Homelessness magnifies vulnerabilities to HIV acquisition and impedes access to related health services. Evidence suggests that stable housing may improve viral suppression and access to HIV care for people living with HIV. A people-centred response to HIV and homelessness needs to prioritize enhanced access to integrated HIV and support services. Read about Annie’s journey through homelessness and living with HIV.
Photo: ©Isabel Corthier/MSF
Someone held my hand when I lost hope, and I got back on my feet. Now, I'm doing the same for my fellow sex workers who have nowhere to call home and restoring hope that even within these hotspots, we can still take our ART and attain viral suppression.
Annie, 26, was diagnosed with HIV three years ago during a service delivery outreach by the Bar Hostess Empowerment and Support Programme (BHESP) team to the hotspot where she worked in Nairobi, Kenya. At that time, she was one of the 150 million people or 2% of the world’s population experiencing homelessness. A further 1.6 billion people or 20% of the world’s population lack adequate housing.
Due to the lack of privacy and a place to store her medication confidentially and safely within her workplace, Annie’s viral load was unsuppressed for a long time. The BHESP case management team was able to link her to a peer navigator who offered her a safe place to store and take her medication in private. Annie is now virally suppressed and works with BHESP as a peer navigator.
As Annie’s story shows, gender-based social and economic inequities can further negatively contribute to women’s experiences of homelessness.
A range of personal stories from people experiencing homelessness and living with or affected by HIV around the world are included in the advocacy brief, Put people first: Enabling access to integrated HIV services for people experiencing homelessness, developed by IAS – the International AIDS Society.
Their stories illustrate some of the models of support currently implemented in various contexts and the positive impacts that they can have in helping people overcome barriers related to stigma, HIV treatment, social support and other factors. These models form the basis of recommendations made for policy makers, service providers, surveillance teams, researchers and advocates for effective responses to homelessness, HIV and other health needs.
Person-centred care and evidence-based interventions for people who are affected by HIV and homelessness
Adapted from Luchenski et al, Lancet, 2018.
Housing and social determinants: The immediate provision of stable housing and reduced engagement with the criminal justice system, combined with the provision of occupational therapy, education, employment and life skills, especially schemes providing individual placement opportunities
Pharmacological interventions: Access to inclusive treatment services for HIV, TB, HCV, opioid use and mental health challenges, including antipsychotics
Psychosocial interventions: Should be based on a multi-modal approach, including contingency management for people who use stimulants, motivational interviewing, cognitive behaviour therapy, mindfulness and peer support
Case management: Enhanced coordination and delivery of health and social services
Disease prevention: Access to prevention and screening services, including harm reduction, vaccination, overdose prevention, and targeted and integrated screening for HIV, HCV and TB (including chest x-rays)
Well-being: Access to exercise, nature and complementary support services
For women: On-site pregnancy services with harm reduction services, parenting skills and integrated maternal mental health services and community empowerment programmes, especially for female sex workers
For young people: Noting the value of a safe environment and caring relationships, as well as the potential for family-based therapy, cognitive behaviour therapy and brief interventions for young people