Insensitive Intolerance...!?

Looking back over the first half of 2002, here on The South Bank; I combed through recent news articles, commission minutes, transcripts of an online conversation with the current commission candidates... I have distilled all these headlines, sound bites and quotes into this simple list of KeyWords:

COVINGTON — People who camp in Covington parks such as Devou and Goebel, as well as along city-owned riverbanks, face possible immediate arrest under a new law.

Approved this week by Covington City Commission, the law will take effect within a couple of weeks. It calls for arrest for camping in parks, especially between 9 p.m. and 9 a.m.; lighting fires anywhere other than on city-owned grills; and drinking alcohol except in certain parts of Devou Park.

Violators of the misdemeanor face a maximum penalty of six months in jail and a $500 fine.

The law pleases people like Joe Mueller, a long-time resident of Covington's MainStrasse neighborhood. He says he's tired of homeless people drinking, defecating and panhandling in Goebel Park.

“Not allowing the homeless to have a fire on the riverbank or to camp on the riverbank is another way of saying "Get out,”' said Mark Teegarden, a civil rights advocate for the homeless of Northern Kentucky.

“To me, that ordinance is a hate crime ordinance. It's targeting the homeless and being done to run them out of the city.”

Mr. Teegarden said the Homeless Advocacy Group of the Recovery Network plans to file an injunction in federal court to overturn the law and stop Covington's periodic sweeps of riverfront homeless camps.

“(Someone) had a beautiful wedding around the bell tower last Saturday, while the homeless people were sitting in the (Goebel Park) shelter house drinking,” he said. “We're tired of homeless people hitting up park visitors and tourists for money, drinking and urinating in the park, and defecating in the shelter house at night. The police do the best they can, but they can't be in the park all the time.”

He challenged Mr. Mueller to prove that it's homeless people who are responsible for many of the parks' problems. “The homeless people always get blamed because they are the ones who are easiest to blame,” he said.

Covington Commissioner Alex Edmondson said that the new law is patterned after one that was upheld in a Florida federal court.

“We're just using the ordinances that are legal to protect our residents,” Mr. Edmondson said. “We're in the unique situation where our riverbanks are unexposed (hidden by vegetation) and we've been getting complaints from residents that people are setting fires (on the riverbank) and doing other things that are unacceptable.”

Covington City Solicitor Jay Fossett said the change was prompted “by continuing problems of people camping out on the riverfront.”

In mid-April, a series of city-authorized sweeps resulted in the razing of homeless camps on west Covington's riverbank. City officials, citing piles of bottles and campfires, described the setting as a health and safety risk.

Eight of those campers responded by filing suit still pending in federal court, claiming city officials violated their constitutional rights when they razed the camps without notice. Three weeks later, 300 people marched on City Hall, asking Covington officials to stop “harassing” homeless people and to address the causes of homelessness and poverty.

“Basically, the city is responding to the problem by criminalizing the situation rather than looking at problem solving and focusing on solutions,” said Linda Young, executive director of the Welcome House social service agency.

She and other homeless advocates say it's unfair to penalize homeless people for camping in public areas when there aren't enough shelter beds in Northern Kentucky.

“It certainly seems that the law in Kentucky is aimed at the homeless, given all that's happened in the past few months, "' said John Halpin, an organizer with the National Homeless Civil Rights Organizing Project. In Cincinnati, he said there are no anti-camping laws for parks.

Elsewhere in Ohio, park systems in Hamilton and Butler counties allow no overnight camping except in designated areas.

Mr. Fossett said that he will meet with Covington police to ensure that the new law is fairly enforced . He said homeless people who violate the law initially will be warned and will be told that there are places where they can stay.

If they are arrested, Mr. Fossett said that he will ask the court to order them to an alcohol treatment facility, if necessary, as a condition of probation; and he also will ask that they be sent to a homeless shelter instead of to jail.

Commissioner Craig Bohman, who cast the sole vote against the tougher law, described the measure as “overkill” and said the additional crimes and penalties are unnecessary.

“If you're reading a newspaper near the Devou Park band shell and the newspaper falls on top of you and you fall asleep, it's now considered camping,” he said.

Why Are People Homeless?

NCH Fact Sheet #1
Published by the National Coalition for the Homeless, June 1999

Two trends are largely responsible for the rise in homelessness over the past 15-20 years: a growing shortage of affordable rental housing and a simultaneous increase in poverty. Below is an overview of current poverty and housing statistics, as well as additional factors contributing to homelessness. A list of resources for further study is also provided.

