Why Housing Has Always Been at the Center of My Work
I have spent much of my life working in community advocacy, especially around housing and HIV. Growing up in a New York City public housing development shaped how I see the world. I learned early that where you live affects everything else in your life. It affects your health, your safety, your opportunities, and your sense of stability.
Over the years, I have worked closely with people living with HIV and with LGBTQ communities who are often facing more than one challenge at a time. One thing has become very clear to me. Housing instability is not separate from HIV risk. It is directly connected. If we want to reduce new infections and improve health outcomes, we have to take housing seriously as a public health issue.
How Housing Instability Creates Vulnerability
Housing instability includes many situations. It can mean living in shelters, moving between temporary places, staying with friends, or facing constant risk of eviction. It can also mean living in overcrowded or unsafe conditions. All of these situations create stress and uncertainty that affect health in real ways.
When someone does not have stable housing, their daily focus often shifts to survival. It becomes harder to think about long term health, regular medical care, or prevention. People may miss appointments because they do not have transportation or a consistent address. Medications can be lost or left behind. These disruptions make it harder to stay connected to HIV prevention or treatment services.
The Connection Between Housing and HIV Risk
Housing instability increases HIV risk in several ways. First, it limits access to healthcare. People who are unstably housed are less likely to get tested regularly or receive preventive services like PrEP. Without access to these tools, the risk of transmission increases.
Second, housing instability often increases exposure to unsafe situations. Some people may engage in survival strategies to meet basic needs such as food or shelter. These situations can increase vulnerability to exploitation or unsafe sexual practices. This is not about personal choice. It is about survival under difficult conditions.
Third, stress plays a major role. Constant stress from not knowing where you will sleep or how you will meet basic needs can affect mental health. Depression, anxiety, and trauma can make it harder to make safe decisions or prioritize health care.
My Experience in the Community
Through my work with GMHC and in LGBTQ advocacy spaces, I have met many people whose struggles with HIV are closely tied to housing instability. I have seen how quickly a person’s health can decline when they do not have a stable place to live. I have also seen how quickly things can improve when housing becomes stable.
When someone has a safe and consistent place to live, everything changes. They can store medication properly. They can rest. They can keep appointments. They can begin to focus on long term health rather than daily survival. Housing stability gives people the foundation they need to take control of their lives again.
What Cities Need to Understand
Cities often treat housing and health as separate issues, but they are deeply connected. If we want to reduce HIV transmission and improve outcomes for people living with HIV, housing must be part of the solution.
One of the first things cities can do is recognize housing as a public health priority. This means investing in affordable housing, expanding supportive housing programs, and ensuring that people living with HIV are not pushed out of stable housing due to cost or discrimination.
Cities also need to improve coordination between housing services and healthcare systems. When housing providers and HIV service organizations work together, people receive more consistent and effective support. For example, case managers can help individuals maintain both housing and medical care at the same time, which leads to better outcomes overall.
The Role of Supportive Housing
Supportive housing has been one of the most effective tools I have seen in addressing both housing instability and HIV care. These programs combine affordable housing with supportive services such as healthcare coordination, mental health support, and case management.
This approach recognizes that housing alone is not always enough. People may also need support with mental health, substance use, or navigating healthcare systems. When these services are available together, people are more likely to stay housed and stay healthy.
Addressing Inequality and Disproportionate Impact
Housing instability does not affect everyone equally. Black and Latino LGBTQ communities are often more likely to experience both housing insecurity and higher rates of HIV. This is not a coincidence. It is the result of long standing structural inequality, discrimination, and lack of access to resources.
If cities want to address HIV effectively, they must also address these inequities. That means investing in communities that have been historically underserved and ensuring that housing policies are fair and inclusive. Equity is not an abstract idea. It is a practical requirement for improving public health.
Moving Toward Real Solutions
I believe cities have both the responsibility and the ability to make meaningful change. Reducing HIV risk and improving outcomes for people living with HIV requires a comprehensive approach that includes housing, healthcare, and community support.
We cannot separate health from housing. When people have stable homes, they are more likely to stay healthy, access care, and avoid new infections. When they do not, every part of their life becomes more difficult.
Over the years, I have seen what is possible when communities and cities work together. I have seen lives stabilized, health restored, and hope rebuilt. The solution is not simple, but it is clear. If we want to reduce HIV risk, we must start by ensuring that everyone has a safe and stable place to call home.