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 him in.
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 disease.
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 first diagnosed.
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 (seewww.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.
Posted on Sun, Dec. 12, 2010
Philippe Bourgois is the Richard Perry University Professor of Anthropology and Family and Community Medicine at the University of Pennsylvania
Amy Nunn is an assistant professor of medicine in the Division of Infectious Diseases at Brown University Medical School
E-mail the writers at bourgois@sas.upenn.edu and amy_nunn@brown.edu.