POVERTY

Homelessness and poverty are inextricably linked. Poor people are frequently unable to pay for housing, food, child care, health care, and education. Difficult choices must be made when limited resources cover only some of these necessities. Often it is housing, which absorbs a high proportion of income, that must be dropped. Being poor means being an illness, an accident, or a paycheck away from living on the streets.

In 1997, 13.3% of the U.S. population, or 35.6 million people, lived in poverty (U.S. Bureau of the Census, 1998a). While the number of poor people remains has not changed much in recent years, the number of people living in extreme poverty has increased. In 1997, 14.6 million people -- 41% of all poor persons -- had incomes of less than half the poverty level. This represents an increase of over 500,000 from 1995. Forty percent of persons living in poverty are children; in fact, the 1997 poverty rate of 19.9% for children is almost twice as high as the poverty rate for any other age group.

Two factors help account for increasing poverty: eroding employment opportunities for large segments of the workforce, and the declining value and availability of public assistance.

Eroding Work Opportunities

Media reports of a growing economy and low unemployment mask a number of important reasons why homelessness persists, and, in some areas of the country, is worsening. These reasons include stagnant or falling incomes and less secure jobs which offer fewer benefits.

While the last few years have seen growth in real wages at all levels, these increases have not been enough to counteract a long pattern of stagnant and declining wages. Low-wage workers have been particularly hard hit by wage trends. Despite recent increases in the minimum wage, the real value of the minimum wage in 1997 was 18.1% less than in 1979 (Mishel, Bernstein, and Schmitt, 1999). Factors contributing to wage declines include a steep drop in the number and bargaining power of unionized workers; erosion in the value of the minimum wage; a decline in manufacturing jobs and the corresponding expansion of lower-paying service-sector employment; globalization; and increased nonstandard work, such as temporary and part-time employment (Mishel, Bernstein, and Schmitt, 1999).

Declining wages, in turn, have put housing out of reach for many workers: in every state, more than the minimum wage is required to afford a one- or two-bedroom apartment at Fair Market Rent (National Low Income Housing Coalition, 1998).¹ In fact, in the median state a minimum-wage worker would have to work 87 hours each week to afford a two-bedroom apartment at 30% of his or her income, which is the federal definition of affordable housing. In addition, 40% of households with "worst case housing needs" -- households paying over half their incomes for rent, living in severely substandard housing, or both -- have at least one working person. This represents a 32% increase in working households with worst case housing needs from 1993 to 1995 (U.S. Housing and Urban Development, 1998).

The connection between impoverished workers and homelessness can be seen in homeless shelters, many of which house significant numbers of full-time wage earners. A survey of 30 U.S. cities found that almost one in five homeless persons is employed (U.S. Conference of Mayors, 1998). In a number of cities not surveyed by the U.S. Conference of Mayors - as well as in many states - the percentage is even higher (National Coalition for the Homeless, 1997).

The future of job growth does not appear promising for many workers: a 1998 study estimated that 46% of the jobs with the most growth between 1994 and 2005 pay less than $16,000 a year; these jobs will not lift families out of poverty (National Priorities Project, 1998).² Moreover, 74% of these jobs pay below a livable wage ($32,185 for a family of four).

Thus, for many Americans, work provides no escape from poverty. The benefits of economic growth have not been equally distributed; instead, they have been concentrated at the top of income and wealth distributions. A rising tide does not lift all boats, and in the United States today, many boats are struggling to stay afloat.

Decline in Public Assistance

The declining value and availability of public assistance is another source of increasing poverty and homelessness. Until its repeal in August 1996, the largest cash assistance program for poor families with children was the Aid to Families with Dependent Children (AFDC) program. Between 1970 and 1994, the typical state's AFDC benefits for a family of three fell 47%, after adjusting for inflation (Greenberg and Baumohl, 1996). The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (the federal welfare reform law) repealed the AFDC program and replaced it with a block grant program called Temporary Assistance to Needy Families (TANF). Current TANF benefits and Food Stamps combined are below the poverty level in every state; in fact, the median TANF benefit for a family of three is approximately one-third of the poverty level. Thus, contrary to popular opinion, welfare does not provide relief from poverty.

