HOUSING FOR PERSONS WITH HIV/AIDS

The service delivery network for AIDS in St. Louis is nationally recognized. However, while the service delivery system is very good, it is not large enough to adequately meet the needs of an increasing population infected with HIV. The latest estimates show a metropolitan area population infected with HIV/AIDS of approximately 7100. Within the next five to ten years most of these persons will need services. In addition, newly infected and diagnosed individuals will enter the HIV/AIDS service delivery network. With the rapid increase in the number of people contracting the virus and the number of people living longer because of medical advances, AIDS providers foresee a shortage in services for people living with HIV/AIDS.
General Support Programs

In St. Louis, services for individuals with AIDS and other related diseases are coordinated through the Missouri Department of Health and the Metropolitan AIDS Program, which implements the statewide system locally. Service coordinators determine eligibility, assess the need for service, offer prior authorization of services for reimbursement, and monitor the provision of services. To be eligible for services, an individual must be assisted by a case manager affiliated with the Missouri Department of Health, Bureau of Special Health Care Needs. There are 5 state case managers and 12 state approved affiliate managers serving the St. Louis region who perform needs assessment for clients, refer them to the various service providers, and help them receive food stamps and other support. The Network keeps service provision costs low and avoids duplication of services.
Current Services

The following are the primary service providers in the St. Louis Metropolitan area.

Missouri Department of Health/Bureau of Special Health Care Needs.
This agency offers care coordination and access to Medicaid waivers, counseling, durable medical goods, lab testing, attendant and home health care. Drug Therapy and continuity of insurance is also provided. Services are offered off site and on site.
St. Louis Metropolitan AIDS Program
This agency offers testing, counseling, case management, and education. Additional Ryan White Title I funding will increase food, transportation, medical, home care, case management and social services available to persons with AIDS. Services are provided off-site and on-site.
St. Louis Effort for AIDS
This organization provides case management and operates the AIDS Hotline. Other services include the "Buddy" program which arranges for volunteers to act as companions, and provides transportation for appointments, food delivery, recreational assistants, letter writers, companions, a drop in center for people with HIV, emergency utility assistance, transportation vouchers, a variety of support groups, and target outreach to at-risk populations. Services are offered off-site and on-site.
Doorways
This organization provides affordable housing, occupancy needs, and advocacy for people with HIV. Housing assistance placements, and referral is also provided. Recently, Doorways inaugurated a 20 unit residential facility for low income individuals infected with the HIV virus. The organization is also developing a supportive housing site that will provide 36 unit. Services are delivered on site and off-site.
Food Outreach
This operation provides nutritious food and dietary supplements for individuals with HIV illness. Food Outreach prepares food in single portions and freezes it. Each delivery provides two weeks worth of lunches and dinners. Services are delivered on-site and off-site.
Northside AIDS Outreach
This organization provides holistic case management as well as minority and women outreach. Educational outreach is another component of the organization, especially outreach to the religious community. Recently the organization has received a sizable capacity building grant to strengthen its organizational structure in order to serve a larger segment of the African American population more effectively. Services are provided off-site and on-site.
Blacks Assisting Blacks Against AIDS
This organization provides case management, minority outreach, education and prevention services. The organization has received a sizable capacity building grant to strengthen its organizational structure and to serve a larger segment of the African American population more effectively. Services are provided off-site and on-site.
St. Louis Children's Hospital
This hospital provides health care to HIV/AIDS affected children and a support group for HIV/AIDS affected families. Services are provided on-site.
Cardinal Glennon Children's Hospital
This hospital provides health care for hemophiliac adults and children who are infected with the HIV virus. Services are provided on-site.
Regional Hospital HIV Clinic
This hospital provides primary health care to low-income individuals. Services are provided on-site and off-site.
St. Clair County Health Department
This agency offers care coordination and access to Medicaid waivers, counseling, durable medical goods, lab testing, attendant and home health care. Drug Therapy and continuity of insurance is also provided. Services are offered off site and on site.
Bethany Place
This AIDS service organization provides free and anonymous HIV testing, counseling, case management, community education programs, and a large volunteer program. Additional services are: clerical and phone support, a buddy program, in home services, transportation, hospital and nursing home visits, pastoral care, recreational and socials program, and support groups to HIV+ individuals and to family and friends. Services are provided on-site and off-site.
Madison County AIDS Program
This organization offers case management, financial assistance for housing, prescription drugs, primary care, lab work, nutritional information and supplements, food pantry program, counseling services, utility assistance and small emergency funds, home service, anonymous counseling and testing, education and outreach to the community, and speakers bureau services. Services are provided on-site and off-site.
Needs and Challenges

