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Housing for Persons Living with HIV/AIDS
Libby Perl
Specialist in Housing Policy
January 21, 2010July 3, 2012
Congressional Research Service
7-5700
www.crs.gov
RL34318
CRS Report for Congress
Prepared for Members and Committees of Congress
c11173008
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Housing for Persons Living with HIV/AIDS
Summary
Since the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in the early
1980s, many individuals living with the disease have had difficulty finding affordable, stable
housing. As individuals become ill, they may find themselves unable to work, while at the same
time facing health care expenses that leave few resources to pay for housing. In addition, many of
those persons living with AIDS struggled to afford housing even before being diagnosed with the
disease. The financial vulnerability associated with AIDS, as well as the human
immunodeficiency virus (HIV) that causes AIDS, results in a greater likelihood of homelessness
among persons living with the disease. At the same time, those who are homeless may be more
likely to engage in activities through which they could acquire or transmit HIV. Further, recent
Further, recent research has indicated that those
individuals living with HIV who live in stable housing have
better health outcomes than those
who are homeless or unstably housed, and that they spend
fewer days in hospitals and emergency
rooms.
Congress recognized the housing needs of persons living with HIV/AIDS when it approved the
Housing Opportunities for Persons with AIDS (HOPWA) program in 1990 as part of the
Cranston-Gonzalez National Affordable Housing Act (P.L. 101-625). The HOPWA program,
administered by the Department of Housing and Urban Development (HUD), funds short-term
and permanent housing, together with supportive services, for individuals living with HIV/AIDS
and their families. In addition, a small portion of funds appropriated through the Ryan White
HIV/AIDS program, administered by the Department of Health and Human Services (HHS), may
also be used to fund short-term housing for those living with HIV/AIDS.
In FY2010FY2012, Congress appropriated $335332 million for HOPWA as part of the Consolidated
Appropriations Act (P.L. 111-117). This is the most funding ever appropriated for the program,
exceeding the FY2009 appropriation by $25 million. 112-55). This was a reduction of $3 million from the $335 million
appropriated in FY2011 and FY2010, the most funding ever appropriated for the program. Prior
to FY2010, the most that had been appropriated for HOPWA was $310 million in FY2009.
HOPWA funds are distributed to states and
localities through both formula and competitive
grants. HUD awards 90% of appropriated funds
by formula to states and eligible metropolitan
statistical areas (MSAs) based on population,
reported cases of AIDS, and incidence of AIDS.
The remaining 10% is distributed through a grant
competition. Funds are used primarily for
housing activities, although grant recipients must
provide supportive services to those persons
residing in HOPWA-funded housing.
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Contents
Introduction ...................................................................................................................................... 1
Housing Status of Persons Living with HIV/AIDS ................................................................... 1
Creation of the Housing Opportunities for Persons with AIDS (HOPWA) Program................ 2
Distribution and Use of HOPWA Funds .......................................................................................... 4
Formula Grants .......................................................................................................................... 4
Competitive Grants .................................................................................................................... 5
Eligibility for HOPWA-Funded Housing .................................................................................. 6
Eligible Uses of HOPWA Funds ................................................................................................6 7
HOPWA Program Formula and Funding ......................................................................................... 8
The HOPWA Formula ............................................................................................................... 8
HOPWA Funding .....................................................................................................................9 10
Housing Funded Through the Ryan White HIV/AIDS Program ................................................... 11 10
The Relationship Between Stable Housing and Health Outcomes ............................................. 12... 14
Tables
Table 1. HOPWA Funding and Eligible Jurisdictions, FY2001-FY2010FY2012 and FY2013
Proposal .................................................................................................................... 10.................. 11
Table A-1. HOPWA Formula Allocations, FY2004-FY2009FY2012 ...................................................... 14.. 16
Appendixes
Appendix. Recent HOPWA Formula Allocations .......................................................................... 1416
Contacts
Author Contact Information ........................................................................................................... 1823
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Introduction
Acquired immunodeficiency syndrome (AIDS), a disease caused by the human
immunodeficiency virus (HIV), weakens the immune system, leaving individuals with the disease
susceptible to infections. As of 20072009, AIDS had been diagnosed and reported in an estimated
468,578 individuals in the fifty490,696 individuals living in the 50 states, the District of Columbia, and the territories.1 These estimates
estimates do not include those diagnosed with HIV where the disease has not yet progressed to
AIDS or
those who have not yet been diagnosed as HIV positive but are currently living with the
disease.
Currently there is no cure for HIV/AIDS, and in the early years of the AIDS epidemic, those
those persons infected with AIDS often died quickly. In recent years, however, medications have
allowed persons living with HIV and AIDS to live longer and to remain in better health.
Despite improvements in health outcomes, affordable housing remains important to many who
live with HIV/AIDS. This report describes recent research that shows how housing and health
status are related and the effects of stable housing on patient health. It also describes the Housing
Opportunities for Persons with AIDS (HOPWA) program, the only federal program that provides
housing and services specifically for persons who are HIV positive or who have AIDS, together
with their families. In addition, the report describes how a small portion of funds appropriated
through the Ryan White HIV/AIDS program may be used by states and local jurisdictions to
provide short-term housing assistance for persons living with HIV/AIDS.
Housing Status of Persons Living with HIV/AIDS
The availability of adequate, affordable housing for persons living with HIV and AIDS has been
an issue since AIDS was first identified in U.S. patients in the early 1980s. The inability to afford
housing and the threat of homelessness confront many individuals living with HIV/AIDS. From
the early years of the epidemic, those individuals who have been infected with HIV/AIDS face
impoverishment as they become unable to work, experience high medical costs, or lose private
health insurance coverage. The incidence of HIV/AIDS has also grown among low-income
individuals who were economically vulnerable even before onset of the disease.2
Not surprisingly, researchers have found a co-occurrence between HIV/AIDS and homelessness.
Homeless persons have a higher incidence of HIV/AIDS infection than the general population,
while many individuals with HIV/AIDS are at risk of becoming homeless.3 Research has found
that rates of HIV among homeless people may be as much as three to nine times higher than
1
1
Note that this represents persons living with AIDS, not a cumulative total. U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, HIV/AIDS Surveillance
Report 20072010, vol. 1922, Atlanta, GA, 2009, p. 25, table 12March
2012, pp. 56-57, table 16b, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/
2007report/pdf/2007SurveillanceReport.pdf (hereinafter, HIV/AIDS Surveillance Report 2007)2010report/pdf/
2010_HIV_Surveillance_Report_vol_22.pdf#Page=1.
2
John M. Karon, Patricia L. Fleming, Richard W. Steketee, and Kevin M. DeCock, “HIV in the United States at the
Turn of the Century: An Epidemic in Transition,” American Journal of Public Health 91, no. 7 (July 2001): 1064-1065.
3
See also, Paul Denning and Elizabeth DiNenno, Communities in Crisis: Is There a Generalized HIV Epidemic in
Impoverished Urban Areas of the United States?, Centers for Disease Control and Prevention, August 2010,
http://www.cdc.gov/hiv/topics/surveillance/resources/other/pdf/poverty_poster.pdf.
3
See, for example, D.P. Culhane, E. Gollub, R. Kuhn, and M. Shpaner, “The Co-Occurrence of AIDS and
Homelessness: Results from the Integration of Administrative Databases for AIDS Surveillance and Public Shelter
Utilization in Philadelphia,” Journal of Epidemiology and Community Health 55, no. 7 (2001): 515-520. Marjorie
Robertson, et al., “HIV Seroprevalence Among Homeless and Marginally Housed Adults in San Francisco,” American
Journal of Public Health 94, no. 7 (2004): 1207-1217. Angela A. Aidala and Gunjeong Lee, Housing Services and
Housing Stability Among Persons Living with HIV/AIDS, Joseph L. Mailman School of Public Health, May 30, 2000,
http://www.nyhiv.org/pdfs/chain/CHAIN%20Housing%20Stability%2032.pdf.(continued...)
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that rates of HIV among homeless people may be as much as three to nine times higher than
among those living in stable housing. 4 Further, those who are HIV positive and homeless have
been found to be more likely than those who are HIV positive and housed to engage in behaviors
associated with the spread of HIV/AIDS. In one study, the use of injectable drugs, sharing
needles, and exchanging sex for drugs or money were more likely among both homeless
individuals and those who were unstably housed compared to those with stable housing.5 (Those
who were considered unstably housed lived in transitional housing, in jail, drug treatment or a
halfway house, or were doubled up in someone else’s home. 6))6 When housing improved for
individuals in the study, their odds of engaging in these behaviors were reduced. Another study
found that homeless persons living with HIV/AIDS were almost twice as likely to engage in
unprotected sex compared to those who had housing.7 (Individuals were considered housed if
they lived in a house or apartment alone or with others, a medical care facility, or a correctional
institution.8))8
Creation of the Housing Opportunities for Persons with AIDS
(HOPWA) Program
In 1988, Congress established the National Commission on AIDS as part of the Health Omnibus
Extension Act (P.L. 100-607) to “promote the development of a national consensus on policy
concerning acquired immune deficiency syndrome (AIDS); and to study and make
recommendations for a consistent national policy concerning AIDS.” In April 1990, in its second
interim report to the President, the Commissioncommission recommended that Congress and the President
provide “[f]ederal housing aid to address the multiple problems posed by HIV infection and
AIDS.”9 About the same time that the Commissioncommission released its report, in March of 1990, the
House Committee on Banking, Finance, and Urban Affairs held a hearing about the need for
housing among persons living with HIV/AIDS. Witnesses as well as committee members
discussed various barriers to housing for persons living with HIV/AIDS. Among the issues
confronting those persons that were discussed at the hearing were poverty, homelessness, and
discrimination10 in attempting to secure housing. 11 Another issue discussed at the hearing was the
(...continued)
http://www.nyhiv.org/pdfs/chain/CHAIN%20Housing%20Stability%2032.pdf.
4
Daniel P. Kidder, Richard J. Wolitski, and Scott Royal, et al., “Access to Housing as a Structural Intervention for
Homeless and Unstably Housed People Living with HIV: Rational, Methods, and Implementation of the Housing and
Health Study,” AIDS and Behavior, vol. 11, no. 6 (November 2007, supplement), pp. 149-150.
5
Angela Aidala, Jay E. Cross, Ron Stall, David Harre, and Esther Sumartojo, “Housing Status and HIV Risk
Behaviors: Implications for Prevention and Policy,” AIDS and Behavior 9, no. 3 (2005): 251-265.
6
Ibid., p. 254.
7
Daniel P. Kidder, Richard J. Wolitski, and Sherri L. Pals, et al., “Housing Status and HIV Risk Behaviors Among
Homeless and Housed Persons with HIV,” Journal of Acquired Immune Deficiency Syndromes, vol. 49, no. 4
(December 1, 2008), pp. 453-454.
8
Ibid., p. 452.
9
The second interim report was released on April 24, 1990. Its recommendations were reprinted in National
Commission on Acquired Immune Deficiency Syndrome, Annual Report to the President and Congress, August 1990,
pp. 106-109.
10
Individuals living with HIV/AIDS have experienced housing discrimination even though they are protected as
persons with a “handicap” under the Fair Housing Act (FHA). 42 U.S.C. §§ 3601-3631. A number of court cases have
established that the definition of “handicap” protects persons who are HIV positive and persons with AIDS. See, for
example, Baxter v. City of Belleville, Ill., 720 F.Supp. 720, 729-730 (S.D.Ill.1989), and Support Ministries for Persons
With AIDS, Inc. v. Village of Waterford, N.Y., 808 F.Supp. 120, 129-133 (N.D.N.Y. 1992).
11
Hearing before the House Committee on Banking, Finance, and Urban Affairs, Subcommittee on Housing and
Community Development, “Housing Needs of Persons with Acquired Immune Deficiency Syndrome,” March 21,
1990, (hereafter Hearing on Housing Needs). See also, Statement of Representative James A. McDermott, 135 Cong.
(continued...)
