Positive Spaces. Healthy Places. An Ontario wide, community-based research study which aims to explore the intersections of HIV, Housing and Health. XVI International AIDS Conference in Toronto Innovations and Partnership to Improve Health Outcomes for People Living with HIV/AIDS and Communities at Risk Presented by Ruthann Tucker, Executive Director Fife House August 16, 2006

Overview Context The Partners Study Objectives Project Overview Current Status Implications for Knowledge Translation Funders Contact Info

Context In 2002, at the Ontario AIDS Network (OAN) annual retreat for Executive Directors of AIDS Service Organizations participants overwhelmingly identified “housing issues” as a significant problem for PHAs across the province. OAN receives Canadian Institutes of Health Research (CIHR) funding for a Research Technical Assistant

Context (2) Proposed Strategy to Address HIV/AIDS in Ontario to 2008 identifies “housing as a key unmet need of PHAs”. Fife House develops new strategic plan, 2003+, that identifies community-based research as a priority for the agency to work on.

Context (3) Key literature reviews indicate no information regarding this issue within the Canadian context. Housing Connections, the agency the maintains the central wait list for social housing in Toronto, depriorizes HIV from the medical priority list in PHAS must now get a Doctor to check a box that states the person has less than 2 years to live.

Context (4) A small baseline study “Assessing the Housing Needs of PHAs Now and Into the Future” is funded by the OHTN. The OHTN offers to assist study group to develop a proposal for submission to the CIHR for a grant to expand study to a more comprehensive 3 year study which includes both quantitative and qualitative methodologies.

Context (5) CIHR funds 3 year study – “A prospective study to explore the impact of housing support and homelessness on health outcomes of PHAs” Positive Spaces. Healthy Places. is created through the amalgamation of Assessing the Need (funded by the OHTN) and Exploring the Outcomes (funded by CIHR).

The Partners Community-based AIDS Organizations  AIDS Thunder Bay – Michael Sobota, Co-Investigator  AIDS Niagara – Steve Byers, Co-Investigator  Bruce House - Jay J. Koornstra, Co-Investigator  Fife House – Ruthann Tucker, Principle Investigator  Ontario AIDS Network – Lea Narciso (on leave), Co-Investigator  Ontario Aboriginal AIDS Network – Laverne Monette, Co-Investigator Universities  McMaster University, CLEAR Unit – Dr. Dale Guenter, Principle Investigator  York University, School of Social Work – Dr. Saara Greene, Principle Investigator Hospitals  St Michaels Hospital, Centre for Research on Inner City Health - Drs. Steven Hwang, Sean Rourke and Jim Dunn

Study Objectives 1.Establish a baseline of the housing status of PHAs in Ontario. 2.Identify the range of housing and supportive housing options currently available to PHAs in Ontario. 3.Identify the characteristics of appropriate housing and supportive environments for PHAs applicable at various stages of the disease course. 4.Determine the kind of housing options desired or required by PHAs that will ensure access to health care, treatment and social services. 5.Identify the factors that affect the housing status and stability of PHAs; and to understand how such factors may impact the physical and mental health of PHAs and their access and utilization of health care, treatment and social services. 6.Determine possible variations in the housing and/or homelessness experiences of PHAs from specific communities.

Project Overview 600 face-to-face quantitative interviews with PHAs from across Ontario within 4 regions (Northern, South West, Eastern and Central/Greater Toronto Area).  Participants will complete two face-to-face interviews across the study period, one at baseline and one at 12 months; and a short telephone survey at six months.  50 of whom will participate in a qualitative sub-study aimed at enhancing our understanding of the housing experiences of PHAs.  Regional epidemiology (R. Remis) used for study stratification.

Current Status Research Coordinator Hired  Dr. Amrita Ahluwalia 6 Peer Research Assistants Hired Participant Recruitment Underway (Baseline)  605 Calls/ 578 Eligible to Participate  535 Interviews Conducted Challenges  Reaching PHAs staying in shelter systems in all four regions  Peer Research Assistant Turnover (30%)  Central Region and Northern Region slower in meeting target numbers

Implications for Knowledge Translation The three (3) key areas for consideration 1.Policy CBR creates evidence which supports transformation of policy Example Housing Connections – changes it’s guidelines for assessing medical priority for people living with HIV/AIDS Increase in units of affordable housing for PHAS Change policy for income support to make maximum housing allowance more realistic for different regions in Ontario

Implications for Knowledge Translation (2) 2.Practice Identify what kind of housing PHAS want and/or need; What health services PHAS want/need associated with their housing; Provide useful data to support proposals for additional funds to meet the need in regions in Ontario; How CBAOs can partner with housing providers to develop strategies to keep PHAs housed;

Implications for Knowledge Translation (3) 3.Public Relations Educate the public about the issue of housing and HIV in Ontario; Example of this is the development of a web-based housing portal for research on HIV, Housing and Health being developed by the OHTN and Fife House Develop plain language Fact Sheets to be used by other communities to support the building of new housing; Develop press releases to educate the public about the current context of HIV in Ontario and Canada;

Funders Canadian Institutes of Health Research (CIHR) - $300,000 Ontario HIV Treatment Network (OHTN) - $170,000 + in-kind (office space, teleconference calls etc) Ontario Ministry of Health and Long-term Care, AIDS Bureau - $35,000 Wellesley Central Health - $18,750 Ontario AIDS Network (OAN) - $6,600 Total = $530,350 over 3 years

Contact Info Ruthann Tucker, Fife House Co-Principal Investigator x33 Positive Spaces. Healthy Places