BUFFALO, N.Y. – Ask Elizabeth Bowen about the intersection
of homelessness and HIV/AIDS in the United States and she’ll
respond without hesitation, “Housing equals
That conclusion seemed clear to Bowen, assistant professor in
the University at Buffalo School of Social Work, during the four
years she worked in a supportive housing program in Chicago,
Illinois. Now as a UB researcher she has published a study that
empirically supports what she experienced on the ground.
“Supportive housing, a program of rental assistance and
support services, is associated with improvements in the health
outcomes of previously homeless people living with HIV/AIDS,”
“Without stable housing it’s hard to achieve these
good health outcomes.”
The study, which appears in the journal AIDS Care, relied on
biometric data that predicts how effectively the body combats the
Prior to publishing their journal article, the team presented
their preliminary findings at the 2016 International AIDS
Conference in Durban, South Africa.
Bowen and her coauthors examined two indicators of health: CD4
count, sometimes called T-cells, which show how well the immune
system is working, and viral load, an indicator of the amount of
virus particles in a person’s blood. A person with a very low
viral load may be described as having achieved viral
“The percentage of participants in our study with a
healthy CD4 count and viral suppression improved significantly
during their time in the program,” says Bowen. “The
positive relationship between length of program stay and viral
suppression suggests that housing stability is key to people living
with HIV/AIDS (PLWHA) in supportive housing maintaining or
improving their health.”
Homelessness and HIV/AIDS overlap often in the United States,
according to Bowen.
Approximately one in 12 PLWHA has an unmet need for housing. And
although thousands of formerly homeless or unstably housed
HIV-positive people live in supportive housing, little research has
examined biometric changes in their HIV health outcomes after they
Bowen says a few previous studies have reported positive health
outcomes for PLWHA in supportive housing, but those studies relied
on small samples. A larger recent study in San Francisco reported
promising findings from a single-site supportive housing program
with on-site nursing care.
Bowen’s research analyzed a scattered-site program, where
participants receive rental assistance while living in apartments
of their choosing in a given community.
“We’re about 35 years into the HIV epidemic in the
U.S. and we’ve reached a point medically where this is no
longer a fatal diagnosis – but only if PLWHA have access to
health care and housing,” says Bowen, an expert in health and
homelessness and the study’s lead author.
Homeless people, due in part to certain risk behaviors, are more
likely to become HIV positive than those with stable housing. In
turn, those with HIV/AIDS, with its associated impact on health,
employment and relationships, are more likely to become homeless
than the general population.
The study grew out of an opportune meeting between Bowen and
representatives of Caracole, a social service agency in Cincinnati,
Ohio, whose programs include a HUD-funded supportive housing model
called Shelter Plus Care.
Part of the challenge in studying the relationship between
housing and health is how researchers can gather the required
In this case, Caracole had the data on their program
participants, who voluntarily provided reports from their medical
providers at periodic intervals. That data was part of
Caracole’s own program evaluation process, but the agency
didn’t have the resources to determine the larger story that
unfolded within the numbers.
“I was excited about this partnership because this is
exactly the kind of social work I did before becoming a
researcher,” says Bowen. “This study speaks to the
power of these collaborations when agencies collect the information
that researchers want to analyze.”