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eligibility for subsidized housing for persons living with the disease. A question raised during the
hearing, but left unresolved, was whether persons living with HIV or AIDS met the definition of
“handicap” in order to be eligible for the Section 202 Supportive Housing for the Elderly program
(which also provided housing for persons with disabilities). 12 Another concern was that persons
living with HIV/AIDS often had difficulty obtaining subsidized housing through mainstream
HUD programs such as Public Housing and Section 8 due to the length of waiting lists;
individuals often died while waiting for available units.13
In the 101st Congress, at least two bills were introduced that contained provisions to create a
housing program specifically for persons living with AIDS. These proposed programs were called
the AIDS Housing Opportunity Act (which was part of the Housing and Community
Development Act of 1990, H.R. 1180) and the AIDS Opportunity Housing Act (H.R. 3423). The
bills were similar, and both proposed to fund short-term and permanent housing, together with
supportive services, for individuals living with AIDS and related diseases. The text from one of
these bills, H.R. 1180, which included the AIDS Housing Opportunity Act, was incorporated into
the Cranston-Gonzalez National Affordable Housing Act (S. 566) when it was debated and passed
by the House on August 1, 1990. In conference with the Senate, the name of the housing program
was changed to Housing Opportunities for Persons with AIDS (HOPWA). In addition, the several
separate housing assistance programs that had been proposed in H.R. 1180—one for short-term
housing, one for permanent housing supported through Section 8, and one for community
residences—were consolidated into one formula grant program in which recipient communities
could choose which activities to fund. The amended version of S. 566 was signed by the President
on November 28, 1990, and became P.L. 101-625, the Cranston Gonzalez National Affordable
Housing Act.
The HOPWA program is administered by the Department of Housing and Urban Development
(HUD) and remains the only federal program solely dedicated to providing housing assistance to
persons living with HIV/AIDS and their families.14 The program addresses the need for
reasonably priced housing for thousands of low-income individuals (those with incomes at or
below 80% of the area median income). HOPWA was last reauthorized by the Housing and
Community Development Act of 1992 (P.L. 102-550). Although authorization for HOPWA
expired after FY1994, Congress continues to fund the program through annual appropriations.
(...continued)
11
Hearing before the House Committee on Banking, Finance, and Urban Affairs, Subcommittee on Housing and
Community Development, “Housing Needs of Persons with Acquired Immune Deficiency Syndrome,” March 21,
1990, (hereafter Hearing on Housing Needs). See also, Statement of Representative James A. McDermott, 135 Cong.
Rec. 23641, October 5, 1989.
12
Hearing on Housing Needs, pp. 25-30. See footnote 11.
13
U.S. Congress, House Committee on Banking, Finance, and Urban Affairs, Housing and Community Development
Act of 1990, report to accompany H.R. 1180, 101st Cong., 2nd sess., June 21, 1990, H.Rept. 101-559.
14
The law is codified at 42 U.S.C. §§ 12901-12912, with regulations at 24 C.F.R. Parts 574.3-574.655.
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Distribution and Use of HOPWA Funds
Formula Grants
HOPWA program funding is distributed both by formula allocations and competitive grants. HUD
awards 90% of appropriated funds by formula to states and eligible metropolitan statistical areas
(MSAs) that meet the minimum AIDS case requirements according to data reported to the Centers
for Disease Control and Prevention (CDC) in the previous year. (For the amounts distributed to
eligible states and MSAs in recent years, see Appendix.) HOPWA formula funds are available
through HUD’s Consolidated Plan initiative. Jurisdictions applying for funds from four HUD
formula grant programs, including HOPWA,15 submit a single consolidated plan to HUD. The
plan includes an assessment of community housing and development needs and a proposal that
addresses those needs, using both federal funds and community resources. Communities that
participate in the Consolidated Plan may receive HOPWA funds if they meet formula
requirements. Formula funds are allocated in two ways:
•
First, 75% of the total available formula funds, sometimes referred to by HUD as
“base funding,” is distributed to
—the largest cities within metropolitan statistical areas (MSAs)16 with populations of at least
500,000 and with 1,500 or more cumulative reported cases of AIDS (which includes those
who have died); and
—to states with at least 1,500 cases of AIDS in the areas outside of that state’s eligible
MSAs.17
•
Second, 25% of total available formula funds—sometimes referred to by HUD as
“bonus funding”—is distributed on the basis of AIDS incidence during the past
three years.18 Only the largest cities within MSAs that have populations of at
least 500,000, with at least 1,500 reported cases of AIDS and that have a higher
than average per capita incidence of AIDS are eligible. 19 States are not eligible
for bonus funding.
Although HOPWA funds are allocated to the largest city within an MSA, these recipient cities are
required to allocate funds “in a manner that addresses the needs within the metropolitan statistical
area in which the city is located.”20 States that receive funds are to use them to benefit areas
outside of eligible MSAs. In FY2009, 90 MSAs (including the District of Columbia) received
funds, while 40 states and Puerto Rico received funds for use in the areas outside of recipientWhile the distribution of the balance of state funds is based on
AIDS cases outside of eligible MSAs, states may use funds for projects in any area of the state,
15
The others are the Community Development Block Grant, the Emergency ShelterSolutions Grants, and HOME.
MSAs are defined as having at least one core “urbanized” area of 50,000 or more and “adjacent territory that has a high
with the MSA comprised of “the central
county or counties containing the core, plus adjacent outlying counties having a high degree of social and economic
integration with the corecentral county or counties as measured bythrough commuting ties.” See Office of Management
and the Budget Bulletin 09-01, Attachment, “Update of Statistical Area Definitions and Guidance on Their Uses,”
November 20, 2008, p. 2, http://www.whitehouse.gov/omb/bulletins/fy2009/09-01.pdf.
17
42 U.S.C. § .” See Office of Management and
Budget, “2010 Standards for Delineating Metropolitan and Micropolitan Statistical Areas,” 75 Federal Register 3724637252, July 28, 2010.
17
42 U.S.C. §12903(c)(1)(A).
18
AIDS incidence is measured as the number of new AIDS cases during a given time period.
19
42 U.S.C. § 12903(c)(1)(B).
20
42 U.S.C. § 12903(f).
16
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MSAs.21 including those that received their own funds.21 According to HUD guidance, states should serve
clients in areas outside of eligible MSAs, but the state may operate anywhere in the state because
it “may be coordinating the use of all resources in a way that addresses needs more appropriately
throughout the state.”22 In FY2012, 94 MSAs (including the District of Columbia) received funds,
while 40 states and Puerto Rico received funds for use in the areas outside of recipient MSAs.23
HUD jurisdictions that receive HOPWA funds may administer housing and services
programs programs
themselves or may allocate all or a portion of the funds to subgrantee private nonprofit
organizations. HOPWA formula funds remain available for obligation for two years.
As a result of language included in every HUD appropriations law since FY1999 (P.L. 105-276),
states do not lose formula funds if their reported AIDS cases drop below 1,500, as long as they
received funding in the previous fiscal year. States generally drop below 1,500 AIDS cases when
a large metropolitan area becomes separately eligible for formula funds. These states are allocated
a grant on the basis of the cumulative number of AIDS cases outside of their MSAs.2224
Competitive Grants
The remaining 10% of HOPWA funding is available through competitive grants. Funds are
distributed through a national competition to two groups of grantees: (1) states and local
governments that propose to provide short-term, transitional, or permanent supportive housing in
areas that are not eligible for formula allocations, and (2) government agencies or nonprofit
entities that propose “special projects of national significance.”2325 A project of national
significance is one that uses an innovative service delivery model. In determining proposals that
qualify, HUD must consider the innovativeness of the proposal and its potential replicability in
other communities. 2426 Competitive grants may not be used to provide supportive services alone;
instead, services can only be provided in conjunction with housing activities, and funds for
services cannot exceed 35% of a project’s budget.2527
The competitive grants are awarded through HUD’s annual SuperNOFA (Notice of Funding
Availability), which is generally published in the Federal Register in the early spring. Since
FY2000 (P.L. 106-377), Congress has required HUD to renew expiring contracts for permanent
supportive housing prior to awarding funds to new projects.26 Beginning in FY2006, competitive
funds remain available for obligation for three years (from FY2002 through FY2005, competitive
funds had been available only for two years). The extension makes the rules for HOPWA’s
competitive program consistent with those of other competitive programs advertised in HUD’s
SuperNOFA.
21 In FY2009 and FY2010, the amount
of funds required for project renewals meant that there were no funds available for new
competitive grants.28 In FY2011, HUD awarded approximately $9 million in new competitive
21
24 C.F.R. §574.3.
U.S. Department of Housing and Urban Development, 2011 HOPWA Formula Operating Instructions, April 28,
2011, p. 3, http://www.hudhre.info/documents/2011Operating_Formula.pdf.
23
U.S. Department of Housing and Urban Development, Office of Community Planning and Development, Office of
HIV/AIDS Housing, list of FY2009 granteesFormula
Allocations for FY2012, http://www.hud.gov/offices/cpd/about/budget/budget09/index.cfm.
22
Thebudget12/.
24
According to HUD, the states that have retained funding under this provision are Arizona, Connecticut, Delaware,
Hawaii,
Massachusetts, Minnesota, Nevada, New Mexico, Oklahoma, and Utah. See U.S. Department of Housing and
Urban Development,
Congressional Justifications for FY2010, May 2009, p. X-14FY2011, p. Z-12, http://www.hud.gov/offices/cfo/reports/20102011/cjs/
cpd2010.pdf (hereinafter, FY2010 Congressional Budget Justifications).
23hofpwAIDS2011.pdf.
25
42 U.S.C. § 12903(c)(3).
2426
Ibid.
25
27
See, for example, U.S. Department of Housing and Urban Development, “FY2008 Notice of Funding Availability
Housing Opportunities for Persons Withwith AIDS,” 73 Federal Register p. 27266, May 12, 2008.
26
In FY2009, the amount of funds required for project renewals meant that there were no funds available for additional
competitive grants. See HUD’s website, http://www.hud.gov/offices/adm/grants/nofa09/grphopwa.cfm.27266, May 12, 2008.
28
See U.S. Department of Housing and Urban Development, Congressional Justifications for 2012 Estimates, p. Z-13,
(continued...)
22
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grants to seven projects.29 HUD anticipates that it will not fund any new grants again in
FY2012.30 Beginning in FY2006, competitive funds remain available for obligation for three
years (from FY2002 through FY2005, competitive funds had been available only for two years).
The extension makes the rules for HOPWA’s competitive program consistent with those of other
competitive programs advertised in HUD’s SuperNOFA.
Eligibility for HOPWA-Funded Housing
In the HOPWA program, individuals are eligible for housing if they are either HIV positive or if
they are diagnosed with AIDS.2731 In general, clients must also be low income, meaning that their
income does not exceed 80% of the area median income. 2832 HUD reports area median incomes for
metropolitan areas and non-metropolitan counties on an annual basis.2933 Housing and some
supportive services are available for family members of persons living with AIDS. When a person
living in HOPWA-supported housing dies, his or her family members are given a grace period
during which they may remain in the housing.3034 This period may not exceed one year, however.
Individuals who are HIV positive or living with AIDS may also be eligible for other HUDassisted housing for persons with disabilities. However, infection itself may not be sufficient to
meet the definition of disability in these other programs. For example, in the case of housing
developed prior to the mid-1990s under the Section 202 Supportive Housing for the Elderly
program and those units developed under the Section 811 Supportive Housing for Persons with
Disabilities program, an individual who is HIV positive or has AIDS must also meet the statutory
definition of disability (in which HIV/AIDS status alone is not sufficient) to be eligible for
housing. 3135 The project-based Section 8 and Public Housing programs may also set aside units or
entire developments for persons with disabilities. The definition of disability for these programs
does “not exclude persons who have the disease of acquired immunodeficiency syndrome or any
conditions arising from the etiologic agent” for AIDS.32 However, the definition does not indicate
whether the status of being HIV positive or having AIDS is alone sufficient to be considered
disabled.
Eligible Uses of HOPWA Funds
HOPWA grantees may use funds for a wide range of housing, social services, program planning,
and development costs. Supportive services must be provided together with housing. Formula
grantees may also choose to provide supportive services not in conjunction with housing,
although the focus of the HOPWA program is housing activities. Allowable activities include the
following.
27
(...continued)
http://portal.hud.gov/hudportal/documents/huddoc?id=HOPWA_2012.pdf.
29
U.S. Department of Housing and Urban Development, “HUD Awards $8.8 Million to Improve Housing and Services
for Families and Individuals Living with AIDS,” press release, September 21, 2011, http://portal.hud.gov/hudportal/
HUD?src=/press/press_releases_media_advisories/2011/HUDNo.11-225.