Welfare caseloads have dropped sharply since the passage and implementation of welfare reform legislation. However, declining welfare rolls simply mean that fewer people are receiving benefits -- not that they are employed or doing better financially. Early findings suggest that although more families are moving from welfare to work, many of them are faring poorly due to low wages and inadequate work supports. Only a small fraction of welfare recipients' new jobs pay above-poverty wages; most of the new jobs pay far below the poverty line (Children's Defense Fund and the National Coalition for the Homeless, 1998). Moreover, extreme poverty is growing more common for children, especially those in female-headed and working families. This increase can be traced directly to the declining number of children lifted above one-half of the poverty line by government cash assistance for the poor.

As a result of loss of benefits, low wages, and unstable employment, many families leaving welfare struggle to get medical care, food, and housing. Many lose health insurance, despite continued Medicaid eligibility: a recent study found that 675,000 people lost health insurance in 1997 as a result of the federal welfare reform legislation, including 400,000 children (Families USA, 1999). In addition, housing is rarely affordable for families leaving welfare for low wages, yet subsidized housing is so limited that fewer than one in four TANF families nationwide lives in public housing or receives a housing voucher to help them rent a private unit. For most families leaving the rolls, housing subsidies are not an option. In some communities, former welfare families appear to be experiencing homelessness in increasing numbers (Children's Defense Fund and the National Coalition for the Homeless, 1998).

In addition to the reduction in the value and availability of welfare benefits for families, recent policy changes have reduced or eliminated public assistance for poor single individuals. Several states have cut or eliminated General Assistance (GA) benefits for single impoverished people, despite evidence that the availability of GA reduces the prevalence of homelessness (Greenberg and Baumohl, 1996).

Disabled people, too, must struggle to obtain and maintain stable housing. In 1998, on a national average, a person receiving Suplemental Security Income (SSI) benefits had to spend 69% of his or her SSI monthly income to rent a one-bedroom apartment at Fair Market Rent; in more than 125 housing market areas, the cost of a one-bedroom apartment at Fair Market Rent was more than a person's total monthly SSI income (Technical Assistance Collaborative & the Consortium for Citizens with Disabilities Housing Task Force, 1999).

Thus, most states have not replaced the old welfare system with an alternative that enables families and individuals to obtain above-poverty employment and to sustain themselves when work is not available or possible.

HOUSING

A lack of affordable housing and the limited scale of housing assistance programs have contributed to the current housing crisis and to homelessness.

The gap between the number of affordable housing units and the number of people needing them has created a housing crisis for poor people. Between 1973 and 1993, 2.2 million low-rent units disappeared from the market. These units were either abandoned, converted into condominiums or expensive apartments, or became unaffordable because of cost increases. Between 1991 and 1995, median rental costs paid by low-income renters rose 21%; at the same time, the number of low-income renters increased. Over these years, despite an improving economy, the affordable housing gap grew by one million (Daskal, 1998). By 1995, the number of low-income renters in America outstripped the number of low-cost rental units by 5.4 million rental units - the largest shortfall on record (Daskal, 1998). More recently, the strong economy has caused rents to soar, putting housing out of reach for the poorest Americans. Between 1995 and 1997, rents increased faster than income for the 20% of American households with the lowest incomes (U.S. Department of Housing and Urban Development, 1999). This same study found that the number of housing units that rent for less than $300, adjusted for inflation, declined from 6.8 million in 1996 to 5.5 million in 1998, a 19 percent drop of 1.3 million units. The loss of affordable housing puts even greater numbers of people at risk of homelessness.

The lack of affordable housing has lead to high rent burdens (rents which absorb a high proportion of income), overcrowding, and substandard housing. These phenomena, in turn, have not only forced many people to become homeless; they have put a large and growing number of people at risk of becoming homeless. A recent Housing and Urban Development (HUD) study found that 5.3 million unassisted, very low-income households had "worst case needs" for housing assistance in 1995 (U.S. Department of Housing and Urban Development, 1998).³ This figure is an all-time high and represents an 8% increase over the 1989 figure.

Housing assistance can make the difference between stable housing, precarious housing, or no housing at all. However, the demand for assisted housing clearly exceeds the supply: only about one-third of poor renter households receive a housing subsidy from the federal, state, or a local government (Daskal, 1998). The limited level of housing assistance means that most poor families and individuals seeking housing assistance are placed on long waiting lists. From 1996-1998, the time households spent on waiting lists for HUD housing assistance grew dramatically. For the largest public housing authorities, a family's average time on a waiting list rose from 22 to 33 months from 1996 to 1998 - a 50% increase (U.S. Department of Housing and Urban Development, 1999). The average waiting period for a Section 8 rental assistance voucher rose from 26 months to 28 months between 1996 and 1998.⁴ Excessive waiting lists for public housing mean that people must remain in shelters or inadequate housing arrangements longer. Consequently, there is less shelter space available for other homeless people, who must find shelter elsewhere or live on the streets.

