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OHTN OHTN/PositiveLite.com

Apr01

A roof over your head: connecting the dots between stable housing and improved health outcomes for people living with HIV

Wednesday, 01 April 2015 Written by // Bob Leahy - Editor Categories // OHTN OHTN/PositiveLite.com, General Health, Mental Health, Research, Sexual Health, Health, Lifestyle, Living with HIV, Bob Leahy

Bob Leahy with the recently released report from Ontario’s Positive Spaces, Healthy Places research project that not only made the case for better housing for people living with HIV but has been a catalyst for making that happen.

A roof over your head: connecting the dots between stable housing and improved health outcomes for people living with HIV

Ten years in the making 

It makes abundant sense that people who live in stable, suitable and affordable housing will have a better chance of coping with HIV and staying well than those who don't. Now there is a substantial body of made-in-Ontario research to prove it. 

Arising from community priorities set at a meeting of the Ontario AIDS Network over ten years ago - I remember being in the room and there was considerable agreement on this score -  a housing and HIV research project emerged under the wing of the Ontario HIV Treatment Network (OHTN) with major funding provided by CIHR. It blossomed over ten years, culminating in a final report released in March 2015. OHTN’s energetic Scientific and Executive Director Sean Rourke believes in research with real world impact. Positive Spaces Healthy Paces is something he is clearly very proud of. You can see him talking to me about the research in the video below, recorded for PositiveLite.com two years ago. 

What did the project achieve? There is a remarkable list, But first Let’s look at how Positive Spaces, Healthy Places, foir that's its name, went about proving the multiple connections between good housing and good health outcomes. 

Mandate 

Here’s what the project set out to achieve:

  • Identify the range of housing options available in Ontario
  • Determine how housing and homelessness experiences vary
  • Investigate the relationship between housing quality/security and physical/mental health, and access to healthcare, treatment, and social services
  • Examine how housing changes for people living with HIV over time
  • Increase understanding and awareness about housing needs and experiences
  • Identify the characteristics of healthy housing 

Methods 

Over 600 participants were interviewed up to four times as part of the study. The sample was selected to reflect the diversity of people living with HIV in Ontario, both in terms of region and social demographic. Thus people like myself, who  enjoy stable housing conditions took part as well as those living in less fortunate circumstances. 

Findings 

Here are the some of the more important findings . .

  • Approximately 50% of participants experienced housing instability
  • Over 30% were at risk of losing their homes
  • 87% were unable to meet their basic needs (e.g., food, clothing, housing) 

More importantly, Positive Spaces Healthy Places demonstrated that housing instability, including inappropriate and unsafe housing, is significantly associated with poorer mental and physical health among people livingwith HIV. Participants with unstable housing were more likely to: 

  • Have substance use issues
  • Experience depression and higher levels of stress
  •  Have lower CD4 counts
  •  Have higher viral loads
  •  Have higher mortality rates 

People living with HIV who face housing instability are less likely to:

  • Access medical and social services
  • Access antiretroviral therapy
  • Adhere to antiretroviral medications

There was also dialogue. Said one study participant on finally finding suitable housing ““My mental health changed and also my physical health changed. Yes, I started to look better physically and mentally I start to think clear, I have my own space, I have my own time. I became more focused and I started to look for other problems like how to deal with my HIV rather than housing... I start to think of the future.” 

Recommendations 

The report concludes that good housing has the potential for multiple major impacts. Here are four the report cites . . 

Housing is Health 

When people with HIV have safe and stable housing, and feel they belong in their neighbourhoods, they are healthier. When they don’t have to move more than once in a year or worry about losing their housing, they enjoy better quality of life. 

Housing is Prevention 

People with HIV who face housing instability have significantly poorer physical and mental health and decreased health related quality of life. Housing interventions can lower a person’s risk of transmitting HIV. 

Housing is Good Healthcare 

People with stable housing are more likely to access medical services and adhere to treatment regimens; people who are unstably housed are less likely to initiate treatment or access health care and social services. 

Housing is Good Policy 

Policies that increase access to stable, appropriate, affordable and supportive housing improve the overall health of people with HIV and help prevent HIV transmission, thereby reducing overall health and housing costs. 

Outcomes 

The project was notable for involving people living with HIV as peer research assistants (PRAs – fanning out across Ontario gathering the data, coordinated by a person living with HIV. In doing so, the report finds, the PRAs benefitted by developing their research skills, securing gainful employment, seeing improvements in their quality of life and helping to shape research that directly affects them. 

As well, the report lists the following outcomes, saying that findings from Positive Spaces Healthy Places have already led to increased funding, collaboration, awareness and policy changes. Data have been used to secure additional funding and support for local, national and international organizations, and researchers have built relationships with partners worldwide. 

Local Highlights:

More Funding for Housing 

Policy Changes 

  • People with HIV and substance use issues are now eligible for new supportive housing developed for people with addictions in Ontario
  • The strategic plans of FIFE house and Bruce House were both influenced by Positive Spaces Healthy Places 
  • Study data have been cited in the Ontario Human Rights Commission report Right At Home: Report on the Consultation on Rental Housing and Human Rights 
  • After reviewing the data from Positive Spaces Healthy Places, Thunder Bay added a fifth pillar, concerning housing, to its Municipal Drug Strategy. 

You can read the full report here. 

Positive Spaces, Healthy Places was funded by: the Ontario Ministry of Health and Long-Term Care, the Wellesley Institute, the Canadian Institutes of Health Research, the Ontario HIV Treatment Network and the Ontario AIDS Network. 

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