30
FY2012 Budget Justifications, p. Z-13.
31
The HOPWA statute defines an eligible person as one “with acquired immunodeficiency syndrome or a related
disease.” 42 U.S.C. § 12902(12). The regulations have further specified that “acquired immunodeficiency syndrome or
related diseases means the disease of acquired immunodeficiency syndrome or any conditions arising from the etiologic
agent for acquired immunodeficiency syndrome, including infection with the human immunodeficiency virus (HIV).”
24 C.F.R. § 574.3.
2832
42 U.S.C. § 12908 and § 12909. The statutory provisions regarding short-term housing and community residences do
not require individuals to be low- income, although to be eligible for short-term housing a person must be homeless or
at at
risk of homelessness. See 42 U.S.C. § 12907 and § 12910.
2933
U.S. Department of Housing and Urban Development, Office of Policy Development and Research, Fiscal Year
20092010 HUD Income Limits Briefing Material, April 20, 2009May 13, 2010, p. 1, http://www.huduser.org/portal/datasets/il/il09/
IncomeLimitsBriefingMaterial_FY09il10/
IncomeLimitsBriefingMaterial_FY10.pdf. Tables showing area median incomes in recent years are available at
http://www.huduser.org/datasets/il.html.
3034
24 C.F.R. § 574.310(e).
31
35
For more information about housing for persons with disabilities and the definitions of disability under these
programs, see CRS Report RL34728, Section 811 and Other HUD Housing Programs for Persons with Disabilities, by
Libby Perl.
32
42 U.S.C. § 1437a(b)(3).
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conditions arising from the etiologic agent” for AIDS.36 However, the definition does not indicate
whether the status of being HIV positive or having AIDS is alone sufficient to be considered
disabled.
Eligible Uses of HOPWA Funds
HOPWA grantees may use funds for a wide range of housing, social services, program planning,
and development costs. Supportive services must be provided together with housing. Formula
grantees may also choose to provide supportive services not in conjunction with housing,
although the focus of the HOPWA program is housing activities. Allowable activities include the
following:
•
The Development and Operation of Multi-Unit Community Residences, Including
the Provision of Supportive Services for Persons Who Live in the Residences.3337
Funds may be used for the construction, rehabilitation, and acquisition of
facilities, for payment of operating costs, and for technical assistance in
developing the community residence.
•
Short-Term Rental, Mortgage, and Utility Assistance to Persons Living with
AIDS Who Are Homeless or at Risk of Homelessness.3438 Funds may be used to
acquire and/or rehabilitate facilities that will be used to provide short-term
housing, as well as to make payments on behalf of tenants or homeowners, and to
provide supportive services. Funds may not be used to construct short-term
housing facilities. 3539 Residents may not stay in short-term housing facilities more
than 60 days in any 6-month period, and may not receive short-term rental,
mortgage, and utility assistance for more than 21 weeks in any 52 -week period.
These limits are subject to waiver by HUD, however, if a project sponsor is
making an attempt to provide permanent supportive housing for residents and has
been unable to do so. Funds may also be used to pay operating and administrative
expenses.
•
Project-Based or Tenant-Based Rental Assistance for Permanent Supportive
Housing, Including Shared Housing Arrangements.3640 In general, tenants must pay
approximately 30% of their income toward rent.3741 Grant recipients must ensure
that residents receive supportive services, and funds may also be used for
administrative costs in providing rental assistance.
•
The New Construction or Acquisition and Rehabilitation of Property for SingleRoom Occupancy Dwellings.3842
36
42 U.S.C. §1437a(b)(3).
42 U.S.C. §12910.
38
42 U.S.C. §12907.
39
HOWPA funds may only be used for construction of community residences and single-room occupancy dwellings.
See 24 C.F.R. §574.300(b)(4).
40
42 U.S.C. §12908.
41
See 24 C.F.R. §574.310(d).
42
42 U.S.C. §12909.
37
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•
Supportive Services, Which Include Health Assessments, Counseling for Those
with Addictions to Drugs and Alcohol, Nutritional Assistance, Assistance with
Daily Living, Day Care, and Assistance in Applying for Other Government
Benefits.3943
•
Housing Information Such as Counseling and Referral Services.4044 Assistance
may include fair housing counseling for those experiencing discrimination. 4145
The majority of HOPWA funds are used to provide housing. According to HUD, in FY2007 and
FY2008, 64for the 20102011 program year, 66% of HOPWA funding was used for housing assistance such as rent and facility
building operating costs.46 An additional 4% was used to help individuals find housing, 2% for
housing development, and 20% was used for supportive services. Of the amounts used for
housing activities, 76% was used to support tenants in permanent housing, of whom more than
95% remained stably housed during the year.47 Grantee performance reports indicate that clients
who receive housing assistance through HOPWA are often at the lowest income levels; in its
FY2013 Congressional Budget Justifications, HUD estimated that 75% of households served
have extremely low incomes (at or below 30% of area median income) and 16% have very low
incomes (at or below 50% of area median income).48
HOPWA Program Formula and Funding
The HOPWA Formula
The HOPWA method for allocating formula funds has been an ongoing issue because the
cumulative number of AIDS cases—including those who have died—is used to distribute funds
rather than the current number of people living with AIDS, and, potentially, HIV. In 1997, GAO
released a report regarding the performance of the HOPWA program in which it recommended
that HUD look at recent changes to the formula used by the Ryan White CARE Act (now called
the Ryan White HIV/AIDS program) to “determine what legislative revisions are needed to make
the HOPWA formula more reflective of current AIDS cases.”49 (At the time of the GAO report,
Congress had recently changed the CARE Act formula to use estimates of persons living with
AIDS instead of cumulative AIDS cases.)50 In response to the GAO report, the House
Appropriations Committee included the GAO language in its report accompanying the FY1998
43
24 C.F.R. §574.300(b)(7).
42 U.S.C. §12906.
45
24 C.F.R. §574.300(b)(1).
46
U.S. Department of Housing and Urban Development, HOPWA National Performance Profile 2010-2011 Program
Year, http://www.hudhre.info/hopwa_Reports/NP_Combined_PY10_11.pdf.
47
Ibid. The percent stably housed includes those living in permanent dedicated housing units as well as those receiving
tenant-based rental assistance.
48
U.S. Department of Housing and Urban Development, Congressional Justifications for 2013 Estimates, p. U-14,
http://portal.hud.gov/hudportal/documents/huddoc?id=Housing_AIDS.pdf.
49
U.S. Government Accountability Office, HUD’s Program for Persons with AIDS, GAO/RCED-97-62, March 1997,
p. 27, http://www.gao.gov/archive/1997/rc97062.pdf.
50
Ryan White CARE Act Amendments of 1996, P.L. 104-146. In 2006, when the Ryan White HIV/AIDS program was
reauthorized as part of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415), the formula
began to incorporate living HIV cases in addition to living AIDS cases.
44
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HUD Appropriations Act (P.L. 105-65) and directed HUD to make recommendations to Congress
about its findings regarding an update to the formula.51
In response to the FY1998 Appropriations Act, HUD issued a report to Congress in 1999 that
proposed changes that could be made to the HOPWA formula.52 The proposed formula in HUD’s
1999 report would have used an estimate of persons living with AIDS (instead of all cumulative
AIDS cases), together with housing costs, to distribute formula funds. It also would have included
a protection for existing grantees. Those recommendations were not adopted by Congress.
A 2006 Government Accountability Office (GAO) report again looked at the way in which the
HOPWA formula allocates funds. The report found that use of the cumulative number of AIDS
cases resulted in disproportionate funding per living AIDS case depending on the jurisdiction.
The GAO report looked at FY2004 HOPWA allocations and found that the amount of money
grantees received per living AIDS case ranged from $387 per person to $1,290.53 According to the
report, if only living AIDS cases had been counted in that year, 92 of 117 grantees would have
received more formula funding, while 25 would have received less.54
While no legislation to change the HOPWA formula has been introduced since the 109th
Congress,55 nearly every Administration budget since FY2007 has discussed the need to change
the formula. In each of President Bush’s budgets from FY2007 through FY2009, the
Administration proposed to change the way in which HOPWA funds are distributed. The FY2009
budget stated that “[w]hereas the current formula distributes formula grant resources by the
cumulative number of AIDS cases, the revised formula will account for the present number of
people living with AIDS, as well as differences in housing costs in the qualifying areas.” The
President’s FY2007 and FY2008 budgets contained nearly identical language. HUD’s budget
justifications for FY2009 elaborated somewhat on the Administration’s proposal to change the
HOPWA distribution formula. HUD’s explanation indicated that a new formula would use the
number of persons living with AIDS, and that eventually, when consistent data on the number of
persons living with HIV become available, that measure might also be used in determining the
distribution of HOPWA funding.56
As part of President Obama’s FY2010 budget, the HUD budget justifications stated that HUD
would review the formula and “make related recommendations at a future time.”57 The
Administration’s National HIV/AIDS Strategy, released in July 2010, stated that HUD would
work with Congress to “develop a plan (including seeking statutory changes if necessary) to shift
51
See U.S. Congress, House Committee on Appropriations, Subcommittee on VA, HUD, and Independent Agencies,
Departments of Veterans Affairs and Housing and Urban Development and Independent Agencies Appropriations Bill,
report to accompany H.R. 2158, 105th Cong., 1st sess., July 11, 1997, H.Rept. 105-175, pp. 33-34.
52
U.S. Department of Housing and Urban Development, 1999 Report on the Performance of the Housing
Opportunities for Persons with AIDS Program, October 6, 1999.
53
U.S. Government Accountability Office, Changes Needed to Improve the Distribution of Ryan White CARE Act and
Housing Funds, GAO-06-332, February 2006, p. 23, http://www.gao.gov/new.items/d06332.pdf.
54
Ibid., p. 24.
55
Two bills in the 109th Congress (S. 2339 and H.R. 5009) would have changed the way that HOPWA formula funds
are allocated by counting the number of “reported living cases of HIV disease” instead of cumulative AIDS cases.
Neither bill was enacted.
56
U.S. Department of Housing and Urban Development, Congressional Justifications for FY2009, p. Q-2,
http://www.hud.gov/offices/cfo/reports/2009/cjs/cpd1.pdf.
57
FY2010 Congressional Budget Justifications, p. X-13.
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to HIV/AIDS case reporting as a basis for formula grants for HOPWA funding.”58 The FY2012
and FY2013 HUD Congressional Budget Justification for HOPWA echoed this goal. Since the
release of the National HIV/AIDS Strategy, HUD has solicited comments from interested policy
advocates, grantees, and HOPWA clients about whether and how the formula might be changed.
HOPWA Funding
As a result of advances in medical science and in the care and treatment of persons living with
HIV and AIDS, individuals are living longer with the disease.59, and 3% for housing
33
42 U.S.C. § 12910.
42 U.S.C. § 12907.
35
HOWPA funds may only be used for construction of community residences and single-room occupancy dwellings.
See 24 C.F.R. § 574.300(b)(4).
36
42 U.S.C. § 12908.
37
See 24 C.F.R. § 574.310(d).
38
42 U.S.C. § 12909.
39
24 C.F.R. § 574.300(b)(7).
40
42 U.S.C. § 12906.
41
24 C.F.R. § 574.300(b)(1).
34
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development.42 Grantee performance reports indicate that clients who receive housing assistance
through HOPWA are often at the lowest income levels; in its FY2009 Annual Performance Plan,
HUD estimated that 81% of households served have either extremely-low incomes (at or below
30% of area median income) or very-low incomes (at or below 50% of area median income). 43
HOPWA Program Formula and Funding
The HOPWA Formula
The HOPWA method for allocating formula funds has been an ongoing issue because the
cumulative number of AIDS cases—including those who have died—is used to distribute funds.