As of April 1, 1994, 2473 case of AIDS and 1558 cases of HIV were reported to the Centers for Disease Control for the St. Louis MO-IL metropolitan statistical area. Table 25 shows the actual reported cases in the St. Louis EMA (Eligible Metropolitan Area). On the Missouri side of the metropolitan area the reported number of AIDS cases totaled 2188, and reported HIV cases totaled 1330. On the Illinois side of the metropolitan area, AIDS cases totaled 285, and HIV cases totaled 228. Demographic characteristics indicate that 13% to 15% of the reported cases involved women, 40% to 45% involved minorities and over 70% of the cases involved people from age twenty to thirty-nine.

Table 25: Reported AIDS/HIV cases in the St. Louis EMA
Area AIDS HIV Total
St. Louis side of metro area 2188 1330 3518
Illinois side of metro area 285 228 513
Total 2473 1558 4031
Source: Richard L. Wiener (1994). Standard Protocol for Initial Needs Assessment in the St. Louis EMA: Worksheet, Table 1-5, and Accompanying Text. Center for the Application of the Behavioral Sciences Saint Louis University Department of Psychology.

However, for long-range planning purposes, the needs assessment study, commissioned by the St. Louis Metropolitan AIDS Program provides a better measure on which to base future planning for the HIV/AIDS population in the St. Louis metro area. Table 26 shows the estimated number of HIV/AIDS cases in the St. Louis EMA. The table indicates that the total HIV/AIDS population in the St. Louis EMA is 7087 individuals. Of these individuals 4477 are white, 2503 African American, 78 Hispanic/Latino, and 28 Asian and Native American. The group most affected by the virus is still Caucasian males. However, 1994 data shows that 60% of the newly reported cases of infection are among African American. In the African American community, males are still most likely to be living with AIDS, however, women are becoming a higher risk population. Among Blacks living with AIDS 12% are adult women while among whites 5% are adult women.

Table 26: Estimated HIV Population by Ethnicity, Gender, and Age May 31, 1994
Men Women Pediatrics Total % of cases
Race/Ethnicity AIDSHIV AIDSHIV AIDSHIV
African-American 4281732 80221 834 250335%
White 6763500 37206 1147 447763%
Hispanic/Latino 963 23 10 781%
Other (Asians,
Native Americans)		 518 23 00 280%
Total 11185313 121433 2081 7086100%
Source: Richard L. Wiener (1994). Standard Protocol for Initial Needs Assessment in the St. Louis EMA: Worksheet, Table 1-5, and Accompanying Text. Center for the Application of the Behavioral Sciences Saint Louis University Department of Psychology.

The study commissioned by the Metropolitan AIDS Program was an initial attempt at a needs assessment of the AIDS population in the St. Louis EMA. Although many areas of need of HIV/AIDS affected individuals are being met, several areas show a need for improved service delivery or indicate a gap in services. Table 27 helps summarize the availability of services and the effectiveness in meeting the needs of the HIV/AIDS affected population. The table shows that primary medical care, dental care, drug reimbursement, food services, and transportation is provided to 80% or more of the population needing the services. The areas in which needs were not met for a large number of the HIV/AIDS population are: buddy/companion services, case management, client advocacy, day/respite care, direct emergency assistance, mental health care, and transportation. Direct emergency assistance is the need which is least met, with over 1400 individuals needing the assistance. Assistance will increasingly become crucial in the area of housing and related services. Currently, over 850 people report needing housing assistance services.

