[HARMRED] Philippe Bourgois letter to the editor on housing for people with HIV!
McLean, Rachel (CDPH-CID-DCDC-STD)
Rachel.McLean at cdph.ca.gov
Mon Dec 13 17:33:55 CST 2010
Too long a wait for housing
Philadelphia needs to help those with HIV/AIDS.
is the Richard Perry University Professor of Anthropology and Family and
Community Medicine at the University of Pennsylvania
is an assistant professor of medicine in the Division of Infectious
Diseases at Brown University Medical School
Carlos Gonzalez was close to death when he arrived at Temple University
Hospital in 2003. His case of AIDS was so advanced that his frail body
was overrun by thrush, meningitis, and pneumonia. It had become painful
for him to swallow and digest food and his weight had dropped to only
117 pounds. His desperate prognosis was made worse by the fact that he
had no home. Recently released from prison, Carlos lived in a drug
treatment recovery house in North Philadelphia. In a room he shared with
10 other men, Carlos was exposed to airborne infections that sent him to
the hospital coughing uncontrollably almost every month.
Over the next few years, Carlos moved between homeless shelters and the
streets. On lucky nights, friends - usually struggling themselves - took
Carlos was too sick to work, and his minimal Social Security disability
benefits weren't enough to pay for a room, food, and medical
co-payments. Forced to forgo one basic necessity for another, Carlos
continued to move in and out of shelters and hospital beds and
frequently missed his medical treatments.
Carlos is not alone. Many people living with HIV face limited access to
health services and housing in Philadelphia. Such conditions not only
devastate the lives of people like Carlos, but they also threaten the
well-being of our entire community. Philadelphia is already home to more
than 19,000 people living with HIV, and our rate of new infections has
grown to five times the national average.
In light of these statistics, Philadelphia must understand that
subsidized housing for the poor who are HIV-positive is an effective and
humanitarian means of treating AIDS and of preventing the spread of the
Studies from around the country demonstrate that stably housed people
with HIV are better able to take their lifesaving treatments regularly;
suffer fewer life-threatening infections; and are less likely to engage
in the unsafe behaviors that spread HIV. Subsidized housing for the sick
also saves taxpayer dollars in other social services by decreasing the
frequency of hospital admissions and shelter visits and by averting
public expenditures on medications for newly infected individuals. Many
other major cities across the country already supplement federal funding
for housing for people with HIV and AIDS with municipal funds.
Philadelphia, however, devotes no direct city funding to housing people
with HIV/AIDS. Instead we shortsightedly maintain a long waiting list
that includes more than 130 individuals and families. In 2009 alone, at
least six Philadelphians living with HIV/AIDS died while on the streets
or in the shelter system.
We represent a group of 80 medical and public-health professionals who
have authored a consensus statement on this crisis. The group includes
experienced physicians such as Ellen Tedaldi, the director of Temple's
comprehensive HIV program and the doctor who treated Carlos when he was
We present the scientific documentation for the effectiveness of
subsidized housing in HIV prevention and treatment and urge city
government to recognize that providing housing for people living with
HIV and AIDS is an essential public-health intervention (see
www.housingistreatment.org). Our city must house everyone on the waiting
list and expand the reach of the federal housing program to include
people before they become so sick that they are on the verge of very
painful deaths. These small steps, which will cost the city
approximately 0.1 percent of its current budget, are necessary
components of any plan to effectively combat our alarming HIV epidemic.
Unlike too many others, Carlos Gonzalez was fortunate enough to see his
condition improve. After two years on the waiting list, Carlos began
receiving rental subsidies in early 2010. He now lives in a one-bedroom
apartment in South Philadelphia. Because he is able to take all
scheduled treatment doses, the HIV virus cannot be detected in his
blood. As a result, his immune system is much stronger, and he no longer
spends two weeks each year in a hospital bed.
Today, Carlos is a certified HIV counselor. He gives back to the
community and provides hope to others going through the same struggles
he successfully overcame. Because he knows that so many of the people he
reaches out to on the streets will not survive the wait for housing,
Carlos has become a tireless advocate. We stand with him in asking Mayor
Nutter and City Council to end the waiting list for housing assistance
for people living with HIV and AIDS.
E-mail the writers at bourgois at sas.upenn.edu
<mailto:bourgois at sas.upenn.edu> and amy_nunn at brown.edu
<mailto:amy_nunn at brown.edu> .
Rachel McLean, MPH
Adult Viral Hepatitis Prevention Coordinator
STD Control Branch
California Department of Public Health
Phone: (510) 620-3403
Email: Rachel.McLean at cdph.ca.gov
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