Affordable housing is a pivotal Social Determinant of Health (SDOH) because it underpins the stability and quality of life necessary for people to achieve better health outcomes. Stable and affordable housing reduces stress and anxiety, which are crucial for mental well-being, and provides a secure base from which individuals can access healthcare services and maintain consistent treatment regimens [1]. This is particularly relevant for HIV-related outcomes, as stable housing has been shown to be associated with improved access to HIV care and adherence to antiretroviral treatment [2]. Housing instability, conversely, is linked to behaviors that increase the risk of HIV transmission, such as substance use and condomless sex, and can lead to delays in entering HIV care, reduced access to regular care, and poorer treatment adherence [3].

According to the Centers for Disease Control and Prevention (CDC), 17% of people living with diagnosed HIV in the U.S. in 2020 experienced homelessness or other forms of unstable housing [4]; and within the context of New York City, 45% of people living with HIV in 2018 accessed housing services and 8% experienced homelessness [2]. Ensuring access to affordable housing is not only a matter of social equity but also a critical component of public health interventions aimed at improving HIV-related health outcomes and a key recommendation of New York State’s Ending the Epidemic Blueprint [5]^.

Housing Data on the Dashboard

Last year, the ETE Dashboard launched a new data visualization featuring SDOH alongside HIV-related outcomes by county in New York State. Among the key SDOH measures viewable on this page, high housing cost burden provides dashboard users a snapshot of the relationship between housing and HIV-related outcomes such as new diagnoses (see figure below). While the chart suggests a potential association between counties with the highest housing costs and more HIV diagnoses, data should be interpreted with caution as further analyses would be needed to assess any correlations or causal relationships between individual SDOH and HIV measures. Visit the the ETE Dashboard's SDOH page to explore other SDOH measures and HIV outcomes, either as shown below or on a county map view.

Programs and Services in New York

New York State operates several housing assistance initiatives including the Housing Retention Services & Financial Assistance (HRFA),  Medicaid Redesign Team (MRT) Housing Retention Services & Financial Assistance for HighNeed Medicaid Beneficiaries (MRT HRFA), and Empire State Supportive Housing Initiative (ESSHI)[6].  HRFA assistance is intended to provide short-term direct financial support to individuals to help them find stable housing and engage in medical treatment.  MRT HRFA provides long-term rental assistance to individuals who are on Medicaid and who are living with HIV or other chronic morbidities. ESSHI assistance is intended to be a means to provide affordable and long-term stable permanent housing as well as supportive services to families, individuals, and youth who are homeless and have at least one or more disabling conditions or other life challenges.

Additional services and programs are administered in New York City to provide housing assistance to residents living with HIV/AIDS. These programs include the Housing Opportunities for Persons with AIDS (HOPWA), the Ryan White Part A Housing Program [7], and the HIV/AIDS Services Administration (HASA) [8]. HOPWA focuses on providing long-term housing assistance in the forms of permanent supportive housing, long-term rental assistance, and housing placement assistance. The Ryan White Part A Housing Program focuses on short-term assistance in the forms of short-term supportive housing, short-term rental assistance, and housing placement assistance. HASA helps those with AIDS or HIV through tailored service plans and case management. Services include help with Medicaid, nutrition assistance, housing, home care, mental health referrals, employment services, and transportation. Clients are supported citywide, with centers in all five boroughs and applications to the program can be found at the following site. All of these programs also help to connect participants with HIV care providers and provide assistance in accessing and maintaining treatment. Long-term participants of HOPWA were found to have higher rates of viral suppression and more likely to possess optimal CD4 counts when compared to those not receiving housing assistance, further emphasizing the importance of these programs in combatting the HIV epidemic.[9]

The intersection of social determinants of health, such as affordable and stable housing, and HIV care outcomes, cannot be overstated. With the recently added SDOH data page on the ETE Dashboard, we aim to provide context and emphasis on one of the key components initially laid out in ETE Blueprint as integral to ending the HIV epidemic in New York State.