A housing trend with a particularly severe impact on homelessness is the loss of single room occupancy (SRO) housing. In the past, SRO housing served to house many poor individuals, including poor persons suffering from mental illness or substance abuse. From 1970 to the mid-1980s, an estimated one million SRO units were demolished (Dolbeare, 1996). The demolition of SRO housing was most notable in large cities: between 1970-1982, New York City lost 87% of its $200 per month or less SRO stock; Chicago experienced the total elimination of cubicle hotels; and by 1985, Los Angeles had lost more than half of its downtown SRO housing (Koegel, et al, 1996). From 1975 to 1988, San Francisco lost 43% of its stock of low-cost residential hotels; from 1970 to 1986, Portland, Oregon lost 59% of its residential hotels; and from 1971 to 1981, Denver lost 64% of its SRO hotels (Wright and Rubin, 1997). Thus the destruction of SRO housing is a major factor in the growth of homelessness in many cities.

Finally, it should be noted that the largest federal housing assistance program is the entitlement to deduct mortgage interest from income for tax purposes. In fact, for every one dollar spent on low income housing programs, the federal treasury loses four dollars to housing-related tax expenditures, 75% of which benefit households in the top fifth of income distribution (Dolbeare, 1996). Moreover, in 1994 the top fifth of households received 61% of all federal housing benefits (tax and direct), while the bottom fifth received only 18%. Thus, federal housing policy has thus not responded to the needs of low-income households, while disproportionately benefitting the wealthiest Americans.

OTHER FACTORS

Particularly within the context of poverty and the lack of afforable housing, certain additional factors may push people into homelessness. Other major factors which can contribute to homelessness include the following:

Lack of Affordable Health Care: For families and individuals struggling to pay the rent, a serious illness or disability can start a downward spiral into homelessness, beginning with a lost job, depletion of savings to pay for care, and eventual eviction. In 1997, approximately 43.4 million Americans had no health care insurance (U.S. Bureau of the Census, 1998b). More than a third of persons living in poverty had no health insurance of any kind. The coverage held by many others would not carry them through a catastrophic illness.

Domestic Violence: Battered women who live in poverty are often forced to choose between abusive relationships and homelessness. In a study of 777 homeless parents (the majority of whom were mothers) in ten U.S. cities, 22% said they had left their last place of residence because of domestic violence (Homes for the Homeless, 1998). In additions, 46% of cities surveyed by the U.S. Conference of Mayors identified domestic violence as a primary cause of homelessness (U.S. Conference of Mayors, 1998).

Mental Illness: Approximately 20-25% of the single adult homeless population suffer from some form of severe and persistent mental illness (Koegel et al, 1996). Despite the disproportionate number of severely mentally ill people among the homeless population, increases in homelessness are not attributable to the release of severely mentally ill people from institutions. Most patients were released from mental hospitals in the 1950s and 1960s, yet vast increases in homelessness did not occur until the 1980s, when incomes and housing options for those living on the margins began to diminish rapidly. According to the Federal Task Force on Homelessness and Severe Mental Illness, only 5-7% of homeless persons with mental illness need to be institutionalized; most can live in the community with the appropriate supportive housing options (Federal Task Force on Homelessness and Severe Mental Illness, 1992). However, many mentally ill homeless people are unable to obtain access to supportive housing and/or other treatment services. The mental health support services most needed include case management, housing, and treatment.

Addiction Disorders: The relationship between addiction and homelessness is complex and controversial. While rates of alcohol and drug abuse are disproportionately high among the homeless population, the increase in homelessness over the past two decades cannot be explained by addiction alone. Many people who are addicted to alcohol and drugs never become homeless, but people who are poor and addicted are clearly at increased risk of homelessness. During the 1980s, competition for increasingly scarce low-income housing grew so intense that those with disabilities such as addiction and mental illness were more likely to lose out and find themselves on the streets. The loss of SRO housing, a source of stability for many poor people suffering from addiction and/or mental illness, was a major factor in increased homelessness in many communities.

