We mapped mean cVL (mCVL) by neighborhood to visually explore spatial differences. As shown in the map (Figure 1), mean cVL varied by neighborhood. Historically, the two areas with highest AIDS case density have been among MSM in the relatively upper-income Castro and among low-income IDU in the Tenderloin. Noe Valley, Bayview and Visitacion Valley have not historically had high AIDS case density but have high mCVLs. It is notable that four of the five neighborhoods with the highest mcVL (Tenderloin, South of Market, Bayview) and have the lowest median incomes in San Francisco. Homeless mean cVL was twice the overall mean cVL (43,818 copies/mL)(p<0.001).4Overall SF mCVL was 20, 563 +/- 81,7934/5 neighborhoods with highest mCVL have the lowest median incomes in San FranciscoTenderloin, South of Market, Bayview and Visitacion ValleyHomeless mCVL was twice the SF mCVL (43,818 +/-103,492)Disparities by:Race/ethnicityTransmission groupInsurance statusEngagement in careGeography/Neighborhood
Vos: Meaningful Dialogue: on Housing & Health
Meaningful Dialogue: on Housing & Health SYNChronicity - Federal Panel Remarks April 20, 2012 David Vos, Director, Office of HIV/AIDS Housing
Housing: Investing in the FutureHousing is a critical component ofHIV care and prevention systems.Helping homeless and unstably housed people: • enter into supportive housing and remain in care • reduce HIV risk behavior & • adhere to complex treatment regimens.Addressing HIV disparities—seen in • retention in care & • delayed entry into care.
Housing: Investing in the FutureNo one should experience homelessness..No one should be without a safe, stable place to call home.Stable supportive housing is the cornerstone of HIV/AIDStreatment, allowing individuals to access care regularly.(Opening Doors: the Federal Strategic Plan to Prevent and End Homelessness, U.S.Interagency Council on Homelessness)Over 25,000 PLWH in homeless situations, sheltered homeless data(2010 AHAR);Sheltered/unsheltered homeless count of 630,000 at point in time, alongwith 1.6 Americans experiencing homelessness during year
Housing: Platform to Improve HealthMaximum impacts • Coordination with mainstream & leveraged resources • Targeting to most pressing housing issues • Synergy in place-based outcomes • Strengthen understanding from cross-program perspectives • Engage with agencies & providers – Health-care City/State Planning – Housing Community Development – Employment Management – Veterans Finance – Social Services Stakeholders/Advisory bodies – Criminal Justice, Oversight
HOPWA: Investing in the FutureU.S. Department of Housing and Urban Development FY12 $38.3 billion—83% used to support 4.5 million households with rental assistance, includes $1.9 billion in homeless assistance fundsHOPWA: $332 million, continues support for 60,234 householdsFormula Allocations (90%): $298.8 million (125 grantees, established in annual action plans and 5 year Consolidated Plans)Competitive Grants (10%): $33.2 million (28 renewals,3-29-12) including models for re-entry post-incarceration efforts, employment services and life skills, action to address chronic homelessness , and rural projects
HOPWA Modernization ProposalsA. Expanding Short-Term Housing Interventions.• Align with related short-term interventions & rapid rehousing• Add more flexible rental assistance terms, up to 24 months (vs. 21 weeks)B. Targeting funding to areas with the greatest needs• Shift HOPWA data source to HIV case reports, and update targeting to address housing costs & community resources, such as use of Fair Market Rents (FMR) and Poverty• Protect current operations & administrative adjustments.
HOPWA & CPD UpdatesOneCPD Technical Assistance on cross cutting needs for local capacity, on-line training on core curricula in grants management & housing service deliveryCommunity planning in Consolidated Plans that use meaningful data, map resources & needs and focus results with updated technology (IDIS)Cross-program leveraging of resources on HIV, health & homelessness – use of core indicators, outcomes & reporting systems (HMIS) & related CAREUse of new authorization -- HEARTH Act homeless assistance, e.g. Emergency Solution Grants (rapid re-housing/homelessness prevention)Housing First service delivery, alignment of systems that target vulnerabilities, build supportive housing alliances
HOPWA & Other UpdatesNew Partnerships with housing authorities – Community Planning and Public Housing networks Promoting Partnerships to Utilize Housing as a Platform for Improving Quality of Life, CPD Notice 2011-09 issued 9/20/11 and related second chance activities in assisting ex-offenders in re-entryHOPWA Integrated HIV Housing Plans – 7 demonstration grants for cross program coordination of housing and service models 2011-2014. Pilot on Getting to Work initiative in 9 communities.LGBT WH Conference on Housing and Homelessness (Detroit 3/12) including issues on runaway and homeless youth.HUD issued Equal Access rule (effective 3/5/12) on rights of LGBT people to prevent discrimination on basis of sexual orientation or gender identity in HUD funded programs.
Opportunities to Lean ForwardYour help on three HUD planning related tasks1. Identify the number of households of PLWH who have a housing need. SUGGEST: Arrange with local Health Dept. to access depersonalized data on CARE beneficiaries who have non-permanent housing situations. Consider client viral load (VL) suppression & differences in homeless situations Map the # or Community VL by census track or geographic basis Targeting tools for future activities Dialogue on cross program support for these households2. Coordinate with area providers in sending HIV housing recommendations to local agencies that manage housing resources.3. Expand partnerships & understanding on the link of affordable housing & HIV care.
Slides used courtesy of Moupali Das-Douglas, Priscilla Chu, Glenn-Milo Santos , Eric Vittinghoff, SusanScheer, Willi McFarland, Grant Colfax , Community Viral Load: Geographic, Clinical and Risk-RelatedDisparities in a Novel Population-Based Biomarker of HIV Prevention and Treatment, IDSA, 10/31/09
HOPWA InformationHOPWA documents, profiles, on-line financial management training, oversight/desk guide and links to webinars & eLearning resourceswww.HUDHRE.info/HOPWA section on the Homelessness Resource Exchange • Find a Local HOPWA Project Info • Email to HOPWA@hud.gov