Research Profile – Home Sweet (and Healthy) Home

CIHR-funded research links stable, secure housing to better outcomes for people living with HIV.

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Dr. Sean B. Rourke believes that good health starts at the doorstep.

"Everyone needs a place to call home," says Dr. Rourke, Scientific and Executive Director of the Ontario HIV Treatment Network. "When we think about the social determinants of health, we often take housing for granted. We assume we have to look at education, income, health care and mental health issues. But without a roof above your head all of that really can't be addressed."

That, he says, is especially true for people living with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS).

"Imagine trying to keep a pill dossier together – some people have up to 10 medications. How do you manage that if you don't have a place where you can organize it? And HIV has an incredible impact on the body. What happens if you don't have a place to take care of your health?"

Dr. Rourke co-leads the Positive Spaces Healthy Places (PSHP) project, a community-based research initiative funded by the Canadian Institutes of Health Research (CIHR) to investigate the relationship between health and housing among people living with HIV and AIDS. The project emerged from a declaration by the leaders of Ontario's HIV/AIDS service organizations about 10 years ago that housing was a significant problem for their clients. That concern was echoed by the Ontario Advisory Committee on HIV/AIDS, which put "affordable housing" at the top of the list of "urgent unmet needs" of people with HIV.

"Back then, there was no Canadian research work being done in HIV, housing and health," says Dr. Rourke. "We looked to the US, and there were some interesting things happening there, but when you're trying to move the ball forward, to really advocate for better services and housing support, you need local data. So that's where PSHP started."

A multidisciplinary team of university researchers, leaders from front-line HIV/AIDS organizations and people living with HIV manages the PSHP project, which consists of an ongoing survey of more than 600 people across Ontario. "Peer research assistants" – people living with HIV – gather much of the data, and also bring the "lived experience" to the work.

The research has led to the publication of papers on several aspects of housing and HIV, including:

• housing experiences of HIV-positive parents in caring for their children;
• housing status and health outcomes in Aboriginal people living with HIV/ AIDS;
• the impact of housing characteristics, such as location, affordability and stability, on health-related quality of life; and
• the impact of housing on adults living with HIV/Hepatitis C co-infection.

But simply publishing papers isn't enough, says Dr. Rourke.

"We're working locally with the key front-line leaders, providing them with the evidence and the information they need to engage decision makers and get funding for what's needed."

Keith Hambly, Executive Director of the Fife House Foundation in Toronto, says
PSHP has "helped build the business case for a number of our current housing programs." He points to a change in ministry policy that made people with HIV eligible for supportive housing through its addiction program, which resulted in $500,000 in ongoing funding as one of the successes that PSHP helped his organization achieve. AIDS Niagara also received an additional $200,000 annually for its supportive housing program from the Local Health Integration Network.

Dr. Rourke finds conducting health research that has such an immediate impact is an "exhilarating" experience.

"When you think about it, how you use research evidence to influence policy and influence the health of Canadians, that's as good as it gets. Finding a cure is one thing, but we can make a difference today."

"Imagine trying to keep a pill dossier together – some people have up to 10 medications. How do you manage that if you don't have a place where you can organize it? And HIV has an incredible impact on the body. What happens if you don't have a place to take care of your health?"
– Dr. Sean B. Rourke, University of Toronto