By Sophie Bell
Decent housing conditions are of vital importance to HIV suffers because they are more vulnerable to infection as the virus attacks the body’s immune system. Housing that is not overcrowded is equally important because a sufferer will develop illnesses after exposure to a virus far quicker than other people. The author explains how discrimination and abuse produce very harmful effects and appeals for careful consideration of their needs.
Many soap fans will recall the infamous scene from Eastenders in which Peggy Mitchell refuses to serve Mark Fowler who she has discovered is HIV positive. A necessary and brave attempt by the writers to challenge some of the stigma and prejudice in abundance at the time and such efforts are, of course, to be applauded. But we must take care. Denial can be just as dangerous as ignorance. Those diagnosed with HIV have needs over and above those of others and there is an equal danger that, in seeking to demonstrate our lack of prejudice, we blind ourselves to the reality of such needs. This is of particular importance in the area of housing.
A person diagnosed with HIV should not be shunned or despised but neither should s/he be ignored or be judged by the same standards as a person who is free HIV free. Thankfully, it is now possible to manage HIV for many years but those diagnosed are still in a precarious situation. This should not be overlooked by those of us charged with the responsibility of housing them. It is precisely this issue that the National AIDS Trust address in their recent paper “HIV and Housing”. This paper urges those allocating housing to recognise that an HIV positive individual has a range of often complex needs and that a careful and informed approach is required to ensure those are met.
Let’s take our fictional character Mark; his CD4 count may have been brought down by medication or not yet have dropped low enough to warrant treatment. His viral load may be well controlled and he may be far from developing an AIDS related illness. But this is not the end of the story. There are many areas in which his situation can be differentiated from that of a person without the virus.
• Mark is more vulnerable to infection as the HIV virus is attacking his body’s immune system. Decent housing conditions are of vital importance. The NAT’s report tells us that the two most common AIDS-defining illnesses in 2006 were pneumonia and TB. Both diseases that attack the lungs and that can caused or exacerbated by cold, damp or draughty living conditions. Housing that is not overcrowded is equally important. An HIV sufferer will develop illnesses after exposure to a virus far quicker than another person and the danger of placing him in close proximity to others is obvious.
• Similarly, can we really allow Mark to become street homeless? The exposure to disease, cold, damp and a whole wealth of other threats to his health are clear. Injury or detriment will result and it is difficult to see how it can be argued otherwise even if his CD4 count is currently stable.
• Mark’s condition can never truly be viewed as stable. By its very nature the HIV virus is a fluctuating one. A sufferer’s health can deteriorate rapidly and although they may be in apparently perfect health one day, they can become very unwell the next. In order for this to be manageable, decent housing is essential.
• If Mark has started a treatment regime this must be adhered. Such regimes can be very complicated: some medication needs to be taken at certain times, some with food, some to be kept in a fridge. The NAT makes clear in “HIV and Housing” that 95% adherence to medication is required. Failure to maintain this can mean that the body will develop resistance to the medication. A change in medication is then required and the sufferer’s options are reduced. This can of course have catastrophic effects for the future.
• There are many ways in which housing (or lack of) can impact on adherence. Mark will find his regime difficult to maintain if he cannot ensure access to a fridge or particular food, if his lifestyle is chaotic, if he is suffering from stress or poor mental or physical health or if he does not have a safe and private environment to take the medication. And what about if the medication is lost or stolen? One man I knew carried his medication around in a rucksack as there was so much of it. And it is not cheap. There are those who would rejoice to get their hands on such a stash and the risk of theft in shared accommodation or on the streets should not be ignored.
• According to the NAT report Mark has a 70% chance of suffering from depression and worryingly may be one of a third of HIV sufferers who experience suicidal thoughts. His mental health must be considered as poor housing or homelessness will almost certainly cause this to deteriorate.
• The reality of the stigma that still surrounds the HIV virus must be considered. The Peggy Mitchells of this world still pose a risk to Mark’s wellbeing. The NAT’s paper shows that HIV sufferers are still frequently discriminated against, abused and harassed. The importance of having a safe and secure environment cannot be underestimated. In a shared hostel Mark may well be exposed to abuse and ignorance. A safe and independent base will more easily allow Mark to access support and treatment services and so, even if he is exposed to discrimination, he can at least have support to help him deal with this. This would become much harder to access if Mark’s mental health was to deteriorate or he was to become homeless. Allowing an HIV sufferer to remain in stressful living conditions may well impact on his mental health and his ability to adhere to a treatment regime.
Sadly, the statistics set out by the NAT and perhaps our own experience show us that HIV sufferers are not being provided with the quality of housing they require or in some cases, at all. In deciding on the allocation of housing to a sufferer such as Mark, a composite assessment of all his needs must be carried out. With so many issues to be considered in each individual case and so many difficulties and challenges intrinsic to the daily life of a sufferer, it is difficult to know how it can ever be justified to refuse housing, repairs or a transfer. But it does happen… frequently.
The potential value of NAT’s recommendations as set out in their report and in their Practical Guide for Housing Officers is huge. These provide a concise and informative guide as to the many complex issues faced by HIV sufferers and the need to treat each case with care and understanding. It cannot ever be enough simply to look at a CD4 count or whether medication has been prescribed. This is to over-simplify a very complicated condition.
Whilst we know that Mark will not infect his fellow Eastenders by drinking from the same glass, we cannot pretend that he will walk out of the Queen Vic and return to his life at it was. His diagnosis has changed his life forever and he is vulnerable to many previously unknown dangers. He will need a far higher level of support and protection than before and if the recommendations set out by the NAT are adopted we might just be able to provide this.
Sophie Bell is a Solicitor at Hodge Jones & Allen LLP