Executive Summary
The West Virginia HIV/AIDS Housing Plan was completed in December 2002 for the West Virginia Coalition for People with HIV/AIDS, Inc. and the AIDS Network by AIDS Housing of Washington, a national technical assistance provider. This Executive Summary includes an overview of the process, critical issues identified, and the recommended strategies developed.
The West Virginia Coalition for People with HIV/AIDS, Inc. includes three organizations: Caritas House, Inc. in Morgantown, Covenant House, Inc. in Charleston, and Community Networks, Inc. in Martinsburg. Each agency serves a region of the state.
The West Virginia Coalition for People with HIV/AIDS, Inc and the AIDS Network contracted with AIDS Housing of Washington to facilitate a needs assessment and planning process in early 2002. The needs assessment included interviews with 107 stakeholders, focus groups and interviews with 36 people living with HIV/AIDS, a written survey of 299 people living with HIV/AIDS, and a review of relevant planning documents and literature. A Steering Committee reviewed the findings and identified critical issues and related strategies.
Context of Housing People Living with HIV/AIDS in West Virginia.
At the end of 2001, a total of 1,100 West Virginians were living with HIV or AIDS, including 524 who had been diagnosed with AIDS, and 576 people were living with HIV without an AIDS diagnosis. Of people living with HIV or AIDS, 69 percent were White/Caucasian, 28 percent were African American/Black, and 3 percent were another race or ethnicity. More than three-quarters (78 percent) were male and 22 percent were female.
Because medical advances are helping people with HIV/AIDS live longer lives, there are now more people living with HIV/AIDS--and potentially in need of related assistance--than ever before.
People living with HIV/AIDS in West Virginia experience many of the same challenges as other West Virginians, especially those with low incomes--difficulties finding affordable, good-quality housing, overcoming geographic barriers to access medical care, services, and employment, and limited employment opportunities in many areas.
Many people living with HIV and AIDS in West Virginia depend on federal benefits as their sole source of income. For example, 43 percent of survey respondents received Social Security Disability Insurance (SSDI) and 29 percent received Supplemental Security Income (29 percent). Although these benefits are a critical source of support, a person with SSI can afford to pay just $164 per month for housing, which is frequently not enough for decent, safe, and sanitary housing. Although some people living with HIV/AIDS are single adults, 16 percent of people who responded to the survey had a child or children in their household.
People living with HIV/AIDS in West Virginia face HIV/AIDS-related stigma from friends, family, employers, property managers, service providers, and even healthcare professionals. Many members of the general public lack an understanding of HIV/AIDS, and as a result, react to people living with HIV/AIDS with fear and prejudice. This affects the willingness of people living with HIV/AIDS to seek services, including even medical care, as well as the ability of providers to help.
In addition, some people living with HIV/AIDS have other challenges related to behavioral health, including mental illness and substance use.
West Virginia receives funding dedicated to serving people living with HIV/AIDS from two federal sources: the U.S. Department of Housing and Urban Development's (HUD) Housing Opportunities for Persons with AIDS (HOPWA) program and the U.S. Department of Health and Human Resources and Services Administration's (HRSA) Ryan White CARE Act. Berkeley and Jefferson Counties receive some funding through Washington D.C., because they are considered to be a part of that metropolitan area. Although these funds allow for the provision of many valuable services, they alone cannot and should not be the sole source of support for people living with HIV/AIDS.
Critical Issues and Related Strategies
The Steering Committee identified the following issues based on the needs assessment findings, and developed related strategies to address them. The strategies developed focused on leadership for implementing recommendations, education and outreach about HIV/AIDS housing, and maintaining and expanding the system of supports available for people living with HIV/AIDS.
Lack of Safe, Affordable, High-Quality Housing
Many people living with HIV/AIDS have low incomes and struggle to afford monthly rent and utility costs; for example, survey respondents had a median income of $673 but paid a median $335 per month for housing. Although public housing authorities provide several types of affordable housing, waiting lists are typically very long. Screening for criminal history, high utility costs, and a need for behavioral health support are other housing barriers for some people living with HIV/AIDS.
Lack of Funding and Collaboration to Meet Current and Emerging Needs
There is great competition for the limited federal and state resources, which necessitates difficult decisions about how to best utilize funding and impacts the ability of nonprofit providers throughout the state to strengthen their agency infrastructure and increase capacity. Elected officials and other decision makers often do not have experience with or understanding of HIV/AIDS-related issues, which probably affects their ability and willingness to take a leadership role on related issues. Collaboration between service providers and systems is critical if the multiple needs of people living with HIV/AIDS are to be met.
Geographic and Transportation Barriers
The topography of West Virginia serves to isolate one region from another and makes travel from region to region difficult. Where available, public bus systems typically offer limited routes and schedules. HIV/AIDS-related fatigue and illness can also make relying on public transportation problematic. Many people living with HIV/AIDS must often travel great distances to access care. For example, 38 percent of survey respondents traveled more than 50 miles to medical and social service appointments.
HIV/AIDS-Related Stigma
People living with HIV/AIDS as well as service providers cited HIV/AIDS-related stigma and the fear of being stigmatized as defining issues in HIV/AIDS service and housing provision in West Virginia. Some people are reluctant or unwilling to access HIV-related medical care and services for fear of compromising confidentiality. Stakeholders and advocates believe that many people in West Virginia are in denial that HIV/AIDS is an issue of concern in their community and that they do not want HIV/AIDS services provided in their communities.
Importance of Access to Health Care
Consistent access to high quality health care is essential for people living with HIV/AIDS. By prioritizing HIV-dedicated funding toward increasing health care access, the state has created important programs like Special Pharmacy and case management. Still, people face challenges in regularly accessing medical care including the availability of medical providers in their community or region, the difficulty in traveling long distances to access care, and concerns about confidentiality and stigma.
Meeting Needs Related to Mental Health and Substance Use
Mental health and substance use issues impact the housing stability and quality of life of many people living with HIV/AIDS in West Virginia. The systems providing treatment for mental health and substance use issues in the state are working at capacity while experiencing cuts in funding and services. These services are very important for individuals' stability and health; however, access is limited. This gap then impacts other systems, such as HIV/AIDS and homeless services, as unmet needs increase.
Issues Related to Maintaining or Gaining Employment
Many available jobs are in the service industry, which typically do not provide high wages or medical benefits, and many areas of West Virginia have limited employment opportunities of any kind. People who are receiving disability benefits must think carefully about returning to work, as they may not receive or be able to afford needed medical insurance once employed. Some need job training or skills development in order to re-enter the workforce or enter the workforce for the first time.
Unmet Needs Related to Incarceration
Individuals face multiple challenges re-entering society after being incarcerated, including difficulty securing and maintaining housing. For people living with HIV/AIDS, a coordinated discharge plan is essential to accessing medical and service providers and transitioning successfully. However, many HIV-positive people leaving jail or prison do not experience coordinated discharge planning and therefore have difficulty connecting with necessary services.
Additional Support Service Gaps
Because housing and medical care are for legitimate reasons prioritized for funding, other support services can be more difficult to provide even though they are critical to people living with HIV/AIDS. Additional support service gaps include food and proper nutrition, clothing, regular support related to daily needs and concerns, and childcare for families.