Housing is Health: Reflections from Durban, South Africa and the International AIDS Conference

When I talk about what I do, I am never sure if I should describe myself as someone who researches homelessness or someone who researches health issues, including HIV/AIDS. In reality, I do both. Before going the research route, I worked as a social worker in Chicago managing supportive housing programs for people who were homeless and HIV positive. The intersection of HIV and homelessness is still a personal passion, as well as the focus of much of my research.

This July I had the opportunity to attend and present at the International AIDS Conference in Durban, South Africa. This conference, held every two years, is a huge gathering of more than 15,000 researchers, health care professionals, activists, policymakers, and government leaders who come together to discuss all aspects of the AIDS epidemic. Presentation topics run the gamut from the development of vaccines and new drugs to the social issues that drive the epidemic, such as the criminalization of sex work, poverty, and social inequalities. It was humbling and exciting to be among this group of people from around the world, with such vast and varied knowledge and experiences.

Initially, I was a little disappointed at what felt like a lack of attention to housing issues in the conference program. My online search of the hundreds of conference presentations yielded only a handful with “homelessness” or “housing” in the title. I soon found, though, that homelessness was in fact addressed in a number of ways. For example, in one session I attended, none of the presenters had made housing and homelessness a focal point of their research—and yet it came up several times. One presenter discussed the HIV risk context of women who were displaced in Haiti after the 2010 earthquake and no longer had permanent housing; another described how young injection drug users in Vancouver were more likely to share needles when they didn’t have a stable home base from which to access syringe exchange and other harm reduction services; and a third presenter discussed homelessness as increasing the risk of sexual assault for HIV positive immigrants in France. Hearing all of these examples solidified my belief that “housing is health”—without stable housing, it is infinitely more difficult to feed one’s self, to seek treatment for various conditions, to take medication, to practice harm reduction with regard to sex or substance use, and to protect one’s body.

One of the highlights of the conference was having the chance to visit the Denis Hurley Centre, a nonprofit agency that works with homeless and low-income people in Durban. Like many of the homeless-serving agencies that I am familiar with in the U.S., the Denis Hurley Centre strives to serve people with dignity, to care for their basic human needs, and to give people opportunities for growth and empowerment. It was interesting to me to learn what this looks like in a South African, and specifically a Durban, context. Durban is a large and diverse city that is home to people of many different racial, ethnic, religious, and national backgrounds. The director of the center, Raymond Perrier, mentioned that he wondered if this was the only social service agency in the world that is named for a Catholic bishop but that maintains a halal kitchen, as the agency has a large Muslim clientele. To me, this is a great example of the social work credo of “meeting where the client is at.”

Disturbingly, I also learned from Mr. Perrier that in advance of the conference, the police had “swept” the central business district and forced many of the homeless people staying there to relocate elsewhere. I have heard of such sweeps occurring before major events in U.S. cities and elsewhere, but to do this before an HIV conference with a theme of “access, equity, rights now” seems particularly cruel and ironic. South Africa has one of the world’s largest HIV epidemics, with approximately one in five adults living with HIV, and even higher rates among poor and marginalized groups. Being homeless is hazardous to one’s health, and it’s particularly detrimental to HIV health. When people don’t have a safe, stable place to stay—and when they are forced by police to move from their places on the street—it is very difficult to adhere to lifesaving HIV medications. I knew this to be the case with the clients I worked with in Chicago, and Mr. Perrier described how it is the same in Durban. The idea that the conference would cause even one HIV-positive homeless person in Durban to disrupt their medication adherence is deeply troubling to me.

I left South Africa with the sense that while it is important to acknowledge our geographic, national, and sociopolitical differences, problems like the criminalization of homelessness and the lack of safe and affordable housing for many HIV-positive and at-risk people are truly global in scope. Visiting the Denis Hurley Centre showed me that the solutions to addressing these problems are both local and global. It is one thing to talk about access, equity, and human rights, but it is a far more difficult thing to live out this mantra in a world that constantly denies the rights and the value of so many lives in so many locations.

And yet, there is always hope and work to be done still.

