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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National Center Staff at UAlbany Publish New Article on Social Work’s Role in Ending the Criminalization of Homelessness

According to the National Law Center on Homelessness and Poverty’s most recent report on the criminalization of homelessness, the number of cities implementing anti-homeless policies has steadily increased over the last several years. In the Law Center’s 2014 analysis of 187 cities across the U.S., many had citywide bans on camping in public (34%), sleeping in public (18%), sleeping in vehicles (43%), begging/panhandling (24%), and loitering (33%). Even higher were the percentages of cities banning these activities in particular spaces, as opposed to citywide restrictions. Given the trend of the last several years, these numbers are likely higher now.

In general, anti-homeless policies are intended to reduce the presence of homeless people in a community by restricting where they are allowed to be and what they are allowed to do when there. While some might rationalize criminalization efforts as a way to pursue valid policy goals, such as increasing community safety or protecting a community’s economy, criminalizing homelessness does little to actually address homelessness. The primary problem with anti-homeless policies is that they are more concerned with perceptions of what homelessness causes, rather than what causes homelessness. Not only are these policies ineffective at reducing or preventing homelessness, many argue that they also violate the constitutional rights of individuals experiencing homelessness.

Luckily, while many communities choose to criminalize homelessness, others have taken to implementing constructive alternatives. The Law Center’s report provides multiple examples, such as engaging police and local business leaders in collaborative strategies to help individuals exit homelessness.

Social workers are well positioned to lead the charge in challenging the validity of laws and policies that criminalize homelessness as well as developing, implementing, and evaluating more effective interventions. Not only do social workers have the skills necessary to do this work, it is well-aligned with our foundational values and ethics.

Amanda Aykanian, M.A. (doctoral student at the UAlbany Social Welfare and Research and Project Lead at the National Center) and Wonhyung Lee, PhD (Assistant Professor at the UAlbany School of Social Welfare) elaborate several suggestions for how social workers can lead the charge in ending the criminalization of homelessness in a recent commentary published in Social Work. Examples include:

  • challenging the unconstitutionality of anti-homeless laws;
  • facilitating cross-sector collaboration, such as partnerships between police and homeless service systems;
  • engaging and educating business leaders; and
  • advocating for the creation of facilities for people experiencing homelessness to conduct basic quality-of-life behaviors (e.g. using the bathroom, basic hygiene, and eating).

To date, social work has offered little input on the criminalization of homelessness. The strategies described by Aykanian and Lee provide feasible and practical opportunities for social workers to take action and join the fight against the criminalization of homelessness.

The full-text of the commentary is linked on the National Center for Excellence in Homeless Services’ website. For more information, contact Amanda Aykanian (amanda.aykanian@gmail.com).

For more information about Amanda Aykanian, M.A. and Wonhyung Lee, PhD visit the National Center’s staff page.