A 2006 Government Accountability Office (GAO) report found that the cumulative measure
resulted in disproportionate funding per living AIDS case, depending on the jurisdiction. The
GAO report looked at FY2004 HOPWA allocations and found that the amount of money grantees
received per living AIDS case ranged from $387 per person to $1,290.44 According to the report,
if only living AIDS cases had been counted in that year, 92 of 117 grantees would have received
more formula funding, while 25 would have received less.45
In each of President Bush’s budgets from FY2007 through FY2009, the Administration proposed
to change the way in which HOPWA funds are distributed. The FY2009 budget stated that
“[w]hereas the current formula distributes formula grant resources by the cumulative number of
AIDS cases, the revised formula will account for the present number of people living with AIDS,
as well as differences in housing costs in the qualifying areas.” The President’s FY2007 and
FY2008 budgets contained nearly identical language. HUD’s budget justifications for FY2009
elaborated somewhat on the Administration’s proposal to change the HOPWA distribution
formula. HUD’s explanation indicated that a new formula would use the number of persons living
with AIDS, and that eventually, when consistent data on the number of persons living with HIV
become available, that measure might also be used in determining the distribution of HOPWA
funding.46 In the FY2010 HUD budget justifications, HUD stated that it will review the formula
and “make related recommendations at a future time.”47
Discussions regarding the HOPWA formula and its use of cumulative AIDS cases to distribute
funds are not new. In 1997, GAO released a report regarding the performance of the HOPWA
program in which it recommended that HUD look at recent changes to the formula used by the
Ryan White CARE Act (now called the Ryan While HIV/AIDS program) to “determine what
legislative revisions are needed to make the HOPWA formula more reflective of current AIDS
42
FY2010 Congressional Budget Justifications, p. X-6.
U.S. Department of Housing and Urban Development, Annual Performance Plan FY2009, February 2008, p. 9,
http://www.hud.gov/offices/cfo/reports/pdfs/app2009.pdf.
43
44
U.S. Government Accountability Office, Changes Needed to Improve the Distribution of Ryan White CARE Act and
Housing Funds, GAO-06-332, February 2006, p. 23, http://www.gao.gov/new.items/d06332.pdf.
45
Ibid., p. 24.
46
U.S. Department of Housing and Urban Development, Congressional Justifications for FY2009, p. Q-2,
http://www.hud.gov/offices/cfo/reports/2009/cjs/cpd1.pdf.
47
FY2010 Congressional Budget Justifications, p. X-13.
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Housing for Persons Living with HIV/AIDS
cases ...”48 (At the time of the GAO report, Congress had recently changed the CARE Act
formula to use estimates of persons living with AIDS instead of cumulative AIDS cases.49) In
response to the GAO report, the House Appropriations Committee included the GAO language in
its report accompanying the FY1998 HUD Appropriations Act (P.L. 105-65) and directed HUD to
make recommendations to Congress about its findings regarding an update to the formula.50
In response to the FY1998 Appropriations Act, HUD then issued a report to Congress in 1999 that
proposed changes that could be made to the HOPWA formula.51 The proposed formula in HUD’s
1999 report would have used an estimate of persons living with AIDS (instead of all cumulative
AIDS cases), together with housing costs, to distribute formula funds. It also would have included
a protection for existing grantees. Those recommendations were not adopted by Congress.
No legislation to change the HOPWA formula has been introduced since the 109th Congress,
when two bills (S. 2339 and H.R. 5009) would have changed the way that HOPWA formula funds
are allocated by counting the number of “reported living cases of HIV disease” instead of
cumulative AIDS cases. Neither bill was enacted.
HOPWA Funding
As a result of advances in medical science and in the care and treatment of persons living with
HIV and AIDS, individuals are living longer with the disease.52 As the number of those with
AIDS grows, so do the jurisdictions that qualify for formula-based HOPWA funds. Since 1999,
there has been a steady increase in the number of jurisdictions that meet the eligibility test to
receive formula-based HOPWA funds. Funding for the HOPWA program has increased in almost
every year since the program was created, with the exception of FY2005 through FY2007, when
funding dropped from the FY2004 level of $295 million. (See Table 1.) In FY2010, Congress
appropriated $335 million as part of the Consolidated Appropriations Act (P.L. 111-117), the most
ever appropriated for the program and FY2011,
the appropriation was the highest ever for the program—$335 million in each year, though the
FY2011 appropriations law (P.L. 112-10) imposed an across-the-board rescission of 0.2% on all
discretionary accounts, reducing the total for HOPWA to about $334.3 million. The FY2012
HOPWA appropriation was $332 million (P.L. 112-55). For information about proposed funding
in FY2013, see CRS Report R42517, Department of Housing and Urban Development (HUD):
FY2013 Appropriations, coordinated by Maggie McCarty.
The number of households receiving HOPWA housing assistance (including short-term housing
assistance, housing provided through community residences, or rental assistance in permanent
housing) has declined in every year but onegenerally declined from FY2003 through FY2009FY2011. (See Table 1.)
Between FY2003
and FY2009, the number of households served has dropped from 78,467 to
48
U.S. Government Accountability Office, HUD’s Program for Persons with AIDS, GAO/RCED-97-62, March 1997,
p. 27, http://www.gao.gov/archive/1997/rc97062.pdf.
49
Ryan White CARE Act Amendments of 1996, P.L. 104-146. In 2006, when the Ryan White HIV/AIDS program was
reauthorized as part of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415), the formula
began to incorporate living HIV cases in addition to living AIDS cases.
50
See U.S. Congress, House Committee on Appropriations, Subcommittee on VA, HUD, and Independent Agencies,
Departments of Veterans Affairs and Housing and Urban Development and Independent Agencies Appropriations Bill,
report to accompany H.R. 2158, 105th Cong., 1st sess., July 11, 1997, H.Rept. 105-175, pp. 33-34.
51
U.S. Department of Housing and Urban Development, 1999 Report on the Performance of the Housing
Opportunities for Persons with AIDS Program, October 6, 1999 (hereafter 1999 HUD Report).
52
According to CDC data, in 1993 there were 137,529 people reportedly living with AIDS in the 50 states, the District
of Columbia, and the territories. By 2007, there were 468,578 people reportedly living with HIV/AIDS in the same
areas. See Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report 1993, Vol. 5, Atlanta, GA,1994,
p. 26, table 3, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/pdf/hivsur54.pdf, and HIV/AIDS
Surveillance Report 2007, footnote 1, p. 25, table 12.
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Housing for Persons Living with HIV/AIDS
58,367.53 These general reductions in households served could be due to a number of factors,
including the growth in jurisdictions eligible for HOPWA grants (which have increased from 111
in FY2003 to 131 in FY2009), the amount of available funds, and housing costs.
Table 1. HOPWA Funding and Eligible Jurisdictions, FY2001-FY2010
Fiscal Year
Number of
Qualifying
Jurisdictions
Households
Receiving Housing
Assistancea
Funding
(thousands of dollars)
2001
105
72,117
257,432
2002
108
74,964
277,423
2003
111
78,467
290,102
2004
117
70,779
294,751
2005
121
67,012
281,728
2006
122
67,000
286,110
2007
123
67,850
286,110
2008
127
62,210
300,100
2009
131
58,367
310,000
2010
134b
—
335,000
Source: Table prepared by the Congressional Research Service based on data from the Department of Housing
and Urban Development budget justifications (number of qualifying jurisdictions and funding levels), P.L. 111-8,
P.L. 111-117, and FY2004, FY2006, FY2007, FY2008, and FY2009 HUD Performance and Accountability Reports
(number of households assisteddropped from 78,467 to 58,367.60 With increased
funding, however, the total households served went up in FY2010 to 60,669 and then fell slightly
in FY2011 to 60,234. These general reductions in households served could be due to a number of
factors, including the growth in jurisdictions eligible for HOPWA grants (which have increased
from 111 in FY2003 to 135 in FY2012), the amount of available funds, and housing costs.
58
National HIV/AIDS Strategy Federal Implementation Plan, July 2010, p. 28, http://aids.gov/federal-resources/
policies/national-hiv-aids-strategy/nhas-implementation.pdf.
59
For example, researchers who analyzed data from 25 states found that from 1996 to 2005, average life expectancy
after HIV diagnosis increased from 10.5 to 22.5 years. See Kathleen McDavid Harrison, Ruiguang Song, and Xinjian
Zhang, “Life Expectancy after HIV Diagnosis Based on National HIV Surveillance Data from 25 States, United
States,” Journal of Acquired Immune Deficiency Syndromes, vol. 53, no. 1 (January 2010), pp. 124-130.
60
HUD provides estimates of the numbers of households served in its annual Performance and Accountability Reports.
The most recent is the FY2009 Performance and Accountability Report, November 16, 2009, p. 349,
http://www.hud.gov/offices/cfo/reports/hudfy2009par.pdf.
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Table 1. HOPWA Funding and Eligible Jurisdictions,
FY2001-FY2012 and FY2013 Proposal
Fiscal
Year
Number of
Qualifying
Jurisdictions
Households
Receiving Housing
Assistancea
President’s Request
(dollars in thousands)
Appropriations
(dollars in
thousands)b
2001
105
72,117
260,000
257,432
2002
108
74,964
277,432
277,432
2003
111
78,467
292,000
290,102
2004
117
70,779
297,000
294,751
2005
121
67,012
294,800
281,728
2006
122
67,000
268,000
286,110
2007
123
67,850
300,100
286,110
2008
127
62,210
300,100
300,100
2009
131
58,367
300,100
310,000
2010
133
60,669
310,000
335,000
2011
134
60,234
340,000
334,330c
2012
135
—
335,000
332,000
2013
—
—
330,000
—
Source: Table prepared by the Congressional Research Service based on data from the Department of Housing
and Urban Development budget justifications and P.L. 112-55 (number of qualifying jurisdictions and
appropriation levels), FY2001 through FY2012 President’s Budget Appendices (President’s request), the FY2004,
FY2006, FY2007, FY2008, and FY2009 HUD Performance and Accountability Reports (number of households
assisted through FY2009), and the FY2012-FY2013 budget justifications (households assisted for FY2010 and
FY2011). For a breakdown of formula funding by jurisdiction, see the Appendix.
a.
Housing assistance includes short-term assistance with rent, mortgage, or utilities; residence in short-term
housing facilities; housing provided through community residences and single-room occupancy dwellings;
and rental assistance for permanent supportive housing.
b.
In the FY2010 Congressional Budget Justifications, HUD estimated that 134 jurisdictions would qualify for
HOPWA funds. As of the date of this report, formula funds had not yet been awardedIncludes rescissions.
c.
The FY2011 Department of Defense and Full-Year Appropriation Act (P.L. 112-10) contained an across-theboard rescission of 0.2% for all discretionary accounts. The rescission reduced the HOPWA appropriation
from $335 million to approximately $334.3 million.
Housing Funded Through the Ryan White
HIV/AIDS Program
In addition to funds for housing provided through HUD, funds appropriated to the Department of
Health and Human Services (HHS) Ryan White HIV/AIDS program may be used to provide
short-term housing assistance to persons living with HIV/AIDS. The Ryan White Comprehensive
AIDS Resources Emergency Act (P.L. 101-381) established the Ryan White program in 1990.
The program provides funds to states and metropolitan areas to help pay for health care and
supportive services for persons living with HIV/AIDS (referred to as “support services” in the
statute).54
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statute).61 The statute governing the use of Ryan White funds does not specifically list housing as
53
HUD provides estimates of the numbers of households served in its annual Performance and Accountability Reports.
The most recent is the FY2009 Performance and Accountability Report, November 16, 2009, p. 349,
http://www.hud.gov/offices/cfo/reports/hudfy2009par.pdf.
54
For more information about the Ryan White program, see CRS Report RL33279, The Ryan White HIV/AIDS
Program, by Judith A. Johnson.
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an eligible activity for which grantees may use funds. However, the statute provides that grantees
may use Ryan White funds to provide support services for persons living with HIV and AIDS.
These services are defined as those “that are needed for individuals with HIV/AIDS to achieve
their medical outcomes ...”55.”62 In 1999, the HIV/AIDS Bureau of the Health Resources and
Services Services
Administration (HRSA) within HHS released policy guidance regarding the type of
housing that
Ryan White grantees could provide for their clients. 56 (Policy Notice 99-02).63 According to the
guidance,
grantees may use funds for housing referral services and for emergency or short-term
housing.
