwell Award for Excellence and a U.S. Department of Housing and Urban Development Best Practices Award. Matthew Teter, a spokesman for the agency, says Doorways' board of directors has been very successful in securing grants from religious and business groups, bringing in $310,000 of the agency's $4.4 million in revenue in 2004 from such donors as Lipton, Anheuser-Busch, Boeing, the Lutheran Foundation, and the United Methodist Church.
'The corporate money that we receive supplements the government grants that keep this organization going,' says Teter. 'We're actually in the process right now of trying to expand our corporate sponsorships because there are fewer government grants out there.'
Kathie Hiers, head of AIDS Alabama, also encourages AIDS housing providers to look beyond HOPWA and the Ryan White Act for government money. 'Even within HUD there are lots of other funding streams to utilize,' she insists. For her organization, other government funding streams include the Section 8 federal rental assistance program, the Section 811 housing program for people with disabilities, emergency provisions through the McKinney-Vento Homeless Assistance Act, and Home, a federal program aimed at increasing home ownership among low-income Americans.
But securing much-needed funding is only the first piece of the complex AIDS housing puzzle. The next is to determine how best to allocate resources to meet the diverse needs of a population with numerous overlapping life struggles, such as mental illness, lack of education, unemployment, criminal history, substance abuse, and hepatitis C coinfection.
'What we really try to do is be flexible with what our services are' to meet the unique needs of each client, says Mark Anderson, executive director of Save Inc. in Kansas City, Mo. 'And if that's an emergency housing program or a transitional housing program or one of our permanent housing programs, then we can do that,' he says.
For some AIDS groups it's not just what services are offered but where they're offered that emerges as another critical issue. In Alabama, for example, many low-income HIVers in rural areas face the double whammy of inadequate housing and an inability to travel to urban hubs for doctor appointments and related care, says Hiers. So AIDS Alabama has constructed 10 permanent housing facilities across the state that also include on-site medical and support services. The agency also is building a new facility specifically for women and children affected by HIV.
In addition to providing on-site medical, mental health, substance abuse, and case management services, many AIDS housing groups also provide a range of supplementary programs, including career counseling and job training to help clients become more financially stable as well as other life-skills'building workshops, including everyday home management.
While some might consider such support programs 'frills,' Hiers says they are actually crucial in helping clients achieve self-sufficiency. 'You can't just stick someone without a lot of skills or with substance-abuse problems or whatever [into a housing facility] and expect them to succeed,' she says. 'It could be basic things, like keeping a checkbook or cleaning the yard or changing the filters on the air conditioner. But for people who never owned a home, those are new things.'
When the right mix of direct and support services is achieved, the impact can be dramatic, say AIDS housing advocates.
A perfect example is New Yorker Thomas D'Angelo. The 55-year-old started taking drugs when he was 11 and then spent decades either in prison or homeless, eventually contracting HIV and hepatitis C. After he attempted suicide in 2001, he found his way to Housing Works, which gave him a place to live, offered him job training, and enrolled him in a 12-step program. Today, he's employed as an administrative assistant in Housing Works' women's transitional housing program and pays $750 in monthly rent for his apartment at the agency's Manhattan AIDS housing facility.
'It's encouraged me to help myself and get the feeling that I can lead by example,' he says of his experience with Housing Works. 'Not that I'm a leading type--I've always been a follower. But I do lead by example.'