Raphael Bostic, Assistant Secretary for Policy Development and Research Last month, I had the privilege of speaking at the sixth annual North American Housing & HIV/AIDS Research Summit, which HUD cosponsored with the National AIDS Housing Coalition and the Ontario HIV Treatment Network among others. This event gave me an opportunity to learn about the latest research on the topic and offer my thoughts about ways that researchers can help advance policy in this area.
From much research, we know much about how important housing is for people living with HIV/AIDS. Those who are homeless or unstably housed are more likely to use use hospital-based emergency or inpatient services frequently than those who are stably housed. Moreover, unstable housing has been associated with more prolonged hospitalization for this population. Homelessness is associated with delayed and poorer access to care for people living with HIV and AIDS.
There are other important benefits. Homelessness increases the probability that a person will engage in sexual and drug-related risk behaviors that put themselves and others at heightened risk for HIV. Entry into stable housing can reduce sex and drug risk behaviors among previously homeless and unstably housed people living with HIV and AIDS, thereby reducing their risk of transmitting the virus to others.
This evidence suggests that housing provision is an important public health intervention and should be supported as such. This view is fully in line with one of the department's important new thrusts. Goal 3 in the Department's strategic plan is to advance the concept of "housing as a platform," which is the idea that when people are housed well, they fare better along other dimensions as well. Children who are housed well do better in school and have less engagement with the criminal justice system. Adults in stable housing show stronger and more long lasting attachment to the labor force. Seniors in better quality housing face lower health care costs because there are fewer accidents.
While "housing as a platform" might seem obvious or intuitive, the fact of the matter is that the evidence base for the concept is thinner than one might expect. Relatively few studies have focused on evaluating this aspect of key policy problems. This has impeded the pursuit and implementation of some potentially important and impactful interdisciplinary policies. The research community should be looking for ways to demonstrate and quantify these cross-sectoral linkages and benefits, so that policy-makers and advocates ccan get the most effective and comprehensive policies in place.
In the case of housing for people living with HIV and AIDS, as I have noted, some of this research has already taken place. This is good, but there is one more aspect that researchers should be emphasizing: impact. Impact analysis - showing the relative costs and benefits of an action or policy, and in dollar terms - is one of the most powerful devices for today's funding debate.
We need to produce statements like a dollar spent on X produces Y dollars of benefit or saving. In this context, X would be housing-related services to people with HIV and AIDS.
Do we know how much providing housing-related services translate to in savings? Is it $5000 for every dollar spent? $500 for every dollar spent? $5 for every dollar spent? These are not hard calculations in some instances. But we have to do them. A few studies have moved in this direction, with the HIV substudy done by the Chicago Housing and Health Partnership representing a significant development whose results will be important. But more needs to be done. A broad consensus must emerge regarding the amount of savings associated with housing-related services provided to people living with HIV and AIDS. With such a consensus, the likelihood of advancing good policy rises significantly.
We have seen the potency of this in the area of general homelessness. There is a consensus on the tremendous value added across many sectors, including health and public safety, from actively working to prevent it. This broad-based understanding is one reason why homelessness continues to receive considerable support and resources. Others should emulate this model.
Next summer, the 19th International AIDS Conference will be held in Washington, DC from July 22-27, 2012. I am hopeful that the conference will produce work that helps advance our "housing as a platform" agenda, and I hope researchers consider incorporating it into their projects. There is a real opportunity — through providing crisp articulate impact analyses, dollar in-dollar out or saved — to move policy and help drive the allocation of resources.
In this sense, I am channeling my boss, Secretary Donovan, who is always saying we should be striving to change the world. He is right. So let's do it. The world is waiting.