Housing, health and HIV

Home is more than where the heart is

November 30, 2015

Writers, philosophers and artists around the globe have tried to capture the feeling of "home"—that psychological state of warmth and security, of familiarity and heart—and even though the feeling may be different for each of us, we can usually agree that "home" is a special place. It's not surprising, then, that where we live can have an impact on our mental and physical well-being.

Research has already pointed to a direct link between housing and health, particularly for people living with HIV. Studies have shown that a person's housing status (stable, unstable or homeless) is a strong predictor for whether or not they'll be able to access and adhere to medical treatment. Housing also plays a role in HIV prevention, as homeless or unstably housed people are more likely to contract HIV.

Armed with this knowledge, the Pacific AIDS Network (PAN) wanted to look at the specific experiences of people living with HIV in British Columbia. With support from the Canadian Institutes of Health Research, PAN co-led the development of Positive Living, Positive Homes (PLPH). Focusing on Kamloops, Prince George and Greater Vancouver as case study sites, the project involves a multi-stakeholder team of researchers, policy makers, service providers and people living with HIV. It was designed to explore the impact of housing-related policies and programs along with the lived experiences of community members.

"People living with HIV have very diverse needs and a range of complexities, just like anyone else," explains Dr. Catherine Worthington, professor in the School of Public Health and Social Policy at the University of Victoria and co-lead of the PLPH study. "By listening to what they've experienced, we can talk about what makes good housing policy. These best practices can then be adapted for other regions, too."

Listening to the needs of the community has been a hallmark of HIV/AIDS research in Canada for decades. This type of research, called community-based research (CBR), can be very powerful. In fact, PAN has an entire CBR program that was made possible through a partnership with the CIHR CBR Collaborative Centre (a program of REACH). For PLPH, this approach means that community voices are helping to shape the research questions and will also help to share and mobilize the results.

"Included in the research team are people living with HIV, who have concrete roles for deep and meaningful involvement in the research process," explains Andrea Langlois, PAN's Director of Community-Based Research. "In each of the three sites [for PLPH], we are mobilizing and bringing people together. Community-based research takes time and patience, but the research-to-impact timeline becomes shorter because we have all the right people at the table."

To date, the study has revealed that the stigma of living with HIV is still prominent in the province, particularly in rural and remote regions.

"There are still a lot of stereotypes and historical baggage associated with HIV," explains Dr. Heather Picotte, PLPH study coordinator at PAN. "Many people don't feel like they can access support or get the housing that they need."

Darren Lauscher, a peer on the PLPH study team, also stresses the role that stigma plays in finding a place to live. "Usually, a housing need comes down to a lack of finances," he explains. "However, when you throw a health condition into the mix, the need changes. More potential barriers come into play, such as physical accessibility, closeness of care providers, and community support structures. Then add HIV-related stigma to all of that, and suddenly the need takes on a whole new dimension."

The personal stories about these housing-related barriers are as diverse as the PLPH participants. For those who have had a long and rocky path to diagnosis, a history of unstable health has had an impact on employment opportunities. For others, advances in treatment have allowed them to age well with HIV—but it means that they are struggling to meet housing costs during a retirement time that they didn't expect to have.

Thankfully, the study results will help address these needs, as the team can work directly with service providers and policy makers to find solutions to housing-related challenges. Since PLPH is documenting housing-related successes and best practices, as well, the findings of the study could also be used or adapted in other areas of the country. Still, the team emphasizes that there is no "one size fits all" solution and that programs should take a holistic approach to well-being.

"Without a home, it's difficult to do anything else," continues Dr. Picotte. "But it's not just a roof over your head. Yes, it's about having stable, secure, and affordable housing—but it's also about having appropriate housing, about being able to live with dignity."

Positive Living, Positive Homes (PLPH) is a community-based research project in British Columbia that involves a multi-stakeholder team to address housing needs for people living with HIV. By engaging policy makers, service providers and community members, the team aims to find practical solutions to housing-related challenges across the province.

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