Ryan White funds must be the payer of last resort, meaning that other sources of funds for
for housing must be exhausted before using Ryan White funds. In 2008, nearly 33,000 persons
living with an HIV positive diagnosis received some sort of housing service through the Ryan
White HIV/AIDS program.64
Initially, the policy regarding use of Ryan White funds for housing did not require that specific
time limits be placed on short-term housing. In its report regarding the new guidance, HRSA
stated:
“Although we are restricting the policy to transitional/temporary housing, we don’t define
‘transitional/temporary.’ Because we don’t know yet what the recent changes in medical treatment
of HIV/AIDS mean to the evolution of the epidemic, it is foolish to adopt any definition of ‘shortterm.’” 5765 However, when the Ryan White program was reauthorized in 2006, the new law limited
the amount of grants to states and urban areas that could be used for supportive services to no
more than 25% by requiring that at least 75% of funds be used for “core medical services.”5866
Previously the law did not limit the amount of funds that could be used for supportivesupport services. In
In December 2006, in response to the “more restrictive funding limits established for support
services in the 2006 reauthorization,” HHS issued a proposed policy notice to limit the amount of
time that any client could spend in Ryan White-funded transitional housing to 24 months in a
lifetime, effective retroactively.5967 This would have meant that those individuals who had already
exhausted the 24-month time period would not be able to receive housing benefits. After
receiving over 200 comments regarding the policy proposal, HHS eventually removed the
provision requiring retroactive application of the 24-month lifetime limit and released a final
policy notice on February 27, 2008.60 The policy took effect on March 27, 2008.
In 2007, HRSA reported that 476 Ryan White-funded service organizations provided housing
services for individuals living with HIV/AIDS.61 In 2006, an estimated 42,178 persons living with
AIDS received some sort of housing service. Note that this estimate includes duplicated services,
55
42 U.S.C. § 300ff-14(d)(1) and §
61
For more information about the Ryan White program, see CRS Report RL33279, The Ryan White HIV/AIDS
Program, by Judith A. Johnson.
62
42 U.S.C. §300ff-14(d)(1) and §300ff-22(c)(1). At the time that HHS established its housing policy, the statute
stated stated
that funds could be used “for the purpose of delivering or enhancing HIV-related outpatient and ambulatory
health and
support services, including case management and comprehensive treatment services ... ” The statute was
amended to
read as stated in the text of this report as part of the Ryan White HIV/AIDS Treatment Modernization Act
of 2006, P.L. 109-415.
56
The use of funds for housing was established in HIV/AIDS Bureau
109-415.
63
Policy Notice 99-02. The notice is reproduced in U.S.
Department of Health and Human Services, Health Resources and
Services Administration, Housing is Health Care: A
Guide to Implementing the HIV/AIDS Bureau (HAB) Ryan White
CARE Act Housing Policy, 2001, p. 3,
ftp://ftp.hrsa.gov/hab/housingmanualjune.pdf, (hereafter (hereinafter, Housing is Health Care).
57
Housing is Health Care, p. 7. See footnote 56.
58
Care).
64
U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau,
Going the Distance: 20 Years of Leadership, A Legacy of Care: 2010 Ryan White HIV/AIDS Progress Report, August
2010, p. 48, http://hab.hrsa.gov/data/files/2010progressrpt.pdf.
65
Housing is Health Care, p. 7. See footnote 63.
66
The program was reauthorized in the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415).
See Section 105.
59
U.S. Department of Health and Human Services, “HIV/AIDS Bureau Policy Notice 99-02 Amendment #1,” 73
Federal Register 10261, February 26, 2008.
60
Ibid., pp. 10260-10261.
61
Information provided to CRS by HRSA on December 4, 2008.
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so an individual who received both housing referral services and spent time in emergency housing
may be counted more than once. 62
The Relationship Between Stable Housing
and Health Outcomes
As mentioned earlier in this report, HIV/AIDS status is associated with homelessness: those
persons who are homeless are more likely to be HIV positive than those who are housed. In
addition, recent research has found that the health outcomes of homeless individuals living with
HIV/AIDS may be improved with stable housing. For example, in a study of HIV positive
individuals living in New York City that was conducted over twelve years from 1994 to 2006,
those who were unstably housed—meaning that they were either living on the street, in a shelter,
in some form of transitional housing, or temporarily living in someone else’s home—were less
likely to access and retain medical care for their disease than those receiving some form of
housing assistance.63
In addition, preliminary findings from two recent studies have found favorable health outcomes
for HIV positive individuals who are stably housed. In one of these studies, called the Housing
and Health Study, HUD, together with the CDC, provided HIV positive individuals who were
homeless or at severe risk of homelessness with HOPWA-funded rental housing. (The study
considered individuals to be at severe risk of homelessness if they frequently moved from one
temporary housing situation to another.) Those individuals in the comparison group received
services, including assistance with finding housing, but did not receive HOPWA-funded
housing. 64 Despite the differences in rental assistance provided between the treatment and
comparison groups, both groups had a statistically significant increase in stable housing.65
Although 4% of all participants were stably housed when the study began, 82% of HOPWAassisted renters and 52% of individuals in the comparison group retained housing 18 months after
the start of the study. Perhaps due to the fact that the comparison group also had some success in
achieving and maintaining housing, both groups saw some improvements in health outcomes.
Findings from the study show that individuals in both groups had fewer emergency room visits,
fewer hospitalizations, reduced opportunistic infections (those infections that occur due to
weakened immune systems), reduced participation in sex trade, and reductions in depression.
62
U.S. Department of Health and Human Services, Health Resources and Services Administration, Ryan White
HIV/AIDS Program Annual Data Summary, 2006, p. P11.
63
Angela A. Aidala, Gunjeong Lee, and David M. Abramson, et al., “Housing Need, Housing Assistance, and
Connection to HIV Medical Care,” Aids and Behavior, vol. 11, no. 6 (November 2007, supplement), pp. 109-112.
64
The methodology of the study is described in Daniel P. Kidder, Richard J. Wolitski, and Scott Royal, et al., “Access
to Housing as a Structural Intervention for Homeless and Unstably Housing People Living with HIV: Rationale,
Methods, and Implementation of the Housing and Health Study,” AIDS and Behavior, vol. 11, no. 6 (November 2007,
supplement), pp. 149-161.
65
Preliminary findings from the Housing and Health Study were presented at the National Housing and HIV/AIDS
Research Summit III, March 6, 2008. Findings are summarized in The National AIDS Housing Coalition, Examining
the Evidence: The Impact of Housing on HIV Prevention and Care, Policy Paper from the Third Housing and
HIV/AIDS Research Summit, 2008, pp. 6-7, http://www.nationalaidshousing.org/PDF/FinalSummit.pdf (hereafter
Examining the Evidence).
Congressional Research Service
12
.
Housing for Persons Living with HIV/AIDS
A second study, called the Chicago Housing for Health Partnership study, identified homeless
individuals with chronic illnesses, including HIV, for participation. Among those who participated
in the study, 36% were HIV positive. The treatment group received housing funded through either
HOPWA or HUD’s Supportive Housing Program for homeless individuals, while the comparison,
or usual care group, received available supportive services but no separate assistance with rent.
According to preliminary findings, 12 months after the study began, the group receiving housing
assistance had higher rates of intact immunity compared to the comparison group and were more
likely to have undetectable viral loads. 66 At the conclusion of the study, the treatment group was
found to have spent fewer days in emergency rooms and hospitals during the 18 month period in
which the researchers followed participants. Specifically, compared to those in the usual care
group, those in the treatment group showed 29% reduction in hospitalizations, a 29% reduction in
the number of days spent in the hospital, and a 24% reduction in visits to the emergency room. 67
66
Like the preliminary findings from the Housing and Health Study, the preliminary findings from the Chicago
Housing for Health Partnership Study were presented at the National Housing and HIV/AIDS Research Summit III.
The findings are summarized in Examining the Evidence, pp. 5-6. See footnote 65.
67
Laura S. Sadowski, Romina A. Kee, and Tyler J. VanderWeele, et al., “Effects of a Housing and Case Management
Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults,” Journal of
the American Medical Association, vol. 301, no. 17 (May 6, 2009), pp. 1775-1776.
Congressional Research Service
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.
Housing for Persons Living with HIV/AIDS
Appendix. Recent HOPWA Formula Allocations
Table A-1. HOPWA Formula Allocations, FY2004-FY2009
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
1,139,000
1,117,000
1,145,000
1,163,000
1,241,000
1,299,792
Birmingham
520,000
497,000
511,000
516,000
538,000
554,848
Arkansas State
Program
752,000
723,000
707,000
720,000
766,000
797,682
Arizona State
Program
164,000
164,000
173,000
180,000
191,000
198,919
Phoenix
1,434,000
1,391,000
1,433,000
1,456,000
1,541,000
1,608,397
Tucson
402,000
390,000
389,000
390,000
411,000
420,497
3,042,000
2,869,000
2,929,000
2,926,000
2,746,000
2,557,875
Bakersfielda
—
—
—
—
323,000
472,334
Fresno
—
—
—
—
—
315,824
10,476,000
11,848,000
10,310,000
10,393,000
10,437,000
10,764,091
Oakland
2,006,000
1,879,000
1,905,000
1,896,000
1,952,000
2,038,921
Riverside
1,772,000
1,683,000
1,684,000
1,689,000
1,751,000
1,850,429
844,000
795,000
786,000
784,000
818,000
844,003
San Diego
2,683,000
2,527,000
2,549,000
2,551,000
2,646,000
2,731,528
San Francisco
8,562,000
8,466,000
8,070,000
8,189,000
8,193,000
9,233,417
792,000
736,000
738,000
739,000
767,000
796,679
1,436,000
1,342,000
1,359,000
1,345,000
1,402,000
1,458,807
366,000
354,000
364,000
363,000
379,000
392,424
1,424,000
1,342,000
1,359,000
1,361,000
1,414,000
1,452,390
Connecticut State
Program
251,000
242,000
253,000
252,000
263,000
268,902
Bridgeport
779,000
717,000
737,000
739,000
771,000
854,931
Hartford
1,023,000
1,285,000
1,108,000
1,098,000
1,140,000
1,084,029
New Haven
1,232,000
1,624,000
1,178,000
1,075,000
946,000
963,113
11,802,000
10,535,000
11,370,000
11,118,000
11,541,000
12,213,518
Delaware State
Program
164,000
162,000
166,000
167,000
179,000
186,286
Wilmingtonb
798,000
703,000
679,000
552,000
604,000
651,902
Florida State
Program
4,063,000
3,581,000
3,312,000
3,316,000
3,191,000
3,012,662
Cape Coralc
—
—
336,000
332,000
350,000
368,963
Alabama State
Program
California State
Program
Los Angeles
Sacramento
San Jose
Santa Anna
Colorado State
Program
Denver
Washington, DC
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.
