This is the second blog in our series highlighting outstanding collaborations between health departments and community partners in jurisdictions working to improve community health and inequities through the national Ending the HIV Epidemic (EHE) Initiative. The EHE Initiative aims to reduce new HIV infections in the United States by 75% by 2025 and by 90% by 2030. To recommend a program to be featured, reach out at [email protected].
The Ending the HIV Epidemic (EHE) Initiative, a national program aiming to substantially reduce new HIV infections in high-incidence jurisdictions across the U.S., emphasizes four “pillars” for addressing HIV: Detect, Prevent, Treat, and Respond. While implementing programs to address these pillars, local health departments (LHDs) in EHE jurisdictions are also working to address the social determinants of health which contribute to inequitable HIV outcomes. One determinant is housing access, which is crucial for people living with HIV to remain engaged in care. Through EHE, an organization in Detroit, MI has crafted an innovative program to combat this obstacle within one of its priority populations.
In the U.S., over 20% of adults diagnosed with HIV have been unstably housed within the last 12 months, according to the National Institutes of Health. Wayne County’s EHE Plan states: “Fractured systems, like transportation and housing, can lead to a breakdown in care coordination for newly diagnosed patients and prevent consistent follow-up for those already in care. Numerous providers emphasized that housing stresses are a higher priority to PLWH than seeking or maintaining HIV treatment. In households with children, parents living with HIV place their children’s immediate needs (e.g., purchasing food) before seeking or maintaining HIV treatment.” While some may see this as a barrier, Detroit’s EHE plan noted that some providers have improved long-term trust and care maintenance by working with patients to address these issues, rather than “pushing” them to enter care immediately.
One of the innovative ways Detroit aims to address housing instability for people living with HIV is through the Our WORK project. Our WORK (Women Organizing Resources and Knowledge) is a demonstration housing project designed to empower young women living with HIV and their children. The program provides a safe, secure home so that residents can access educational training, job opportunities, and other wraparound services. Our WORK is funded through the Ryan White HIV/AIDS Program (RWHAP) from the Michigan Department of Health and Human Services, and in 2022, EHE funding from the Detroit Health Department allowed for the expansion to a second home with additional support services.
Our WORK operates on a referral process from local Ryan White funded providers. Eligible clients include women between 18-30 years old with a child 3 years old or younger. Once candidates are identified, they’re invited to the home to ask questions and meet the staff and other residents. This Meet and Greet always includes a signature meal that they cook whenever engaging potential residents, to evoke a family atmosphere. The final step to the informal process is a psychological assessment with an outside counseling center to ensure the potential resident is mentally and emotionally fit to participate in the housing program and cohabitate with others. Once enrolled, families can stay up to 3 years, to allow them to achieve their goals and experience stable housing while attending school and job training. Aside from housing, residents in the program take life skills courses such as parenting tips, financial literacy and conflict resolution. Our WORK also provides services that include transportation to and from medical visits, qualified childcare, and mental healthcare as well as other services.
In addition to housing access, Detroit recognizes that people living with HIV are often underrepresented and/or underpaid within the job market and care/social systems., Their EHE plan includes the goal to “address systemic racism by increasing women of color’s representation in multiple systems, including the housing, medical, and court systems.”
The plan states: “All community groups stressed the need for better representation of PLWH at all levels of the care system, especially in clinical settings. Heterosexual women of color specifically noted the need to employ more HIV-positive Black women in these settings to help other women navigate systemic racism, Black cultural and religious mores, and the ubiquity of LGBTQ-focused resources, which they felt prevented heterosexual Black women from seeking or being able to access services.”
As such, Detroit’s EHE initiative aims to build the capacity of people living with HIV. This specifically includes measures to hire people with lived experience. With this in mind, Our WORK collaborates with Wayne State (WSU), the larger university system under which the organization operates, to prioritize lived experience in its hiring processes. Employing women living with HIV helps to support them to not only serve in entry level positions but thrive in leadership roles. In this way, Our WORK provides professional opportunities and development for the women that they employ, offering them equitable wages and access to benefits.
In a conversation with NACCHO, Evelyn Postel Franklin, WSU Sinai Grace Programs Coordinator and Chunnika Hodges, Housing Program Coordinator shared how this program came to existence. “Basically, [Our Work] has been a dream 10 years in the making. It’s been a long fight,” Hodges says. The work began on the Ryan White Part D Detroit Community Health Awarness Group (CHAG), where, under the leadership of Franklin, a group of women with lived experience championed this idea from conception; volunteering to meet on weekends to conduct needs assessments, joining planning bodies, and participating in quality-related activities in order to learn the regulations and boundaries surrounding Ryan White dollars. The group secured a local grant to kickstart their efforts, and through EHE Phase I funding distributed by Detroit Health Department, the vision of a physical housing program emphasizing interpersonal development became a reality. Our WORK collaborated with partners such as Horizons Daycare, their primary referral partner, as well as Flemming Estates, Family Matters Psychological and Counseling Services, and Peace at Home Childcare, to build the program, and by December 2022, key staff had been hired, policies/procedures were in place, and renovations on the new houses had been done. Today, the program has two properties. These properties house two and three families each and have stabilized housing for 4 family units to date Currently, the program is 100% virally suppressed and has already produced 1 program graduate.
According to Franklin and Hodges, the greatest success is the peer experience. By serving as birthing partners for each other and sharing names of endearment such as ‘Auntie’, the women of Our WORK create a community where everyone uplifts and holds each other accountable, like family.
Franklin believes that a strong partnership with the local health department is the key to making this happen. “The people who fund your program fund it because they want to be successful. Don’t be afraid to be transparent about what you need. Ask them to participate. Ask them to show up as human beings,” says Franklin. “Also, make sure to have community at the table for every step of the process!”
Our WORK is just one of the multiple innovative projects implemented to address social determinants of health related to HIV exposure or status in Detroit. The Detroit Community Health Access Group developed and distributed a Housing Resource Guide and participated in housing planning processes and workgroups to develop a team of housing experts that helps PLWH and providers overcome barriers to accessing stable housing. That guide is available here. To learn more about EHE activities in Detroit, visit the Detroit Ending the HIV Epidemic website here.
Want to be featured in an upcoming EHE Superstars blog? Tell us about your Ending the HIV Epidemic activities at [email protected]!