Table 27 - Estimated Number of People Needing Specific Services by Gender and Age EMA : Greater St. Louis Metropolitan Area
Services% of males in need% of females in need% of children in needTotal in need# being served# not being served% not served
Adoption/foster care 1 10 01206060 50%
Buddy/Companion Service 252501775 1010765 43%
Case Management 22 3739 165096069042%
Client Advocacy 385541 27911590120143%
Day/Respite care (children) 148 10 341176 16548%
Dental care 8673 100603758092284%
Direct emergency assistance 223701621162 145990%
Drug reinbursement 26 25 41815 149432118%
Food Services 44 54 39 3169 2633 536 17%
Home Health Care 1611 25 1115 834 281 25%
Hospice Care 11 0 70 14 56 80%
Housing prog./related services 34 50 33 2498 1620 878 35%
Information dissemination 5 2 29 362 0 362 100%
Mental Health Care 36 22 6 2443 1719 724 30%
Primary Medical care 94 100 100 6701 6455 246 4%
Rehabilitation services 8 14 20 612 507 105 17%
Substance Abuse services 42 1 269 134 135 50%
Trasportation 32 89 5 2558 2057 501 20%
Other: Adult Day Care 5 5 0 349 193 156 45%
Source: Richard L. Wiener (1994). Standard Protocol for Initial Needs Assessment in the St. Louis EMA: Worksheet, Table 1-5, and Accompanying Text. Center for the Application of the Behavioral Sciences Saint Louis University Department of Psychology.

Of the total 7087 estimated cases, 3777 or 53% are under care. The estimated population not in care comprises both people who are unable to access services and people who do not yet need services. In the next five to ten years most of these individuals will enter the AIDS service delivery network.

In addition to closing the existing gaps in the service provision system, an ongoing challenge is insuring accessibility of services to specific populations. Women and minority populations have greater difficulties accessing services, in part because so many of them have less income. Services which were initially designed to serve a white gay male population are now being redesigned to serve a more diverse population, including minorities and women. With the face of the epidemic changing, the service delivery has to take into consideration the additional needs and challenges faced by people in poverty.

Gay men
The estimated data indicates that approximately 3000 of the HIV/AIDS cases are among gay white men, and approximately 1500 cases are among African-American gay men. These numbers indicate that the gay male population is still the largest group affected by the HIV/AIDS illness. Recent rates of infection appear to indicate that HIV infection, after a period of decline and stabilization, is starting to increase again among younger gay men.

One of the greatest needs among this population is outreach and education. Outreach efforts need to communicate information in a way that is meaningful to gay men's experience, particularly the special concerns of closeted gay men. Many, because of fear of disclosure of their sexual orientation, fail to seek supportive services and become isolated and depressed. Mental health counseling is a need that many gay men wish to access but are unable to. Although white gay men who are HIV/AIDS affected show an overall higher income than other HIV challenged groups, many continue to need assistance in accessing services or in meeting insurance or house payments. Many white gay men, as a result of illness, run out of insurance but do not qualify for Medicaid and cannot purchase medication without assistance. Companion services still figure as a big need among this population.

HIV infection is also on the upswing for African American gay men. Many gay men of color are "closeted" and are married or bisexual. This factor poses a great risk to their partners because of unsafe sexual practices. A major obstacle to outreach among this population is the extent of denial about sexual orientation.

Women and children
Although women and children make up a smaller percent of HIV/AIDS cases, their rate of infection is rapidly increasing, particularly among African American women and children. A close look at Table 27 shows that Women and children are in greatest need of: case management, client advocacy, day/respite care, food services, direct emergency assistance, transportation, and housing and related services.

In general, women, especially those living in poverty, seek services later in the progression of the illness. Usually they are more likely to seek services for their children and other family members before they seek help for themselves. It can be inferred from Table 27 that a higher percentage of women are in need of services that are not prevalent such as adoption/foster care services, day/respite care and companion services. As the numbers of families affected by the illness increases, recognition of their needs is crucial. Currently, no specific program or paid position exists to coordinate these services.

Client advocacy has been identified as an expanding area of need among a greater percentage of women affected with HIV. Women and their families need help in dealing with legal issues concerning provision for their children's future care. These women need assistance in permanency planning in the form of adoption, foster care, or guardianship for times when they are sick or after they die. Other needs that women share with the rest of the AIDS population include tenant/landlord mediation , help dealing with credit issues, legal assistance to insure access to basic economic survival needs. However, strategies are often more complex because of their families impoverished conditions.

Additional obstacles are the lack of adequate child care services and coordinated mother/child health services. Obstacles lie in location, transportation, and lack of sufficient outreach. Lack of coordination between services for mother and children are also a barrier in the provision of this service.

Minority population
Another serious obstacle faced by the African-American community is outreach. Typically, a large percentage of people infected are not reached until the later stages of HIV illness. This is particularly true for impoverished, minority individuals. A growing challenge consists in identifying these individuals and providing them with assistance and services. The combination of racism, sexism, substance abuse, and poverty creates greater obstacles for this population. Denial is the largest obstacle in providing services. Many refuse to admit to be at risk and do not seek help.
Recommendations

Table 27 indicates the entire range of services needed to effectively deal with HIV/AIDS. Especially important are the following recommended initiatives:

a) Establish a one-stop-shop service site to provide the whole range of services that women and their families need.
Special attention should be given to services for women of color and women who are substance abusers. This site should provide medical and support services to both children and their mothers. An adequate number of case managers needs to be available to insure consumers can access a full continuum of services.
b) Expand family support services for women, families, minority population and people in poverty.
An increase in these services will increase participation rates of women in primary care services. Child care services and respite care for families affected by HIV should be a priority.

Home health care services should be expanded. In addition to more paraprofessional and professional home health services, funding should be available to provide financial assistance to family members who are caregivers for persons with HIV. Since in-home service provision is considerably cheaper than hospital care, specific efforts should be made to facilitate in home care.

Emergency assistance funding needs to be expanded considerably since an increasing number of consumers starts out with limited financial resources. Funding in this area needs to assist individuals with housing-related costs, food, and basic supply expenses.

c) Establish companionship programs that take into consideration the needs of specific consumer populations.
Existing buddy programs need to receive ongoing support so that they can expand with the growing need. Additional funding for coordination of companionship programs need to be secured in order to provide support specific to the diverse and unique needs of women and children, minorities, white gay men and gay men of color.
d) Continue support of existing programs geared to the specific needs of gay men.
Support services that help this population deal with the emotional aftermath of the HIV illness is a continuously growing need. Mental health services and buddy/companionship programs are currently unable to meet the demand.
e) Significantly increase support to minority service organization to enhance their capacity to directly serve their consumer population.
Provide funding to assist ASOs to develop joint ventures with other ASOs to directly provide services like food, housing support as other support services delivered through case management.
f) Aggressively pursue outreach efforts to identify those individuals who are in need of services but are not actively seeking them.
Outreach in homeless shelters and the streets needs to be promoted and funded. These efforts would help identify injecting drug users and help them gain access to the appropriate services.
g) Establish substance abuse treatment centers that provides services specific to HIV+ positive users.
This population needs help in dealing both with the reality of their addiction as well as the reality of their HIV status.
h) Increase funding for transportation services.
Transportation assistance is critical if individuals are to access services. As the numbers of impoverished individuals increases, access to transportation will determine their ability to access medical and other support services.

HOUSING CONCERNS

Housing services continues to be the number one priority in AIDS service delivery. Many individuals affected by HIV lose their homes as a result of AIDS discrimination, loss of income caused by HIV related illness, or pre-existing conditions of poverty. Whatever the reasons, an increasing number of individuals and families are homeless or at risk of homelessness. The National Commission on AIDS, in its report Housing and the HIV/AIDS Epidemic, estimates that approximately 15% of homeless persons are infected with HIV/AIDS and that 30% of persons with AIDS are homeless or at immediate risk for homelessness. These estimates are reflective of the conditions in the St. Louis EMA, which indicates that approximately 2100 HIV+ people in the St. Louis EMA are homeless or at risk of homelessness . Unless additional steps are taken, the increasing number of people affected by HIV/AIDS entering the homeless network will cause an overwhelming crisis. In the absence of adequate housing options, people will continue to enter and exit the shelter network and public hospitals, overburdening an already taxed system. Housing is a foundation from which all other services are provided. Priority needs must be given to supportive programs that enables individuals and families to keep their homes.

People at different stages of HIV disease are faced with different housing needs. A study undertaken by Bear Stearn found that treating HIV/AIDS consumers at their home costs about $2,820 per month, whereas a one month stay at a hospital would total $23,190. Individuals need a range of options from affordable housing referral to supportive housing.
Current Services

Currently only one organization is adequately equipped to provide housing services on the Missouri side of the EMA. Doorways is an interfaith program that has provided housing options since 1988. For the past seven years they have led the way in providing housing for individuals and families affected by HIV/AIDS. The organization provides referral and advocacy, emergency/transitional assistance, housing subsidies, and residential housing for individuals and families with HIV and AIDS. The agency operates several housing projects funded through a combination of private, local, state and federal resources. HUD funded programs include Permanent Housing for Disabled Homeless, Supportive Housing, and Section 811. Many of these projects involve rehabilitation or construction undertaken by Doorways. Doorways' philosophy is based on the belief that a safe, adequate home is the cornerstone of cost effective treatment of HIV illness. Persons who have suffered the physical and economic devastation of HIV illness can receive coordinated medical and social services while remaining as independent and self reliant as possible. The continuum of services model adopted by Doorways insures that clients access the most appropriate service reflecting their specific and unique needs.

The Illinois side of the EMA has not yet established a coordinated system of care comparable to the one in St. Louis. The St. Clair County Health Department has great difficulties in meeting the housing needs of its HIV/AIDS affected population. The East side of the EMA needs all the types of services sought by St. Louis providers; in addition, they need to establish a basic housing service agency to coordinate housing options.

Currently, the St. Clair County Health Department provides monthly rental assistance subsidies of $100 and limited emergency assistance to prevent eviction by paying past due rent and utility bills. Funding for these services comes from Ryan White Title I and Title II grants. The Department also coordinates housing assistance with supportive services funded from the Ryan White Care Act programs. The Metro-East AIDS Task Force Services Subcommittee is preparing a strategic plan for housing options that addresses gaps in housing services identified by consumers and providers. Local agencies and community leaders are reviewing both private and public funding avenues for development of long-term housing options.
The following services are provided:

Housing Clearing House
This resource provides housing coordination and resource identification. Lists of property managers and available units are provided. Housing advocacy, placement assistance and outreach to all HIV affected individuals, as well as management of rental assistance programs are additional services. Currently this is the only coordination program in the EMA. The HOPWA application for 1994 call for a resource identification coordinator position for the Illinois side of the EMA.
Emergency and Transitional Housing Assistance
Emergency and transitional housing assistance has several components. The primary goal of these services is to help individuals and families maintain and stabilize their current living arrangements and to secure housing to those who do not have it. This service addresses the largest area of need among consumers served through Doorways . Two thirds of consumers receive this type of assistance.

Both side of the EMA provide this service. Emergency funds provide short-term rental subsidy payments for stabilization of an immediate housing crisis. Often individuals are in need of a one time assistance to pay rent or their utility bills while waiting to become eligible for SSI and SSDI or they are in need of short term assistance to become current on debts and to avoid eviction or shut-off of utilities.

Transitional housing packages of $3,400 are provided through Doorways for establishing new housing for homeless HIV+ individuals and families. The transitional housing package can be used to cover expenses of a short term stay in a hotel, rental deposits, rent payments, utility deposits, repairs, moving expenses and basic occupancy costs. The Illinois side of the EMA identifies and creates transitional housing space for HIV+ individuals and families.

Currently, on the St. Louis side of the EMA, efforts are underway to provide emergency/transitional housing for multiple diagnosed HIV+ individuals (mentally ill and/or substance abusers) who are homeless or at immediate risk of homelessness.

Housing subsidies
This service consists of long term-rental or mortgage assistance to individuals and families who otherwise would not be able to afford to stay in their own homes.
Residential Program
This housing option provides fully furnished apartments to low income families and individuals. This allows for independent living with support services provided in the home. An established service fee is proportional to individual and family incomes. Currently Doorways provides this option to more than 50 consumers.
Supportive housing
This housing option will be available in 1995. A building is currently under renovation which will provide 36 private rooms. This option will serve individuals who are too sick to live alone but strong enough to stay out of a hospital. In this setting all types of supportive services will be made available. Laundry, housekeeping, food and nutrition, home health services, IV infusion therapy and social support will all be present in a supportive housing environment.
Needs and Challenges

An increasing number of people and families from the entire EMA needs access to information about housing options. This is especially true for people living in poverty, women, minorities, and larger families. The stigma associated with HIV/AIDS makes it difficult to identify adequate housing options. This problem is especially acute in St. Louis county where no landlord has been identified who is willing to provide housing for individuals and families affected by HIV/AIDS.

As more people become affected by HIV, more housing coordinators will be needed to meet the growing challenge. These coordinators will be faced with the dual task of identifying housing and reaching out to landlords who can provide adequate and safe housing for persons and families affected by HIV/AIDS.