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
—
—
—
—
—
312,215
Fort Lauderdale
6,240,000
6,106,000
6,637,000
6,878,000
7,351,000
7,545,922
Jacksonville
1,564,000
1,624,000
1,587,000
1,630,000
1,988,000
2,265,720
—
378,000
445,000
418,000
509,000
491,383
10,715,000
10,351,000
11,189,000
11,689,000
12,370,000
12,599,526
3,189,000
2,871,000
2,906,000
2,895,000
3,234,000
3,533,132
—
—
—
—
311,000
317,829
397,000
548,000
390,000
391,000
409,000
421,099
Tampa
2,389,000
3,049,000
2,542,000
2,772,000
3,193,000
3,449,810
West Palm Beach
3,836,000
3,426,000
3,595,000
3,235,000
3,271,000
3,200,060
Georgia State
Program
1,515,000
1,527,000
1,576,000
1,621,000
1,744,000
1,860,455
Atlanta
4,899,000
6,592,000
5,290,000
6,801,000
7,034,000
8,788,464
Augusta
373,000
418,000
376,000
394,000
385,000
398,640
Hawaii State
Program
181,000
169,000
162,000
160,000
164,000
168,039
Honolulu
452,000
428,000
429,000
419,000
433,000
444,761
Iowa State Program
347,000
329,000
330,000
336,000
354,000
367,359
Illinois State Program
864,000
827,000
875,000
875,000
916,000
945,467
8,338,000
5,379,000
5,561,000
5,572,000
5,819,000
5,993,040
Indiana State
Program
836,000
806,000
818,000
822,000
863,000
892,730
Indianapolis
759,000
738,000
751,000
752,000
782,000
806,705
Kansas State
Program
363,000
349,000
331,000
332,000
346,000
357,333
Kentucky State
Program
423,000
407,000
410,000
408,000
431,000
452,782
Louisville
462,000
443,000
447,000
453,000
476,000
502,511
Louisiana State
Program
940,000
932,000
951,000
975,000
1,034,000
1,090,045
Baton Rouge
1,813,000
1,659,000
1,572,000
1,409,000
1,433,000
1,797,197
New Orleans
2,992,000
3,398,000
2,997,000
2,914,000
2,769,000
3,089,672
525,000
178,000
168,000
166,000
173,000
180,471
Boston
1,829,000
1,721,000
1,719,000
1,690,000
1,747,000
1,779,243
Lowell
659,000
623,000
627,000
622,000
644,000
658,318
—
316,000
317,000
312,000
326,000
331,866
Springfield
461,000
433,000
424,000
418,000
426,000
445,162
Worcester
369,000
348,000
354,000
349,000
368,000
377,385
Deltona
Lakelandc
Miami
Orlando
Palm
Bayc
Sarasota/Bradenton
Chicago
Massachusetts State
Program
Lynn
Congressional Research Service
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Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
345,000
335,000
348,000
345,000
357,000
362,346
Baltimore
7,936,000
7,754,000
7,649,000
8,038,000
8,195,000
8,657,224
Frederickd
535,000
518,000
524,000
539,000
575,000
603,776
Michigan State
Program
911,000
862,000
877,000
893,000
941,000
980,158
Detroit
1,979,000
1,554,000
1,597,000
1,640,000
1,979,000
2,066,997
Warren
405,000
392,000
397,000
409,000
437,000
456,391
Minnesota State
Program
110,000
105,000
112,000
114,000
119,000
124,525
Minneapolis
839,000
797,000
829,000
833,000
873,000
903,558
Missouri State
Program
496,000
475,000
455,000
450,000
473,000
492,485
Kansas City
978,000
924,000
918,000
918,000
955,000
1,016,453
1,217,000
1,158,000
1,150,000
1,140,000
1,227,000
1,264,901
Mississippi State
Program
756,000
749,000
778,000
783,000
833,000
858,039
Jackson
724,000
998,000
868,000
899,000
885,000
881,503
2,082,000
2,010,000
2,097,000
2,154,000
2,272,000
2,387,029
Charlotte
571,000
565,000
597,000
626,000
671,000
714,063
Wake County
352,000
337,000
366,000
382,000
434,000
459,800
—
—
—
—
306,000
317,829
1,106,000
1,050,000
1,064,000
1,056,000
1,079,000
1,109,696
657,000
628,000
620,000
610,000
642,000
655,912
—
2,240,000
2,545,000
2,443,000
2,534,087
2,358,602
Newark
5,182,000
5,014,000
5,246,000
4,924,000
5,167,000
4,913,428
Paterson
—
1,265,000
1,282,000
1,250,000
1,286,736
1,301,766
1,462,000
1,366,000
1,375,000
1,351,000
1,390,000
1,408,877
New Mexico State
Program
533,000
503,000
514,000
514,000
532,000
552,442
Nevada State
Program
238,000
219,000
219,000
219,000
228,000
236,818
Las Vegas
916,000
886,000
882,000
897,000
952,000
1,002,015
1,776,000
1,702,000
1,797,000
1,809,000
1,897,000
1,938,459
Albany
429,000
415,000
436,000
439,000
462,000
471,430
Buffalo
472,000
456,000
480,000
480,000
507,000
521,962
Maryland State
Program
St. Louis
North Carolina
Program
Nebraska State
Program
New Jersey State
Programb
Camden
Jersey City
Woodbridge
New York State
Program
Congressional Research Service
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Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
1,660,000
1,565,000
1,617,000
1,608,000
1,675,000
1,711,266
60,355,000
47,056,000
56,610,000
54,723,000
56,811,177
52,654,359
Poughkeepsie
604,000
577,000
679,000
812,000
947,000
655,310
Rochester
597,000
575,000
599,000
605,000
640,000
658,519
1,041,000
1,024,000
1,037,000
1,051,000
1,108,000
1,157,420
Cincinnati
550,000
517,000
518,000
530,000
562,000
584,124
Cleveland
854,000
822,000
826,000
840,000
870,000
895,337
Columbus
584,000
584,000
596,000
608,000
641,000
667,342
Oklahoma State
Program
518,000
494,000
498,000
506,000
226,000
230,000
Oklahoma City
466,000
441,000
435,000
437,000
459,000
483,261
Tulsae
—
—
—
—
307,000
324,647
Oregon State
Program
—
321,000
319,000
317,000
335,000
350,114
Portland
1,006,000
949,000
947,000
943,000
988,000
1,016,854
Pennsylvania State
Program
1,540,000
1,511,000
1,548,000
1,527,000
1,670,000
1,755,180
Philadelphia
7,632,000
7,336,000
7,083,000
6,650,000
7,052,000
8,716,376
626,000
620,000
623,000
619,000
649,000
676,967
Puerto Rico State
Program
1,748,000
1,636,000
1,633,000
1,616,000
1,679,000
1,709,461
San Juan
7,140,000
5,324,000
5,874,000
5,632,000
6,144,000
6,266,967
807,000
764,000
776,000
773,000
801,000
820,541
1,387,000
1,356,000
1,387,000
1,403,000
1,491,000
1,563,881
418,000
390,000
397,000
401,000
419,000
437,943
1,270,000
1,160,000
1,041,000
1,034,000
1,138,000
1,404,470
739,000
718,000
747,000
756,000
796,000
830,568
Memphis
2,134,000
1,462,000
1,882,000
1,879,000
2,115,000
2,019,277
Nashville
737,000
840,000
737,000
757,000
795,000
829,966
2,736,000
2,634,000
2,691,000
2,733,000
2,841,000
2,625,853
Austin
988,000
931,000
940,000
947,000
987,000
1,029,086
Dallas
3,192,000
3,867,000
3,141,000
3,134,000
3,332,000
3,642,608
—
—
—
—
—
327,655
835,000
805,000
813,000
819,000
863,000
892,529
Houston
5,068,000
9,669,000
6,039,000
6,579,000
6,038,000
7,315,504
San Antonio
1,027,000
960,000
971,000
972,000
1,025,000
1,064,378
120,000
111,000
112,000
111,000
115,000
117,707
Islip
New York City
Ohio State Program
Pittsburgh
Providence
South Carolina State
Program
Charleston
Columbia
Tennessee State
Program
Texas State Program
El Paso
Fort Worth
Utah State Program
Congressional Research Service
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.
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
Salt Lake City
386,000
354,000
353,000
346,000
357,000
363,348
Virginia State
Program
640,000
612,000
618,000
615,000
634,000
667,943
Richmond
692,000
658,000
665,000
660,000
690,000
702,433
1,022,000
958,000
941,000
937,000
968,000
1,002,215
652,000
619,000
620,000
622,000
651,000
671,553
1,688,000
1,611,000
1,615,000
1,604,000
1,663,000
1,705,852
Wisconsin State
Program
405,000
383,000
389,000
391,000
407,000
422,102
Milwaukee
512,000
487,000
497,000
492,000
515,000
531,988
—
—
—
—
—
309,608
263,039,000
251,323,000
256,162,000
256,162,000
267,417,000
276,089,000
29,227,000
27,925,000
28,463,000
28,463,000
29,713,000
30,676,000
2,485,000
2,480,000
1,485,000
1,485,000
1,485,000
1,485,000
294,751,000
281,728,000
286,110,000
286,110,000
300,100,000
310,000,000
Virginia Beach
Washington State
Program
Seattle
West Virginia State
Program
—Subtotal formula
grants
—Subtotal competitive
grants
—Subtotal technical
asst.
Total HOPWA
Source: U.S. Department of Housing and Urban Development, Office of Community Planning and Development
Program Formula Allocations, available at http://www.hud.gov/offices/cpd/about/budget/budget08/index.cfm, and
FY2006-FY2010 Congressional Budget Justifications.
a.
The State of California administers the grant for the Bakersfield MSA (See FY2010 HUD Congressional
Budget Justifications, p. X-14).
b.
According to directions in HUD Appropriations Acts, funds awarded to the Wilmington MSA are
transferred to the State of New Jersey to administer the HOPWA program for the one New Jersey county
that is in the Wilmington MSA (Salem county).
c.
The State of Florida administers the grants for the Cape Coral, Lakeland, and Palm Bay MSAs.
d.
The State of Maryland administers the grant for the Bethesda-Frederick-Gaithersburg MSA.
e.
The State of Oklahoma administers the grant for the Tulsa MSA.
Author Contact Information
Libby Perl
Specialist in Housing Policy
eperl@crs.loc.gov, 7-7806
Congressional Research Service
1867
U.S. Department of Health and Human Services, “HIV/AIDS Bureau Policy Notice 99-02,” 71 Federal Register
70781, December 6, 2006.
Congressional Research Service
12
Housing for Persons Living with HIV/AIDS
policy notice on February 27, 2008 (Amendment #1 to Policy Notice 99-02).68 The policy took
effect on March 27, 2008. However, as the 24-month deadline approached, in February 2010
HRSA released another notice announcing that it was rescinding Amendment #1 to Policy Notice
99-02, and that grantees would not be required to enforce the previous 24-month limit on housing
services.69 HRSA also noted that it would be “undertaking a comprehensive review of the
Housing Policy.”70
On May 12, 2011, HRSA released a final notice (Notice 11-01) laying out how Ryan White funds
may be used for housing.71 Ryan White Parts A, B, and D funding (grants to urban areas, states,
and public or nonprofit entities) can be used to fund housing search assistance and “short-term or
emergency housing.” Although Notice 11-01 did not specifically limit the amount of time that
housing can be funded, it defined “short-term or emergency housing” as:
transitional in nature and for the purposes of moving or maintaining an individual or family
in a long-term, stable living situation. Thus, such assistance cannot be permanent and must
be accompanied by a strategy to identify, relocate, and/or ensure the individual or family is
moved to, or capable of maintaining, a long-term, stable living situation.72
In addition, the notice strongly encouraged grantees or local planning bodies to define short-term
housing themselves, recommending that they consider adopting the HUD definition of
transitional housing: 24 months.73
Under Notice 11-01, housing must either provide medical or supportive services, or, if it does not
provide these services, the housing must be necessary for clients to gain access to or compliance
with medical care. Ryan White funds may not be used to make direct payments to clients or for
mortgage payments, and Ryan White must be the payer of last resort.
68
U.S. Department of Health and Human Services, “HIV/AIDS Bureau Policy Notice 99-02 Amendment #1,” 73
Federal Register 10260-10261, February 26, 2008.
69
U.S. Department of Health and Human Services, Health Resources and Services Administration, “HIV/AIDS
Bureau: Policy Notice 99-02 Amendment #1,” 75 Federal Register 6672-6673, February 10, 2010.
70
Ibid.
71
U.S. Department of Health and Human Services, Health Resources and Services Administration, “HIV/AIDS Bureau
Policy Notice 11–01 (Replaces Policy Notice 99–02),” 76 Federal Register 27649-27651, May 12, 2011.
72
Ibid., p. 27650.
73
Transitional housing is defined in the law governing the HUD Homeless Assistance Grants as “housing the purpose
of which is to facilitate the movement of individuals and families experiencing homelessness to permanent housing
within 24 months or such longer period as the Secretary determines necessary.” 42 U.S.C. §11360(29).
Congressional Research Service
13
Housing for Persons Living with HIV/AIDS
The Relationship Between Stable Housing
and Health Outcomes
As mentioned earlier in this report, HIV/AIDS status is associated with homelessness: those
persons who are homeless are more likely to be HIV positive than those who are housed. In
addition, recent research has found that the health outcomes of homeless individuals living with
HIV/AIDS may be improved with stable housing. In response to evidence from recent studies, the
Administration’s National HIV/AIDS Strategy, published in 2010, acknowledged that “access to
housing is an important precursor to getting many people into a stable treatment regimen.
Individuals living with HIV who lack stable housing are more likely to delay HIV care, have
poorer access to regular care, are less likely to receive optimal antiretroviral therapy, and are less
likely to adhere to therapy.”74 The National HIV/AIDS Strategy included pursuing the goal of
housing as one of the ways to increase access to care and improve health outcomes for individuals
living with HIV and AIDS.75
This section of the report gives a short overview of several studies that have examined how
access to stable housing influences health outcomes for those living with HIV and AIDS.
Community Health Advisory & Information Network (CHAIN) Project Data
The CHAIN Project is a longitudinal study, begun in 1994, of a sample of individuals who are
living with HIV/AIDS in New York City and the northern suburbs. In 2007, researchers released a
study that used the CHAIN data to examine the effects of stable housing on health care for
individuals living with HIV and AIDS.76
The study looked at those who were unstably housed—meaning that they were either living in
some form of transitional housing; in a jail, drug treatment facility, or halfway house; in a
hospice; or temporarily living in someone else’s home—or who were homeless, meaning that
they were living in a shelter or place not meant for human habitation. Researchers measured the
likelihood of six scenarios involving the receipt or continuity of both medical care in general and
appropriate HIV medical care. In general, individuals who were unstably housed were less likely
to enter into and retain both medical care and appropriate HIV care.77 However, the likelihood of
obtaining and retaining medical care increased if individuals received some form of housing
assistance.78 In addition, receipt of mental health services and social services case management
had a statistically significant relationship to individuals entering into and retaining medical care.
74
National HIV/AIDS Strategy for the United States, July 13, 2010, p. 28, http://www.whitehouse.gov/sites/default/
files/uploads/NHAS.pdf.
75
Ibid., pp. 27-28.
76
Angela A. Aidala, Gunjeong Lee, and David M. Abramson, et al., “Housing Need, Housing Assistance, and
Connection to HIV Medical Care,” Aids and Behavior, vol. 11, no. 6 (November 2007, supplement), pp. S101-S115.
77
The statistical significance of the likelihood varied among the models used. See Table 3, pp. S110-S111 for
significance.
78
Findings were statistically significant in all but one of six models—continuity of appropriate HIV medical care.
Congressional Research Service
14
Housing for Persons Living with HIV/AIDS
Housing and Health Study
In the Housing and Health Study, HUD, together with the CDC, provided HIV positive
individuals who were homeless or at severe risk of homelessness with HOPWA-funded rental
housing. (The study considered individuals to be at severe risk of homelessness if they frequently
moved from one temporary housing situation to another.) Those individuals in the comparison
group received services, including assistance with finding housing, but did not receive HOPWAfunded housing.79 Despite the differences in rental assistance provided between the treatment and
comparison groups, both groups had a statistically significant increase in stable housing.80 After
18 months, 82% of HOPWA-assisted renters and 52% of individuals in the comparison group
were living in their own housing. Perhaps due to the fact that the comparison group also had some
success in achieving and maintaining housing, both groups saw statistically significant
improvements in health outcomes. After 18 months, both groups had fewer emergency room
visits, fewer hospitalizations, reduced opportunistic infections (those infections that occur due to
weakened immune systems), and reduced use of medical care generally. Self-reported depression
and perceived stress saw improvement as well.
Chicago Housing for Health Partnership Study
The Chicago Housing for Health Partnership study identified homeless individuals with chronic
illnesses, including HIV, for participation. Among those who participated in the study, 36% were
HIV positive. The treatment group received housing funded through either HOPWA or HUD’s
Supportive Housing Program for homeless individuals, while the comparison, or usual care
group, received available supportive services but no separate assistance with rent. The study
found that, after 12 months, the group receiving housing assistance had higher rates of intact
immunity compared to the comparison group and were more likely to have undetectable viral
loads.81 There was no statistically significant difference between CD4 counts for the treatment
and usual care group. (Very generally, CD4 counts are a measure of immune system strength.) At
the conclusion of the study, the treatment group was found to have spent fewer days in emergency
rooms and hospitals during the 18 month period in which the researchers followed participants.
Specifically, compared to those in the usual care group, those in the treatment group showed 29%
reduction in hospitalizations, a 29% reduction in the number of days spent in the hospital, and a
24% reduction in visits to the emergency room.82
79
The methodology of the study is described in Daniel P. Kidder, Richard J. Wolitski, and Scott Royal, et al., “Access
to Housing as a Structural Intervention for Homeless and Unstably Housing People Living with HIV: Rationale,
Methods, and Implementation of the Housing and Health Study,” AIDS and Behavior, vol. 11, no. 6 (November 2007,
supplement), pp. 149-161.
80
Richard J. Wolitski, Daniel P. Kidder, and Sherri L. Pals, et al., “Randomized Trial of the Effects of Housing
Assistance on the Health and Risk Behaviors of Homeless and Unstably Housing People Living with HIV,” AIDS &
Behavior, vol. 14, no. 3 (2010), pp. 493-503.
81
David Buchanan, Romina Kee, and Laura S. Sadowski, et al., “The Health Impact of Supportive Housing for HIVPositive Homeless Patients: A Randomized Controlled Trial,” American Journal of Public Health, vol. 99, no. S3
(November 2009), pp. S675-S680.
82
Laura S. Sadowski, Romina A. Kee, and Tyler J. VanderWeele, et al., “Effects of a Housing and Case Management
Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults,” Journal of
the American Medical Association, vol. 301, no. 17 (May 6, 2009), pp. 1775-1776.
Congressional Research Service
15
Housing for Persons Living with HIV/AIDS
Appendix. Recent HOPWA Formula Allocations
Table A-1. HOPWA Formula Allocations, FY2004-FY2012
MSA, State, or
Territory
Alabama State
Program
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
1,139,000
1,117,000
1,145,000
1,163,000
1,241,000
1,299,792
1,403,821
1,402,039
1,419,006
Birmingham
520,000
497,000
511,000
516,000
538,000
554,848
593,523
586,116
582,166
Arkansas State
Program
752,000
723,000
707,000
720,000
766,000
797,682
531,915
544,150
543,382
—
—
—
—
—
—
317,437
319,590
320,567
164,000
164,000
173,000
180,000
191,000
198,919
219,282
223,148
230,334
Phoenix
1,434,000
1,391,000
1,433,000
1,456,000
1,541,000
1,608,397
1,769,291
1,779,736
1,808,832
Tucson
402,000
390,000
389,000
390,000
411,000
420,497
453,391
453,761
459,084
3,042,000
2,869,000
2,929,000
2,926,000
2,746,000
2,557,875
2,746,244
2,694,723
2,696,922
Bakersfielda
—
—
—
—
323,000
472,334
635,917
375,881
384,879
Fresnoa
—
—
—
—
—
315,824
346,048
352,275
358,363
10,476,000
11,848,000
10,310,000
10,393,000
10,437,000
10,764,091
12,384,800
12,627,562
15,305,260
Oakland
2,006,000
1,879,000
1,905,000
1,896,000
1,952,000
2,038,921
2,208,481
2,514,177
2,673,899
Riverside
1,772,000
1,683,000
1,684,000
1,689,000
1,751,000
1,850,429
1,990,870
1,970,602
1,981,582
844,000
795,000
786,000
784,000
818,000
844,003
906,991
884,723
900,755
San Diego
2,683,000
2,527,000
2,549,000
2,551,000
2,646,000
2,731,528
2,935,661
2,884,983
2,883,128
San Francisco
8,562,000
8,466,000
8,070,000
8,189,000
8,193,000
9,233,417
9,977,748
9,782,816
9,731,577
792,000
736,000
738,000
739,000
767,000
796,679
871,489
861,520
878,197
1,436,000
1,342,000
1,359,000
1,345,000
1,402,000
1,458,807
1,568,178
1,540,447
1,548,618
366,000
354,000
364,000
363,000
379,000
392,424
425,407
424,707
426,632
Little Rock
Arizona State
Program
California State
Program
Los Angeles
Sacramento
San Jose
Santa Anna
Colorado State
Program
CRS-16
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
Denver
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
1,424,000
1,342,000
1,359,000
1,361,000
1,414,000
1,452,390
1,572,773
1,565,263
1,573,947
Connecticut State
Program
251,000
242,000
253,000
252,000
263,000
268,902
286,319
283,878
282,574
Bridgeport
779,000
717,000
737,000
739,000
771,000
854,931
846,219
832,063
829,320
Hartford
1,023,000
1,285,000
1,108,000
1,098,000
1,140,000
1,084,029
1,153,422
1,131,275
1,126,735
New Haven
1,232,000
1,624,000
1,178,000
1,075,000
946,000
963,113
1,021,853
1,001,946
989,999
11,802,000
10,535,000
11,370,000
11,118,000
11,541,000
12,213,518
14,118,841
13,795,546
13,623,582
Delaware State
Program
164,000
162,000
166,000
167,000
179,000
186,286
202,783
205,796
204,213
Wilmingtonb
798,000
703,000
679,000
552,000
604,000
651,902
771,469
686,951
639,156
4,063,000
3,581,000
3,312,000
3,316,000
3,191,000
3,012,662
3,655,741
3,680,729
3,714,625
Cape Coralc
—
—
336,000
332,000
350,000
368,963
402,434
451,881
411,395
Deltonad
—
—
—
—
—
312,215
—
—
—
Fort Lauderdale
6,240,000
6,106,000
6,637,000
6,878,000
7,351,000
7,545,922
8,646,967
9,305,740
9,482,644
Jacksonville
1,564,000
1,624,000
1,587,000
1,630,000
1,988,000
2,265,720
2,510,630
2,815,995
2,584,823
—
378,000
445,000
418,000
509,000
491,383
545,040
635,095
678,078
10,715,000
10,351,000
11,189,000
11,689,000
12,370,000
12,599,526
12,935,584
12,498,939
12,163,466
3,189,000
2,871,000
2,906,000
2,895,000
3,234,000
3,533,132
3,347,552
3,640,338
3,401,180
—
—
—
—
311,000
317,829
341,871
340,775
340,949
397,000
548,000
390,000
391,000
409,000
421,099
460,283
459,410
457,699
Tampa
2,389,000
3,049,000
2,542,000
2,772,000
3,193,000
3,449,810
3,721,763
3,548,685
3,190,576
West Palm Beach
3,836,000
3,426,000
3,595,000
3,235,000
3,271,000
3,200,060
3,466,709
3,478,287
3,404,924
Georgia State
Program
1,515,000
1,527,000
1,576,000
1,621,000
1,744,000
1,860,455
2,025,746
2,019,428
2,038,769
Atlanta
4,899,000
6,592,000
5,290,000
6,801,000
7,034,000
8,788,464
9,224,086
10,142,432
8,539,053
Augusta
373,000
418,000
376,000
394,000
385,000
398,640
429,792
425,918
425,840
Hawaii State Program
181,000
169,000
162,000
160,000
164,000
168,039
181,691
178,357
176,906
Washington, DC
Florida State Program
Lakelandc
Miami
Orlando
Palm
Bayc
Sarasota/Bradentonc
CRS-17
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
Honolulu
452,000
428,000
429,000
419,000
433,000
444,761
473,440
472,726
477,883
Iowa State Program
347,000
329,000
330,000
336,000
354,000
367,359
400,137
405,944
409,416
Illinois State Program
864,000
827,000
875,000
875,000
916,000
945,467
1,014,962
1,015,666
1,028,784
8,338,000
5,379,000
5,561,000
5,572,000
5,819,000
5,993,040
6,426,836
6,371,215
6,417,879
Indiana State Program
836,000
806,000
818,000
822,000
863,000
892,730
971,314
980,761
980,105
Indianapolis
759,000
738,000
751,000
752,000
782,000
806,705
878,589
884,925
895,610
Kansas State Program
363,000
349,000
331,000
332,000
346,000
357,333
384,683
384,759
386,858
Kentucky State
Program
423,000
407,000
410,000
408,000
431,000
452,782
493,906
501,578
510,929
Louisville
462,000
443,000
447,000
453,000
476,000
502,511
554,887
553,834
557,629
Louisiana State
Program
940,000
932,000
951,000
975,000
1,034,000
1,090,045
1,203,335
1,234,375
1,266,439
Baton Rouge
1,813,000
1,659,000
1,572,000
1,409,000
1,433,000
1,797,197
2,225,972
2,303,702
2,552,872
New Orleans
2,992,000
3,398,000
2,997,000
2,914,000
2,769,000
3,089,672
3,385,486
3,416,072
3,584,653
525,000
178,000
168,000
166,000
173,000
180,471
194,639
197,121
1,878,288
Boston
1,829,000
1,721,000
1,719,000
1,690,000
1,747,000
1,779,243
1,889,165
1,884,046
197,288
Lowell
659,000
623,000
627,000
622,000
644,000
658,318
702,955
704,550
709,998
—
316,000
317,000
312,000
326,000
331,866
355,028
355,907
359,748
Springfield
461,000
433,000
424,000
418,000
426,000
445,162
481,793
471,919
474,123
Worcester
369,000
348,000
354,000
349,000
368,000
377,385
408,282
401,707
405,261
Maryland State
Program
345,000
335,000
348,000
345,000
357,000
362,346
401,808
399,689
409,020
Baltimore
7,936,000
7,754,000
7,649,000
8,038,000
8,195,000
8,657,224
10,043,043
8,887,872
9,038,879
Fredericke
535,000
518,000
524,000
539,000
575,000
603,776
977,937
823,714
707,425
Michigan State
Program
911,000
862,000
877,000
893,000
941,000
980,158
1,056,103
1,051,579
1,064,798
1,979,000
1,554,000
1,597,000
1,640,000
1,979,000
2,066,997
1,944,506
2,016,944
2,200,845
Chicago
Massachusetts State
Program
Lynn
Detroit
CRS-18
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
Warren
405,000
392,000
397,000
409,000
437,000
456,391
498,501
495,727
504,993
Minnesota State
Program
110,000
105,000
112,000
114,000
119,000
124,525
137,625
139,821
142,672
Minneapolis
839,000
797,000
829,000
833,000
873,000
903,558
977,370
1,006,587
1,019,484
Missouri State
Program
496,000
475,000
455,000
450,000
473,000
492,485
526,694
531,035
532,894
Kansas City
978,000
924,000
918,000
918,000
955,000
1,016,453
1,108,522
1,110,292
1,115,258
1,217,000
1,158,000
1,150,000
1,140,000
1,227,000
1,264,901
1,362,053
1,375,810
1,394,864
Mississippi State
Program
756,000
749,000
778,000
783,000
833,000
858,039
948,759
951,304
977,731
Jackson
724,000
998,000
868,000
899,000
885,000
881,503
970,233
982,379
1,147,882
2,082,000
2,010,000
2,097,000
2,154,000
2,272,000
2,387,029
2,685,680
2,397,730
2,445,019
571,000
565,000
597,000
626,000
671,000
714,063
793,382
813,905
830,903
—
—
—
—
—
—
—
309,502
316,214
352,000
337,000
366,000
382,000
434,000
459,800
721,566
678,603
670,467
—
—
—
—
306,000
317,829
344,586
348,643
358,165
1,106,000
1,050,000
1,064,000
1,056,000
1,079,000
1,109,696
1,180,213
1,178,084
1,184,121
657,000
628,000
620,000
610,000
642,000
655,912
713,814
711,612
719,694
—
2,240,000
2,545,000
2,443,000
2,534,087
2,358,602
2,926,790
2,920,338
3,002,370
Newark
5,182,000
5,014,000
5,246,000
4,924,000
5,167,000
4,913,428
6,620,013
6,646,588
7,218,919
Paterson
—
1,265,000
1,282,000
1,250,000
1,286,736
1,301,766
1,404,206
1,381,032
1,380,000
1,462,000
1,366,000
1,375,000
1,351,000
1,390,000
1,408,877
1,516,177
1,497,875
1,497,762
533,000
503,000
514,000
514,000
532,000
552,442
272,536
280,246
281,585
—
—
—
—
—
—
320,778
324,634
326,702
St. Louis
North Carolina
Program
Charlotte
Greensboro
Wake County
Nebraska State
Program
New Jersey State
Programb
Camden
Jersey City
Woodbridge/Edisonf
New Mexico State
Program
Albuquerqueg
CRS-19
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
Nevada State
Program
238,000
219,000
219,000
219,000
228,000
236,818
254,785
255,631
255,069
Las Vegas
916,000
886,000
882,000
897,000
952,000
1,002,015
1,098,706
1,105,651
1,122,382
1,776,000
1,702,000
1,797,000
1,809,000
1,897,000
1,938,459
2,139,773
2,154,810
2,098,332
Albany
429,000
415,000
436,000
439,000
462,000
471,430
508,525
508,035
500,639
Buffalo
472,000
456,000
480,000
480,000
507,000
521,962
565,329
567,151
550,703
1,660,000
1,565,000
1,617,000
1,608,000
1,675,000
1,711,266
1,848,859
1,836,229
1,789,637
60,355,000
47,056,000
56,610,000
54,723,000
56,811,177
52,654,359
54,718,998
55,968,315
54,245,344
Poughkeepsie
604,000
577,000
679,000
812,000
947,000
655,310
702,119
698,901
672,598
Rochester
597,000
575,000
599,000
605,000
640,000
658,519
709,220
713,226
691,595
1,041,000
1,024,000
1,037,000
1,051,000
1,108,000
1,157,420
1,249,280
1,264,841
1,274,948
Cincinnati
550,000
517,000
518,000
530,000
562,000
584,124
643,644
657,741
672,796
Cleveland
854,000
822,000
826,000
840,000
870,000
895,337
960,454
963,208
967,243
Columbus
584,000
584,000
596,000
608,000
641,000
667,342
735,952
768,105
793,899
Oklahoma State
Program
518,000
494,000
498,000
506,000
226,000
230,000
243,925
247,359
246,560
Oklahoma City
466,000
441,000
435,000
437,000
459,000
483,261
513,746
519,333
519,042
Tulsa
—
—
—
—
307,000
324,647
342,706
349,450
349,062
Oregon State
Program
—
321,000
319,000
317,000
335,000
350,114
374,867
376,285
378,349
Portland
1,006,000
949,000
947,000
943,000
988,000
1,016,854
1,088,055
1,086,484
1,090,721
Pennsylvania State
Program
1,540,000
1,511,000
1,548,000
1,527,000
1,670,000
1,755,180
1,615,167
1,600,168
1,615,304
Allentownh
—
—
—
—
—
—
317,228
322,414
324,921
Philadelphia
7,632,000
7,336,000
7,083,000
6,650,000
7,052,000
8,716,376
8,786,271
7,385,176
7,701,943
626,000
620,000
623,000
619,000
649,000
676,967
731,148
729,568
731,171
New York State
Program
Islip
New York City
Ohio State Program
Pittsburgh
CRS-20
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
Puerto Rico State
Program
1,748,000
1,636,000
1,633,000
1,616,000
1,679,000
1,709,461
1,825,260
1,806,368
1,810,019
San Juan
7,140,000
5,324,000
5,874,000
5,632,000
6,144,000
6,266,967
6,430,001
6,312,892
5,882,407
807,000
764,000
776,000
773,000
801,000
820,541
874,203
872,012
877,009
1,387,000
1,356,000
1,387,000
1,403,000
1,491,000
1,563,881
1,708,727
1,728,286
1,474,412
418,000
390,000
397,000
401,000
419,000
437,943
477,408
547,873
560,081
Columbia
1,270,000
1,160,000
1,041,000
1,034,000
1,138,000
1,404,470
1,566,258
1,540,616
1,584,363
Greenville
—
—
—
—
—
—
—
—
297,217
739,000
718,000
747,000
756,000
796,000
830,568
911,377
916,803
947,455
Memphis
2,134,000
1,462,000
1,882,000
1,879,000
2,115,000
2,019,277
1,701,201
1,540,635
1,705,456
Nashville
737,000
840,000
737,000
757,000
795,000
829,966
903,441
911,759
900,557
2,736,000
2,634,000
2,691,000
2,733,000
2,841,000
2,625,853
2,818,502
2,807,104
2,830,690
Austin
988,000
931,000
940,000
947,000
987,000
1,029,086
1,103,927
1,096,976
1,100,219
Dallas
3,192,000
3,867,000
3,141,000
3,134,000
3,332,000
3,642,608
3,722,637
3,969,841
4,060,375
—
—
—
—
—
327,655
355,028
355,503
355,395
835,000
805,000
813,000
819,000
863,000
892,529
950,848
936,172
942,706
Houston
5,068,000
9,669,000
6,039,000
6,579,000
6,038,000
7,315,504
7,793,944
7,127,183
7,572,952
San Antonio
1,027,000
960,000
971,000
972,000
1,025,000
1,064,378
1,151,125
1,168,601
1,187,881
Utah State Program
120,000
111,000
112,000
111,000
115,000
117,707
126,975
127,715
129,216
Salt Lake City
386,000
354,000
353,000
346,000
357,000
363,348
387,189
387,583
386,858
Virginia State
Program
640,000
612,000
618,000
615,000
634,000
667,943
703,999
725,533
727,609
Richmond
692,000
658,000
665,000
660,000
690,000
702,433
774,169
781,825
864,491
1,022,000
958,000
941,000
937,000
968,000
1,002,215
1,079,493
1,093,344
1,089,336
652,000
619,000
620,000
622,000
651,000
671,553
728,016
722,709
728,203
Providence
South Carolina State
Program
Charleston
Tennessee State
Program
Texas State Program
El Paso
Fort Worth
Virginia Beach
Washington State
Program
CRS-21
Housing for Persons Living with HIV/AIDS
MSA, State, or
Territory
Seattle
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
1,688,000
1,611,000
1,615,000
1,604,000
1,663,000
1,705,852
1,821,710
1,809,798
1,814,768
Wisconsin State
Program
405,000
383,000
389,000
391,000
407,000
422,102
455,271
460,217
463,438
Milwaukee
512,000
487,000
497,000
492,000
515,000
531,988
574,936
576,432
579,000
—
—
—
—
—
309,608
336,232
336,134
339,564
263,039,000
251,323,000
256,162,000
256,162,000
267,417,000
276,089,000
298,485,000
297,888,030
298,800,000
29,227,000
27,925,000
28,463,000
28,463,000
29,713,000
30,676,000
33,165,000
32,100,000i
33,200,000
2,485,000
2,480,000
1,485,000
1,485,000
1,485,000
1,485,000
3,350,000
3,343,000
—
294,751,000
281,728,000
286,110,000
286,110,000
300,100,000
310,000,000
335,000,000
334,330,000j
332,000,000
West Virginia State
Program
—Subtotal formula
grants
—Subtotal competitive
grants
—Subtotal technical
asst.
Total HOPWA
Source: U.S. Department of Housing and Urban Development, Office of Community Planning and Development Program Formula Allocations, http://portal.hud.gov/
hudportal/HUD?src=/program_offices/comm_planning/communitydevelopment/budget, and the Office of Community Planning and Development Appropriations Budget
page, http://www.hud.gov/offices/cpd/about/budget/index.cfm.
a.
The State of California administers the grant for the Bakersfield and Fresno MSAs. See U.S. Department of Housing and Urban Development, 2012 HOPWA Formula
Operating Instructions, January 31, 2012, p. 4, http://www.hudhre.info/documents/2012Operating_Formula.pdf.
b.
According to directions in HUD Appropriations Acts, funds awarded to the Wilmington MSA are transferred to the State of New Jersey to administer the HOPWA
program for the one New Jersey county that is in the Wilmington MSA (Salem county).
c.
The State of Florida administers the grants for the Cape Coral, Lakeland, Bradenton, and Palm Bay MSAs. 2012 HOPWA Formula Operating Instructions, p. 4.
d.
After FY2009, Deltona no longer qualified for funds. U.S. Department of Housing and Urban Development, 2010 HOPWA Formula Operating Instructions, April 1, 2010,
p. 1, http://www.hudhre.info/documents/2010Operating_Formula.pdf.
e.
The State of Maryland administers the grant for the Bethesda-Frederick-Gaithersburg MSA. 2012 HOPWA Formula Operating Instructions, p. 4.
f.
Starting in FY2010, Edison, NJ replaced Woodbridge as the designated HOPWA grantee. 2010 HOPWA Formula Operating Instructions, p. 1.
g.
The State of New Mexico administers the grant for Albuquerque. 2012 HOPWA Formula Operating Instructions, p. 4.
h.
The State of Pennsylvania administers the grant for Allentown. 2012 HOPWA Formula Operating Instructions, p. 4.
i.
Competitive grants for FY2011 are based on HUD’s announcement of the renewal of existing grants ($23 million) and the NOFA for new competitive grants ($9.1
million).
j.
The FY2012 Department of Defense and Full-Year Appropriation Act (P.L. 112-10) contained an across-the-board rescission of 0.2% for all discretionary accounts. The
rescission reduced the HOPWA appropriation ($335 million) by approximately $670,000.
CRS-22
Housing for Persons Living with HIV/AIDS
Author Contact Information
Libby Perl
Specialist in Housing Policy
eperl@crs.loc.gov, 7-7806
Congressional Research Service
23