The Ending the HIV Epidemic in the United States (EHE) plan aims to reduce the number of new HIV infections across states by ninety percent by 2030. By providing treatment for people with HIV, as well as services to address related social determinant needs, states can help to increase viral suppression rates and reduce new infections.

Housing supports for people with HIV can pose a particular challenge for states, as housing and treatment services for people with HIV are coordinated and funded through separate systems at both the federal and state levels. The National HIV/AIDS Strategy, a “roadmap” that can be used by states to consider treatment and supportive services initiatives for people with HIV, emphasizes integrating programming across healthcare and housing systems, tailoring care to include housing services, and leveraging data to improve health outcomes and reduce homelessness.

In Ohio, where data from 2014 (the most recent year available) showed that nineteen percent of HIV/AIDS clients served by the Ryan White HIV/AIDS Program (RWHAP) experienced housing instability, institutionalization, or had an unknown housing status, state leaders have operationalized this approach, setting a goal of reducing the rate of people engaged in HIV treatment experiencing housing instability by at least 3%.

Four Strategies Ohio Uses to Integrate HIV and Housing Services

1. Engaging in cross-systems planning. Ohio’s 2017-2021 HIV Prevention and Care Plan outlines a systematic approach to identify needs and coordinate across agencies, creating opportunities for state agencies to leverage existing resources to better connect individuals engaged in Ryan White services to housing resources.
2. Formalizing leadership. The Ohio Department of Health (ODH) created a full-time position within the HIV Care division to coordinate all housing initiatives and lead a state housing workgroup. This workgroup has regional representation across the state and directs the implementation of the housing objectives in the state’s HIV Prevention and Care Plan.
3. Using data to perform statewide needs assessments and track outcomes. At the core of Ohio’s strategy to reduce housing instability among people with HIV is a comprehensive needs assessment to identify gaps in services and resources. The HIV Care Team within ODH has established a regional inventory of housing providers, programs, and community resources. After clarifying definitions around housing status and training case managers on how to collect these data, ODH gathered data on housing status across Ryan White HIV/AIDS Program (RWHAP) participants through their case management system. ODH is developing an asset map that will overlay housing resources — collated from regional partners in the housing workgroup — with housing status across the state to identify service gaps and concentration of need. Ohio is also leveraging data to track outcomes and connect housing case managers across all Ohio regions. Between October 2019 and October 2020, the state of Ohio engaged 551 RWHAP clients, whose housing needs were served by housing case managers across all regions in the state. 
4. Braiding funding resources to coordinate services. With the fragmentation of health and housing systems in mind, Ohio has braided funds from HRSA’s Ryan White HIV/AIDS Program and the federal Department of Housing and Urban Development’s (HUD) Housing Opportunities for People with AIDS (HOPWA) programs to support connecting people with HIV with housing. In Ohio, most direct housing supports for RWHAP clients are funded through the state’s HOPWA dollars, while coordination and supportive services are funded using RWHAP resources. This includes the state employing housing case managers as non-clinical case managers to help clients identify housing opportunities and access HOPWA funds. Housing case managers are key to Ohio’s goal of removing barriers and freeing up resources to access available housing, by coordinating across regions and systems, and assisting clients with their housing-specific needs.

What’s Next for Ohio

ODH is currently assessing demographic and population data collected by RWHAP case managers to analyze and plan for housing needs across the state, an exercise that includes comprehensively mapping available resources to identify gaps by geography and population indicators and efficiently target resources. This is reflective of Ohio’s overall approach to housing supports for people with HIV, which emphasizes leveraging existing resources and creating new pathways for RWHAP clients to access them.

Acknowledgements

The authors at the National Academy for State Health Policy (NASHP) would like to thank the state officials from the state of Ohio who contributed to the blog, including reviewing a draft of the document. In addition, we thank Health Resources and Services Administration Project Officer Diba Rab and her colleagues for their feedback and guidance. NASHP also thanks Mia Antezzo for her work on this blog while on staff at NASHP.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under co-operative agreement number UD3OA22891, National Organizations of State and Local Officials. The information, content, and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.

Key Data

• Among people with HIV, 10% experienced homelessness in the United States in 2019.
• Reducing homelessness among people with HIV is a national and state-level priority. The National HIV/AIDS Strategy aims to halve the rate of homelessness among this population by 2025 from a 2018 rate of 9.1%.
• Housing insecurity and homelessness present additional risks to the health of PWH, including heightened exposure to infectious diseases in shelters and on the streets.
• Stigma and housing discrimination, as well as the complex care needs and high cost of medication for HIV/AIDS, can create further barriers to housing.