Addiction does increase the risk of displacement for the precariously housed; in the absence of appropriate treatment, it may doom one's chances of getting housing once on the streets. Homeless people often face insurmountable barriers to obtaining health care, including addictive disorder treatment services and recovery supports. The following are among the obstacles to treatment for homeless persons: lack of health insurance; lack of documentation; waiting lists; scheduling difficulties; daily contact requirements; lack of transportation; ineffective treatment methods; lack of supportive services; and cultural insensitivity. An in-depth study of 13 communities across the nation revealed service gaps in every community in at least one stage of the treatment and recovery continuum for homeless people (National Coalition for the Homeless, 1998).

Even when disabling conditions such as addiction or mental illness are treated, homeless addicts and mentally ill people must compete with all other poor people for a dwindling supply of low-income housing. Homelessness can thus be seen as a perverse game of musical chairs, in which the loss of "chairs" (low cost housing) forces some people to be left standing (homeless). Those who are least able to secure a chair -- the most disabled and therefore the most vulnerable -- are more likely to be left without a place to sit.

CONCLUSION

Homelessness results from a complex set of circumstances which require people to choose between food, shelter, and other basic needs. Only a concerted effort to ensure jobs that pay a living wage, adequate support for those who cannot work, affordable housing, and access to health care will bring an end to homelessness.

The homeless and their advocates, saying they will protest Covington's insensitivity to their needs, plan to march to City Hall from Goebel Park next week.

''There'll be in excess of 300 people,'' predicted Mark Teegarden, local volunteer civil rights advocate for the National Coalition for the Homeless Civil Rights Project. The Monday march, which should reach City Hall by 10 a.m., will be peaceful, he promised.

At the city building, marchers will urge officials to adopt eight major recommendations, including creating 50 emergency shelter beds for the homeless, with emphasis on beds for men; supporting programs like the Life Learning Center that can help the homeless return to society; and refraining from using ''inflammatory rhetoric when referring to the homeless or projects associated with homelessness.''

The demonstration is prompted partly by the city's April 15 riverbank ''sweep,'' in which city workers removed anything that looked like housing or bedding from squatters' camps. None of the at least 17 people who were living there were warned about the sweep and many lost their possessions.

''The people who lost their belongings weren't there because they were at work,'' Teegarden said. He has a particular empathy because he lived on Covington's riverbank for three years until about a year ago, when Welcome House helped him rebuild his life. He now has a steady job and an apartment.

Most who lived on the river work full-time jobs, an indication the homeless are not lazy, Teegarden said. Most would rather have homes.

Nationally, 20 percent of the homeless are employed, and 39 percent are supposed to be taking a prescription medication but can't afford it, the coalition said, citing figures from the U.S. Conference of Mayors and the Department of Housing and Urban Development.

Also spurring the march is the city's recent decision against a proposed Life Learning Center at Madison Avenue and 13th Street, a facility aimed at giving the homeless the help and skills they need to return to steady jobs and homes.

''According to the National Low Income Housing Coalition, in order to afford a two-bedroom apartment in the Covington area, a person making minimum wage would have to work 86 hours a week,'' the local coalition of homeless groups wrote in an announcement of the event.

When Monday's march reaches City Hall, Teegarden says he will attempt to present Mayor Butch Callery a list of recommendations collected from dozens of Covington's homeless.

Teegarden predicted Callery will not be available, and will not address the crowd, which he promises will be respectful and peaceful. He said Callery has ''blown off'' earlier requests for meetings, including a phoned request to his office about two weeks ago.

''I was more than willing to talk with them, but they sued me personally and the city,'' Callery said. Because of the lawsuit, ''I was advised by counsel not to speak on this issue.''

The eight major recommendations that Covington's homeless and their advocates have for city officials:

Create 50 new emergency shelter beds for the homeless, with primary emphasis on emergency beds for men. The 2000 U.S. Census estimated 3,000 homeless people live in the city, including children; they stay doubled-up with friends or family, in transitional housing, shelters or on the streets.

There are only 84 shelter beds for all homeless people, none of them funded by the city, the homeless say. Of the 84, only 22 are for men, and eight of those are long-term, leaving 14 emergency shelter beds. Of the rest, 35 are used for women and children seeking refuge from domestic violence, and the others are for single women.

