In this guest post, Kate Jongbloed presents housing instability as social determinant of HIV/AIDS in Canada. Kate draws on others’ arguments that the absence of a national housing policy is to blame for fueling housing instability, with severe implications for the HIV epidemic. Kate is the web coordinator for HealthyHousing.ca, a Canada-wide online resource on HIV and housing. She blogs weekly for Plan Canada’s Because I am a Girl campaign to engage young Canadian girls in global gender issues. See Kate’s full bio here.
Housing instability and HIV are parallel epidemics – what puts an individual at risk for one also increases their risk of the other.
Rent Versus Own
Canada ranks high on most measures of global development and health, but is not fulfilling its international obligations to providing the right to shelter for its citizens. The issue is primarily one of renters versus owners.
The cult of home ownership, the “Canadian Dream,” is supported by government incentives, and as a result we have a very high percentage of homeowners compared to most other countries. At the same time, renting is stigmatized and the gap in income between owners and renters is growing. With the absence of a national housing strategy and a steadily declining role in housing, the Canadian government has failed to implement policy that will reduce this gap and support housing options for renters as well as buyers, serving low and moderate income households (Shapcott).
The result is high rates of homelessness and hidden homelessness in Canada, a fact that has severe implications for the health of all Canadians.
Health and Housing
The impact poor housing conditions are well documented: they cause negative physical and mental health outcomes. Unstable housing, especially at the extreme of homelessness, is also associated with lower life expectancies and higher death rates. On the flip side, unhealthy individuals find themselves disadvantaged in the housing market (Bryant).
Housing stability plays a crucial role in both HIV treatment and prevention. Both the material benefit and meaning derived from housing play a role in preventing new infections and supporting those living with HIV.
Drug Use: Individuals with substance use issues are highly vulnerable to HIV infection and often lead very chaotic lives. Housing can help to stabilize drug use, reducing unsafe injections and providing a safe place to store clean needles between injections. (See Dickson-Gomez et al.)
Safe Sex: “Particularly important for understanding relationships between housing and HIV is the extent to which access to housing structures intimate relations,” say Aidala and Sumartojo. For example, women in sex work who have a safe place to conduct business can increase control over condom use and reduce the danger of a bad date.
Unstable Housing and Homelessness: Unstable housing has been independently associated with both HIV and Hepatitis C infection. Some researchers have also found a dose response relationship between HIV and the housing continuum (Elifson et al; Coady et al). Others have noticed that the longer someone has spent on the street, the more vulnerable they are to infection (Rosenthal et al; German et al; Rice et al).
HIV Treatment and Care
Lack of stable housing is a major obstacle to treatment and care of HIV positive individuals, but the challenges of living with the disease can also make housing situations tenuous.
“The type of housing you live in, the amount of money you spend each month for your housing, and how often you have to move directly affect your health when you are living with HIV…if you have stable housing, you will be healthier, less stressed and enjoy a better quality of life,” says Tucker.
Loss of Housing: Episodic illness may make it difficult for an individual to work to make rent or keep up with mortgage payments. Disability insurance or social assistance is often insufficient to meet housing needs. Co-occurring conditions, including substance use and mental health issues, can lead to eviction.
Stigma and Discrimination: HIV status can make searching for housing challenging when faced with stigma from landlords and neighbours. Using disability income to pay for housing may prompt questions from a landlord and living in housing specially designated for people with HIV can lead to unwanted disclosure.
Accessibility: People with HIV may need special facilities, such as wheelchair accessibility or support from home care workers. Proximity to doctors and pharmacists is also particularly important.
Healthy Environments: Living on the street or in shelters can increase exposure to infections, such as pneumonia and tuberculosis. During periods of sickness, lack of housing can mean having nowhere to recouperate, such as if shelters require residents to leave during the day. This increases reliance on hospital services.
Treatment Adherence: Safe, secure and adequate housing provides stability and structure that can make storing and taking medications more straightforward, as well as make it easier to attend regular doctor’s appointments.
For people vulnerable to or living with HIV, housing is a matter of life and death. The stability that a roof provides can help prevent HIV infection and improve quality of life for people living with HIV. Canada’s housing policy choices are daily determinants of the health of those living with HIV and those at risk of infection.
Shapcott calls for a National Housing Strategy – Canada is one of the few countries in the world without one – that includes ensuring adequate rental units available; improvements in social welfare to decrease inequality between renters and owners; and subsidized construction of rental units. Without a national housing strategy, reduction in the growing gap between renters and owners, and an investment in rental housing, Canada will continue to violate citizens’ rights to both health and housing.