Leicester City Council is consulting on five proposals to re-configure our homeless services to ensure the most vulnerable receive the support they need.
Around one in three people living with HIV have experienced poverty, leaving the vulnerable to housing problems and homelessness. HIV is a complex condition, affecting many areas of someone’s life. Understanding how to assess housing needs for someone living with HIV requires a good knowledge of these complexities.
People living with HIV need to keep strictly to their treatment regime which is known as adherence. Being adherent is not just about taking pills every day, it is about taking them in the right way (for example, with or without food, depending on the medicine) and at the right time. At least 95% adherence to treatment is needed to avoid HIV developing drug resistance. This means that if someone is taking once-daily treatments, they can only miss one dose a month.
The ability to adhere to treatment requires a stable home environment. Good housing is critical to ensure this. Without this, treatment can fail and people become very unwell and can even die. It is important to remember that for those not yet on treatment, unsuitable housing can lead to more rapid deterioration of their condition.
So what does this mean for housing and homeless applications?
Many housing organisations still use out of date measures of HIV, for example an AIDS diagnoses to decide housing need. Others look for symptoms of HIV ill-health, or a low CD4 count. There is nothing wrong with considering these criteria, but they are simplistic measures and ignore one crucial element – the health of people living with HIV fluctuates and can change suddenly.
The result of only using these simple measures is that people’s true health needs are missed. Housing offers should carry out a more comprehensive assessment of the needs of people living HIV. This should include considering the fluctuating health of people living with HIV, mental health issues and the need to comply with the very strict treatment adherence standards essential for treatment to work.
Adherence may be particularly difficult for people are:
- Homeless or living in insecure accommodation, including bed and breakfasts
- Living in overcrowded or shared accommodation with little privacy
- Without access to a private fridge in which to store certain HIV medications
- Unable to afford food to eat healthy and adequately
- Isolated from, or having difficulty accessing support services
- Experience mental health problems.
Homelessness clearly has a detrimental effect on someone living with HIV. Adhering to treatment becomes extremely difficult when living on the streets or in living in shared or unsuitable accommodation.
Even if a person is currently managing their condition well, becoming homeless will have an enormous impact on their health. For example, they may not be able to take their treatment as directed, may be unable to adequately feed themselves and may lose touch with medical services and go untreated, leading to the development of serious infections that can be life-threatening.
People living with HIV who are placed in accommodation with shared facilities such as kitchens and bathrooms may have serious concerns about other residents finding out about their HIV status. For example, people living with HIV may be reluctant to store their medications in shared fridges and may need immediate access to a bathroom or toilet because of the side effects of treatment (which frequently include diarrhoea).
Funding cuts to Leicester homeless services
The proposed cuts to homeless services in Leicester will have huge impact, not only to those living with HIV, but to other vulnerable people in our city.
The Council in reviewing the homeless strategy is proposing to stop the grant subsidy it currently gives to The Centre Project and Leicestershire Cares but retain the Day Centre at the Dawn Centre which provides support and education opportunities to homeless service users. The Council claims in its proposal that the Centre Project ‘only delivers support programmes to strengthen employment opportunities for those who are homeless. This work can be redirected to the job centres who offer similar opportunities’.
However, the Centre Project provides a safe and accessible service for people to come and get support, prevent loneliness and generally promote wellbeing. Some people need a lot of support before they can be work ready or be able to sustain their tenancies.
The Housing Scrutiny Commission’s strategy is available here:
You can provide your valuable opinion directly with Leicester City Council at their survey site here: