Housing for Persons Living with HIV/AIDS

Changes from July 3, 2012 to January 7, 2013

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Housing for Persons Living with HIV/AIDS
Libby Perl
Specialist in Housing Policy
July 3, 2012January 7, 2013

Congressional Research Service
7-5700
www.crs.gov
RL34318

CRS Report for Congress
Prepared for Members and Committees of Congress

 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
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 FY2012, Congress appropriated $332 million for HOPWA as part of the Consolidated
Appropriations Act (P.L. 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. The Appendix provides the formula grants distributed to
eligible states and metropolitan statistical areas from FY2004 to FY2012.

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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 .......................................................................................... 43
Formula Grants .......................................................................................................................... 43
Competitive Grants.................................................................................................................... 5
Eligibility for HOPWA-Funded Housing .................................................................................. 6
Eligible Uses of HOPWA Funds................................................................................................ 76
HOPWA Program Formula and Funding ......................................................................................... 8
The HOPWA Formula ............................................................................................................... 8
HOPWA Funding ..................................................................................................................... 10
Housing Funded Through the Ryan White HIV/AIDS Program ................................................... 1112
The Relationship Between Stable Housing and Health Outcomes ................................................ 1415

Tables
Table 1. HOPWA Funding and Eligible Jurisdictions, FY2001-FY2012 and FY2013
Proposal ...................................................................................................................................... 11
Table A-1. HOPWA Formula Allocations, FY2004-FY2012 ........................................................ 1617

Appendixes
Appendix. Recent HOPWA Formula Allocations .......................................................................... 1617

Contacts
Author Contact Information........................................................................................................... 2324

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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 2009, AIDS had been diagnosed and reported in an estimated
490,696 individuals living in the 50 states, the District of Columbia, and the territories.1 These
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 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 foundStudies of the
relationship between HIV and homelessness have found prevalence among homeless populations
that range from 2% to 22%.4 Further, homelessness has been found to be associated with greater
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 Surveillance Report 2010, vol. 22, Atlanta, GA, March
2012, pp. 56-57, table 16b, http://www.cdc.gov/hiv/surveillance/resources/reports/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.
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,
(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 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.)8M-J Milloy, B.D. Marshall, and J. Montaner, et al., “Housing Status and the Health of People
Living with HIV/AIDS,” Current HIV/AIDS Reports, vol. 9, no. 4 (December 2012), pp. 364-374.
4
David Buchanan, Romina Kee, and Laura Sadowski, et al., “The Health Impact of Supportive Housing for HIV(continued...)

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likelihood of participation in the risk factors that might lead to HIV/AIDS (multiple sexual
partners, sex exchange, drug use, and diagnosis of a sexually transmitted infection),5 as well as
lowered adherence to anti-retroviral therapy.6

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 commission recommended that Congress and the President
provide “[f]ederal housing aid to address the multiple problems posed by HIV infection and
AIDS.”97 About the same time that the commission 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 personspersons living with HIV/AIDS that were discussed at the hearing were poverty, 
homelessness, and
discrimination10 discrimination in attempting to secure housing. 118 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).

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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

hearing was the 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).9 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.10
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
(...continued)
PositiveHomeless Patients: A Randomized Controlled Trial,” American Journal of Public Health, vol. 99, no. S3
(September 3, 2009), pp. S675-S680.
5
See, for example, Danielle German and Carl A. Latkin, “Social Stability and HIV Risk Behavior: Evaluating the Role
of Accumulated Vulnerability,” AIDS and Behavior, vol. 16, no. 1 (January 2012), pp. 168-178.
6
See, for example, Anita Palepu, M-J Milloy, and Thomas Kerr, et al., “Homelessness and Adherence to Antiretroviral
Therapy among a Cohort of HIV-Infected Injection Drug Users,” Journal of Urban Health, vol. 88, no. 3 (June 2011),
pp. 545-555.
7
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.
8
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. See also, Statement of Representative James A. McDermott, 135 Cong. Rec. 23641, October 5, 1989.
9
Ibid., pp. 25-30.
10
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.

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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 into law 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.1411 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 of appropriations
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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appropriations.

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,1512 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:
•

11
12

First, 75% of the total available formula funds, sometimes referred to by HUD as
“base funding,” is distributed to


The law is codified at 42 U.S.C. §§12901-12912, with regulations at 24 C.F.R. Parts 574.3-574.655.
The others are the Community Development Block Grant, the Emergency Solutions Grants, and HOME.

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—the largest cities within metropolitan statistical areas (MSAs)1613 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.1714

•

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 : newly
diagnosed AIDS cases as reported by the CDC for the time period April 1
through March 31 of the year preceding the appropriations law. 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.1915 States are not eligible
 for bonus funding.

Although HOPWA funds are allocated to the largest city within an MSA, thesethe 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.”2016 While 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 Solutions Grants, and HOME.
MSAs are defined as having at least one core “urbanized” area of 50,000 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 central county or counties as measured through commuting.” 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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including those that receivedreceive their own funds.2117 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.”2218 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 based on the number of AIDS cases outside of
recipient MSAs.23
19 HUD jurisdictions that receive HOPWA funds may administer housing and 
services programs
 themselves or may allocate all or a portion of the funds to subgrantee private nonprofit

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.2420
13

MSAs are defined as having at least one core “urbanized” area of 50,000 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 central county or counties as measured through commuting.” See Office of Management and
Budget, “2010 Standards for Delineating Metropolitan and Micropolitan Statistical Areas,” 75 Federal Register 3724637252, July 28, 2010.
14
42 U.S.C. §12903(c)(1)(A).
15
42 U.S.C. §12903(c)(1)(B).
16
42 U.S.C. §12903(f).
17
24 C.F.R. §574.3.
18
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.
19
U.S. Department of Housing and Urban Development, Office of Community Planning and Development, Formula
Allocations for FY2012, http://www.hud.gov/offices/cpd/about/budget/budget12/.
20
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 FY2011, p. Z-12, http://hud.gov/offices/cfo/reports/2011/cjs/
hofpwAIDS2011.pdf.

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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
states and units of general local
government or nonprofit entities that propose “special projects of national significance.”25 A 21 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.26 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.27 other communities.22
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. 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, Formula
Allocations for FY2012, http://www.hud.gov/offices/cpd/about/budget/budget12/.
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 FY2011, p. Z-12, http://hud.gov/offices/cfo/reports/2011/cjs/
hofpwAIDS2011.pdf.
25
42 U.S.C. §12903(c)(3).
26
Ibid.
27
See, for example, U.S. Department of Housing and Urban Development, “FY2008 Notice of Funding Availability
Housing Opportunities for Persons with AIDS,” 73 Federal Register 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.23 In FY2011, HUD awarded approximately $9 million in new competitive
grants to seven projects.24 HUD did not award new competitive grants in FY2012.25 Beginning in
FY2006, competitive funds have remained available for obligation for three years (from FY2002
through FY2005, competitive funds had been available only for two years). The extension made
the rules for HOPWA’s competitive program consistent with those of other competitive programs
advertised in HUD’s SuperNOFA.

21

42 U.S.C. §12903(c)(3).
Ibid.
23
See U.S. Department of Housing and Urban Development, Congressional Justifications for 2012 Estimates, p. Z-13,
http://portal.hud.gov/hudportal/documents/huddoc?id=HOPWA_2012.pdf.
24
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.
25
FY2012 Budget Justifications, p. Z-13.
22

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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.3126 In general, clients must also be low income, meaning that their
income does not exceed 80% of the area median income.3227 HUD reports area median incomes for
metropolitan areas and non-metropolitan counties on an annual basis.3328 Housing and some
supportive services are available for family members of persons living with AIDS. A family
member is defined broadly in regulation to include someone who lives with an eligible individual,
regardless of “actual or perceived sexual orientation, gender identity, or marital status,” and who
is important to the eligible individual or their care or well being.29 When a person When a person
living in 
HOPWA-supported housing dies, his or her family members are given a grace period
during  during
which they may remain in the housing.3430 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(which also funded units for persons with disabilities) and 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.3531 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

(...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

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,
26

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.
3227
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
risk of homelessness. See 42 U.S.C. §12907 and §12910.
3328
U.S. Department of Housing and Urban Development, Office of Policy Development and Research, Fiscal Year
2010 HUD Income Limits Briefing Material, May 13, 2010, p. 1FY2013 HUD Income Limits Briefing Material, December 11,
2012, http://www.huduser.org/portal/datasets/il/il10/
IncomeLimitsBriefingMaterial_FY10il13/IncomeLimitsBriefingMaterial_FY13.pdf. Tables showing area 
median incomes in recent years are available at
 http://www.huduser.org/datasets/il.html.
3429
24 C.F.R. § 574.3.
30
24 C.F.R. §574.310(e).
3531
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.3733
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.3834 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.3935 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.4036 In general, tenants must pay
approximately 30% of their income toward rent.4137 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.42

36

42 U.S.C. §1437a(b)(3).
42 U.S.C. §12910.
38
42 U.S.C. §12907.
3938

•

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.39

•

Housing Information Such as Counseling and Referral Services.40 Assistance
may include fair housing counseling for those experiencing discrimination.41

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).
4036
42 U.S.C. §12908.
4137
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.43

•

Housing Information Such as Counseling and Referral Services.44 Assistance
may include fair housing counseling for those experiencing discrimination.4538
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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The majority of HOPWA funds are used to provide housing. According to HUD, for the 2010201120112012 program year, 66nearly 67% of HOPWA funding was used for housing assistance such as rent and

and building operating costs.4642 An additional 42% was used to help individuals find housing, 2% for
less
than 1% for housing development, and 2023% 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

nearly 95% remained stably housed during the year.4743 Grantee performance reports indicate that clients

clients who receive housing assistance through HOPWA are often at the lowest income levels; in its

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).4844

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.
47due to the data that
are used to distribute the majority of funds. Since the inception of HOPWA, 75% of funds have
been distributed using the cumulative number of AIDS cases as reported by the CDC, including
those who have died. An alternative way of distributing funds would be to use the current number
of people living with AIDS and, potentially, HIV. HOPWA was enacted within four months of
another federal program targeted to assist those living with HIV and AIDS, the Ryan White
CARE Act program (now called the Ryan White HIV/AIDS program). Both programs relied to
some degree on the cumulative number of AIDS cases in distributing funding to eligible
jurisdictions;45 the data reported by the CDC at the time were cumulative cases.46 Since then,
however, the Ryan White program stopped using cumulative AIDS cases and now uses the
number of people living with AIDS and HIV. The HOPWA formula has remained the same.
The Ryan White program formula change came about shortly after the program’s enactment. In
1995, at the request of two senators from the Labor and Human Resources Committee, the
General Accounting Office (GAO, now the Government Accountability Office) examined funding
disparities per person living with AIDS that resulted from using cumulative AIDS cases to
distribute Ryan White funds.47 It proposed several data changes that would result in more
42

U.S. Department of Housing and Urban Development, HOPWA National Performance Profile 2011-2012 Program
Year, http://www.hudhre.info/hopwa_Reports/NP_Combined_PY11-12.pdf.
43
Ibid. The percent stably housed includes those living in permanent dedicated housing units as well as those receiving
tenant-based rental assistance.
4844
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
45
Part A of the Ryan White CARE Act distributed funds to metropolitan statistical areas using “the cumulative number
of cases of acquired immune deficiency syndrome in the eligible area involved.... ” See P.L. 101-381. While the
HOPWA statute did not use the word “cumulative” in describing the formula distribution, the program’s regulations,
issued in 1992, described the formula factor as cumulative cases. See U.S. Department of Housing and Urban
Development, “Housing Opportunities for Persons with AIDS,” 57 Federal Register 61735-61751, December 28, 1992.
46
When HOPWA and Ryan White were enacted, in 1990, the CDC issued annual HIV/AIDS Surveillance Reports that
contained the number of new AIDS cases, and the cumulative number of cases, but not the number of persons living
with AIDS. These were the data relied on by both programs. In 1993, the CDC released estimates of persons living
with AIDS by state, but the report did not contain estimates broken down by metropolitan statistical area.
47
U.S. General Accounting Office, Ryan White CARE Act of 1990: Opportunities to Enhance Funding Equity,
(continued...)

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equitable per-case funding, including a way to weight CDC data to arrive at an estimate of
persons living with AIDS.48 The next year, in 1996, Congress reauthorized the Ryan White
program and changed the way in which grants to metropolitan areas were distributed to use CDC
estimates of persons living with AIDS (P.L. 104-146). The data change included hold-harmless
provisions to ensure that the shift in funding would not be too dramatic. Since then, in 2006, the
Ryan White program formula has been further modified to incorporate living HIV cases in
addition to living AIDS cases.49
Both Congress and recent presidential administrations have acknowledged that the HOPWA
formula could be modified, but the formula has not been changed. Shortly after the first change to
the Ryan White program formula, 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 program to “determine what legislative revisions are needed to make the
HOPWA formula more reflective of current AIDS cases.”50 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.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. ThoseThe recommendations were not adopted by Congress.
 A 2006 
Government Accountability Office (GAO) report again looked at the way in which the
HOPWA  HOPWA
formula allocates funds.53 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 cases
resulted in disproportionate funding per living AIDS case depending on the jurisdiction.54 Two
bills were introduced in the 109th Congress (S. 2339 and H.R. 5009) that 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.
While no legislation to change the HOPWA formula has been introduced since the 109th
Congress, nearly every Administration budget since FY2007 has discussed the need to change the
(...continued)
GAO/HEHS-96-26, November 1995, http://www.gao.gov/assets/230/221925.pdf.
48
Ibid., pp. 21-27.
49
Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415).
50
U.S. General Accounting Office, HUD’s Program for Persons with AIDS, GAO/RCED-97-62, March 1997, p. 27,
http://www.gao.gov/archive/1997/rc97062.pdf.
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
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. 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.
Ibid., p. 24.