Support programs that help reintegrate the homeless into society. Advocates cited the proposed Life Learning Center, which city commissioners rejected last month for the area of Madison Avenue and 13th Street on Mayor Butch Callery's swing vote. Callery has said he remains open to discussing other Covington locations.

Avoid using ''inflammatory rhetoric'' when discussing the homeless or projects that address homeless issues.

Stop blaming the homeless and social agencies for the fact 18.4 percent of city residents live at or below the poverty level. The agencies are only responding to human needs, advocates argue. .

Support more affordable housing for the homeless, including Section 8 vouchers and public housing.

Treat homeless people with respect, stop unannounced sweeps of homeless camps, stop destroying personal property and recognize the homeless as city residents who are entitled to basic human rights. ''Life-sustaining activities, sleeping or camping outdoors do not constitute criminal acts,'' the statement said.

Support programs that address root causes of homelessness. Most necessary programs either don't exist or are grossly underfunded, advocates say.

The groups also recommended local officials open a hypothermia shelter space during cold weather; promote free parenting and life skills classes; create a tracking system for children who are taken from homeless parents; open a location for the homeless to take showers and do laundry; and create free or low-cost day care so parents can work.

HIV/AIDS and Homelessness

NCH Fact Sheet #9
Published by the National Coalition for the Homeless, April 1999

Lack of affordable housing is a critical problem facing a growing number of people living with Acquired Immunodeficiency Syndrome (AIDS) and other illnesses caused by the Human Immunodeficiency Virus (HIV). People with HIV/AIDS may lose their jobs because of discrimination or because of the fatigue and periodic hospitalization caused by HIV-related illnesses. They may also find their incomes drained by the costs of health care.

Tragically, individuals with HIV/AIDS may die before they are able to receive housing assistance. Efforts to build HIV/AIDS housing often encounter chronic funding shortfalls, bureaucratic indifference, and the stigma and fear of AIDS. Projects to create HIV/AIDS housing may fail because of local opposition by neighborhood or community groups.

PREVALENCE

Studies indicate that the prevalence of HIV among homeless people is between 3-20%, with some subgroups' having much higher burdens of disease:

In a survey of the Heatlh Care for the Homeless program, a plurality of projects reported that HIV/AIDS is increasing among the homeless population (O'Connell, J., Lozier, J., and Gingles, K., 1997).
36% of people with AIDS have been homeless since learning that they had HIV or AIDS (Robbins and Nelson, 1996).
A Los Angeles study found that two-thirds of people with AIDS had been homeless (Shelter Partnership, 1997).
Up to 50% of persons living with HIV/AIDS are expected to need housing assistance of some kind during their lifetimes (Robbins and Nelson, 1996).

Many homeless adolescents find that exchanging sex for food, clothing, and shelter is their only chance of survival on the streets. In turn, homeless youth are at a greater risk of contracting AIDS or HIV-related illnesses. HIV prevalence studies anonymously performed in four cities found a median HIV-positive rate of 2.3% for homeless persons under age 25 (Robertson, 1996).

ISSUES

To address the special considerations and challenges that primary care providers may face in caring for homeless individuals with HIV, the Health Care for the Homeless Clinicians' Network is undertaking a project focusing on HIV and homelessness. The following information is taken from the Network's September 1999 newsletter, Healing Hands.

HIV infection exacerbated by homelessness deserves special attention for the following reasons:

High morbidity and mortality: HIV-infected homeless persons are believed to be sicker than their domiciled counterparts. For example, they tend to have higher rates and more advanced forms of TB, and higher incidence of other illnesses such as Bartonella. Another study has demonstrated that more homeless people die of AIDS than other HIV-infected populations.

Barriers to care: Homeless people with HIV may face many barriers to optimal care. Injection drug use and lack of insurance, common among homeless people, have been shown to negatively affect health care utilization, level of medical care and health status.

Challenges to adherence: Adherence to complex medical regimens may be more difficult if one does not have stable housing or access to basic subsistence needs such as food. As it is believed that decreased adherence is the single best predictor of protease inhibitor failure and the primary cause of medication resistance, this problem has grave personal and public health implications.

POLICY RECOMMENDATIONS

Homeless persons with HIV/AIDS need safe, affordable housing and supportive, appropriate health care. Emergency housing grants should be available for persons with HIV-related illnesses who are in danger of losing their homes, and housing assistance should be available for those already on the streets. Federal assistance must be provided through adequate funding of targeted housing and health programs, and through the enforcement of anti-discrimination laws.