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Blog Post Author: Elizabeth Bowen, PhD

Elizabeth Bowen, PhD, is an Assistant Professor in the School of Social Work at the University at Buffalo (UB)-State University of New York. Her research focuses on the relationship between housing and health. She is the UB faculty contact for the National Homelessness Social Work Initiative and co-leads the New York/New Jersey regional network of social work programs.

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NCEHS Regional Hub Leader: University of Southern California

In Year 2 of the National Homelessness Social Work Initiative, the National Center for Excellence in Homeless Services (NCEHS) selected the University of Southern California School of Social Work (USCSSW) to be one of six Regional Hub Leader Schools.

The USCSSW, one of two regional hubs in California (the other is CSU, Long Beach), is recognized as one of the best for clinical training, with graduates also excelling in policy practice, advocacy, and program administration. The school houses the Research Cluster of Excellence on Homelessness, Housing and Social Environment, which has nurtured multiple partnerships with agencies serving people experiencing homelessness, including those providing shelter, permanent supportive housing, drug treatment, veterans services, and integrated health care. Faculty in the research cluster also serve in pro bono roles in the community as advisors and consultants.  Several faculty from the research cluster have been active in NCEHS activities, including Drs. Suzanne Wenzel, Eric Rice, and Ben Henwood. Doctoral students in the school have also gotten involved. For example, doctoral candidate Robin Petering wrote a guest blog about her experience teaching yoga to homeless youth.

Dr. Ben Henwood, Assistant Professor, has been particularly active in advancing the work of the National Center. He is a national leader in research on Housing First and recently co-authored a book on the subject. Dr. Henwood led the development of the Grand Challenge of Ending Homelessness (GCEH) concept paper, which was adopted by the American Academy of Social Work and Social Welfare (AASWSW) as one of 12 grand challenges to the social work profession. He now co-leads the implementation of this grand challenge.

As a Regional Hub Leader, the USCSSW aims to: 1) pursue NIH funds for new homelessness research, mentoring, outreach, and homeless service partnerships; 2) advance collaborative homelessness research across schools of social work; 3) create local collaboratives with policymakers and providers; and 4) disseminate homelessness knowledge through conferences and leadership positions to advance data-driven policies and programs. The research cluster provides a laboratory for federal research grant development and advancing international research on homelessness through interdisciplinary networking and events. Efforts also address identifying opportunities to further develop expertise in homelessness across the region and nationally, such as through training grants and conferences.

The USCSSW’s role as a Regional Hub leader has coalesced with Dr. Henwood’s role as the co-lead of the AASWSW GCEH and USC’s own initiative in which the University has taken on homelessness as a “wicked problem”. Recent highlights include:

  • Continued NIH and other funding for research on homelessness:
    • HIV Risk, Drug Use, Social Networks: Homeless Persons Transitioned to Housing, National Institute of Drug Abuse (PI: Wenzel; 1R01DA036345-01A1)
    • Understanding Risk Environment for Youth in Supportive Housing, National Institute of Mental Health (PI: Henwood; 1R01MH110206-01)
    • Peers and Social Media to Promote HIV Testing and Treatment of Homeless Youth, California State Funded (PI: Rice)
    • Addressing Geriatric Syndromes within Permanent Supportive Housing, National Institute on Aging. (PI: Henwood; 1R21AG050009)
  • USC Homelessness Summit: In April, USC launched an initiative aligning the university with the community and local governments in the effort to end homelessness in Los Angeles. This university-wide initiative advances the concept that universities can serve as “anchor institutions” in their communities for important social problems. As part of the USC initiative, the SSW has been selected to consult on the 2017 regional homeless count.
  • Grand Challenge to End Homelessness Enhanced Field-Placement (EFP) Project: This fall the USCSSW launched a pilot project in which a cohort of 15 MSW students were placed in a field practicum designed to educate students on policy and clinical practice to combat homelessness. Students participated in a kick-off event prior to their placement and will meet monthly as a cohort.
  • Survey on Social Work Research focused on homelessness: As part of a NCEHS research workgroup, USCSSW has helped develop a survey to assess what social work research is being conducted on homelessness and how that research addresses a larger research agenda. Data collection will begin this fall.

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Check out this one for an overview of USC’s Research Cluster.

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