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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.55
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.”56 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
to HIV/AIDS case reporting as a basis for formula grants for HOPWA funding.”57 The FY2012
and FY2013 HUD Congressional Budget Justification for HOPWA echoed this goal. Since the
release of the National HIV/AIDS Strategy in 2010, 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.58 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 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 generally declined from FY2003 through FY2011. (See Table 1.) Between FY2003
and FY2009, the number of households served dropped 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)

55

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.
56
FY2010 Congressional Budget Justifications, p. X-13.
57
National HIV/AIDS Strategy Federal Implementation Plan, July 2010, p. 28, http://aids.gov/federal-resources/
policies/national-hiv-aids-strategy/nhas-implementation.pdf.
5958
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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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 generally declined from FY2003 through FY2011. (See Table 1.) Between FY2003
and FY2009, the number of households served dropped from 78,467 to 58,367.59 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.
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.

Includes 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.

59
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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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

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statute).6160 The statute governing the use of Ryan White funds does not specifically list housing as
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.”6261 In 1999, the HIV/AIDS Bureau of the Health Resources and Services
Administration (HRSA) within HHS released policy guidance regarding the type of housing that
Ryan White grantees could provide for their clients (Policy Notice 99-02).6362 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 housing must be exhausted before using Ryan White funds. In 2008, the most recent year for
which HHS has data available regarding housing services, nearly 33,000 persons
 living with an 
HIV positive diagnosis received some sort of housing service through the Ryan
 White HIV/AIDS 
program.6463
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 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.’” 6564 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.”66
Previously the law did not limit the amount of funds that could be used for support services.
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.67 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

61

60
For more information about the Ryan White program, see CRS Report RL33279, The Ryan White HIV/AIDS
Program, by Judith A. Johnson.
6261
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
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.
6362
Policy Notice 99-02 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 (hereinafter, Housing is Health
Care).
6463
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.
67
U.S. Department of Health and Human Services, “HIV/AIDS Bureau Policy Notice 99-02,” 71 Federal Register
70781, December 6, 2006.

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policy notice on February 27, 2008 (Amendment #1 to Policy Notice 99-02).6864
Housing is Health Care, p. 7. See footnote 62.

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more than 25% by requiring that at least 75% of funds be used for “core medical services.”65
Previously the law did not limit the amount of funds that could be used for support services.
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.66 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 (Amendment #1 to Policy Notice 99-02).67 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.6968 HRSA also noted that it would be “undertaking a comprehensive review of the
Housing Policy.”7069
On May 12, 2011, HRSA released a final notice (Notice 11-01) laying out how Ryan White funds
may be used for housing.7170 Ryan White Parts A, B, and D funding (grants to urbanmetropolitan areas, 
states,
 and public or nonprofit entities) can be used to fund housing search assistance and “short-term or
shortterm or emergency housing.” Although Notice 11-01 did not specifically limit the amount of time that

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.7271

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.7372
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

65

The program was reauthorized in the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415).
See Section 105.
66
U.S. Department of Health and Human Services, “HIV/AIDS Bureau Policy Notice 99-02,” 71 Federal Register
70781, December 6, 2006.
67
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.
6968
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.
7069
Ibid.
7170
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.
7271
Ibid., p. 27650.
7372
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).

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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.

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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 (see “Housing Status of Persons Living with
HIV/AIDS”). In . In
addition, recentduring the last decade, 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 recentsome 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.”7473 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.7574
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.7675
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.7776 However, the likelihood of
obtaining and retaining medical care increased if individuals received some form of housing
assistance.7877 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.

7473
National HIV/AIDS Strategy for the United States, July 13, 2010, p. 28, http://www.whitehouse.gov/sites/default/
files/uploads/NHAS.pdf.
7574
Ibid., pp. 27-28.
7675
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.
7776
The statistical significance of the likelihood varied among the models used. See Table 3, pp. S110-S111 for
significance.
7877
Findings were statistically significant in all but one of six models—continuity of appropriate HIV medical care.

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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 individualsIndividuals in the comparison
group  group
received services, including assistance with finding housing, but did not receive HOPWAfunded HOPWA-funded
housing.7978 Despite the differences in rental assistance provided between the treatment and
comparison groups, both groups had a statistically significant increase in stable housing.8079 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  weakened
immune systems), and reduced use of medical care generally. Self-reported depression
and  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.8180 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

7981

78
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.
8079
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.
8180
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.
8281
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.

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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-1617

 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-1718

 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-1819

 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-1920

 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-2021

 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-2122

 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-2223

 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

2324

 