With skyrocketing rents that give sticker shock to long-term residents and recent transplants alike, San Francisco’s housing affordability crisis leaves no one untouched. That includes people living with HIV, who are particularly vulnerable when left without housing.
“Housing is health care,” says Bobby Fisher, the housing and benefits manager for San Francisco AIDS Foundation. “When people don’t have housing, it’s more difficult for them to stabilize their health. They may be less likely to keep doctor’s appointments or adhere to their medications. People living with HIV are better able to take care of themselves if they’re properly housed.”
To help low-income people with HIV find and maintain housing, the San Francisco AIDS Foundation Housing and Financial Benefits program helps clients navigate available rental subsidy programs. In a city with severely limited low-cost housing options and a steady influx of new residents, their work is rife with challenge. But their hard-won success stories speak volumes about the key role that housing can, and must, play in HIV prevention and care.
San Francisco AIDS Foundation administers three rental assistance programs that are specifically designated to help people with HIV who are homeless or on the verge of losing their housing come up with their monthly rent payments. The subsidies can either be tenant-based, so that the person can apply the subsidy to a housing unit found on the private housing market, or project-based, so that the person can apply the subsidy to a unit renting below market value that’s available only to people who meet income qualifications.
As an example, a client who receives $450 per month in income from General Assistance qualifies for a maximum monthly rental assistance of $545. The housing case manager provides the client with paperwork to present to potential landlords as evidence of the rental assistance so the landlord is able to see that they can pay the rent. The client would apply for the unit, and if they’re accepted, the housing and benefits team conducts a Housing Quality Inspection to ensure the unit meets habitability standards. Once the unit passes inspection, the foundation sends the rental subsidy check—supported by funds from the city—directly to the landlord each month.
As you might guess, demand far exceeds supply.
It’s estimated that 12,344 low-income people living with HIV in San Francisco are at-risk of becoming homeless and are not receiving any housing support. This is 78% of the total number of people living with HIV in San Francisco. And at this point in time, only 998 rental subsidies exist to support people with HIV in San Francisco—less than one-tenth the number actually needed.
“It’s just so difficult to find new places for people to live right now. I’ve had people call me from other places around the country, asking about moving to San Francisco and what options are available for housing support. There is help for people living with HIV, but everything has a wait list, and those are all closed,” says Jesus Moreno, a housing case manager for the foundation.
One problem is that, for people seeking housing in the tenant-based system, the rent of eligible housing units cannot exceed values established by the U.S. Department of Housing and Urban Development (HUD) fair market rent (FMR) price guidelines. And unfortunately, the realities of the city’s housing market make it “extremely difficult to find an apartment at or under HUD’s FMR value,” according to a housing report prepared by the City and County of San Francisco. For instance, the FMR for a studio apartment is $1,382 per month, far below the average studio price in San Francisco which now runs more than $2,500.
The Housing and Benefits program team helps clients think creatively about where to look for housing. Moving in with roommates can be cost-effective, as can smaller in-law units or neighborhoods like the Sunset or Bayview. “The Mission and Tenderloin also used to be options, but they’re becoming hot-spots and rents in those neighborhoods are going up quickly,” explains Moreno.
The team is motivated by the impact they see daily from clients who do receive housing subsidies through the program. “It’s life-changing,” says Danny Castelow, another housing case manager at the foundation.
“Most of our clients who receive the standard subsidy only pay 30% of their income to rent. The majority of our clients wouldn’t be able to stay in their apartment without the subsidy. For some clients, the subsidy helps move them into a nicer unit, say from an single-resident occupancy (SRO) hotel in the Tenderloin to an in-law unit or shared apartment with roommates,” says Castelow.
Castelow, who was part of the initial housing and benefits team at San Francisco AIDS Foundation more than 20 years ago, says the city has done an excellent job maintaining funding for the program and adapting to the changing needs of clients with HIV.
“The original intent of the program, in 1994, was to help people who were living with HIV or AIDS who were likely going to pass away soon. Many clients died within the first few months of receiving their first subsidy. But those subsidies helped clients stay in their apartment—perhaps with their partner—if they weren’t going to die in the hospital. Protease inhibitors changed everything. People started living longer, so the program had to adapt to accommodate people who were going to live longer and longer. We have some clients who’ve been getting subsidies for 15 years or more.”
Soon, the housing and benefits team will provide input to San Francisco’s Getting to Zero consortium by discussing how housing can fit within the city’s plan to reach zero new HIV infections, zero deaths from AIDS and zero HIV stigma.
This close relationship between housing and health now dictates how city funds for housing are allocated to people living with HIV. Clients are typically referred from clinics where they’re getting medical care by social workers or case workers if the client is homeless or at risk for homelessness (i.e., paying more than half their income to rent). People qualify by meeting certain criteria related to income, housing status or rent burden, connection to care and funding availability. Once the referral happens, the foundation’s team can begin the process, which can take a few weeks.
“I saw a guy last week after his social worker sent all the paperwork over. I ran over and did an HQS [housing quality standards] inspection, the paperwork was done, we started a file for him, and his first check is going out on the first [of the month]. He was paying $750 a month in rent, and now he’ll be getting $388 a month to help pay for that,” says Castelow.
“With the subsidy, almost instantly he can take the money he’s saving and hopefully use that to pay for food and the other things he needs to keep up his health.”
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