Unless adequate funding is allocated, short term transitional housing will quickly outstrip the availability of services .Safe temporary shelter space equipped to provide services to individuals and families affected by HIV/AIDS is necessary. As more people in poverty enter the AIDS service network, the demand for emergency assistance and rental assistance will rise proportionately. This is especially true for the minority population in the St. Louis EMA. In general their needs for emergency assistance and occupancy needs arises much sooner than with a more affluent population. With this reality in mind, it is imperative to assist and support the African-American AIDS service organizations and to enable them to meet the fast emerging needs of their clients.

In the next five years, with a swelling population affected by HIV and a longer life-expectancy due to medical advancements, the need to help people maintain their homes will grow. More people will be needing assistance in maintaining their homes for increasingly longer periods of time. Continuous funding in this area will be crucial in averting a homeless crisis. Unless aggressive efforts are made to expand housing options, large number of individuals will be entering the homeless/shelter system in order to access basic services.

A specific challenge is to reach persons who have already lost their homes. Active outreach to shelters is necessary to identify these individuals and families. Lack of adequate funding and assistance fails to identify individuals in the shelter and homeless network who are eligible for services. This factor is already exacerbating the homeless crisis. Moreover, most shelters are inadequate for persons living with HIV disease. The stress involved in living in shelters and the increased chance of exposure to viruses and bacteria can prove lethal to individuals with a compromised immune system. Persons living with HIV/AIDS need to avoid crowded and stressful living conditions to minimize their chances of developing opportunistic infections.

Assistance is especially problematic for consumers with dual diagnosis. Individuals with multiple diagnoses, either HIV and mental illness or HIV and substance abuse, or both, have to negotiate a system which does not know what to do with them. Often consumers end up being bounced from one special care provider to another.

The need for residential programs is increasing. The growing number of individuals with HIV illness identified through the emergency transitional housing options is quickly outpacing the availability of independent living arrangements. The need for residential housing options is growing rapidly as individuals who are currently outside of the AIDS service delivery network are getting sicker and will start entering the system. If steps are not taken to design and develop additional residential programs in the immediate future, the St. Louis area will be faced with a severe housing and homeless crisis for people affected by HIV/AIDS.

As more women, minorities and IV drug users need housing services, housing options that reflect their unique circumstances will have to be developed. Women with children can find a supportive environment and better share their resources in a group home setting. IV drug users in recovery may find these housing option necessary in order to successfully continue their recovery. Group homes provide an ideal living arrangement to individuals who function better in social settings. Persons in recovery, gay men, women with children could all benefit from this type of housing option.

Currently Doorways is developing a 36 bed facility to meet this need. However, the facility will immediately operate at 100% capacity. This indicates the urgency in developing supportive housing programs to meet future escalating need. This is especially true if outreach efforts to individuals outside the service delivery network are intensified. Outreach will quickly identify a large number of people without adequate housing who are in need of on-going supervised care.
Recommendations

a) Expand housing clearinghouse services.
Continue to fund the coordinators' position in the St. Louis EMA for housing information and resource identification. Insure that enough positions are funded to meet the growing needs in the entire EMA. Provide resources to enable coordinators to educate landlords in order to secure adequate and safe housing.
b) Improve the emergency and transitional housing assistance program.
Continue to increase funding for emergency assistance and rental assistance. African-American ASOs need additional funding to meet growing emergency assistance needs.

Increase funds for transitional housing packages which may include a short term stay in a hotel, rental deposits, rent payments, utility deposits, repairs, moving expenses and basic occupancy costs.

Increase funding for outreach to identify individuals who have lost their homes or who are at an immediate risk of loosing their home.

Establish temporary shelters that target persons and families affected by HIV. In order to meet the specific needs of HIV affected consumers, shelters need to offer privacy, toilet facilities, and private sleeping rooms. These shelter conditions need to be offered in conjunction with on site supervision (to deal with emergency cases) , primary care, service coordination, food and nutritional supplement, mental health services, and drug and alcohol rehabilitation.

Establish shelter space and transitional housing specifically to serve individuals with multiple diagnosis. The multiple needs of this population should be addressed simultaneously. Adequate space needs to be available in order to deliver HIV/AIDS specific services in conjunction with substance abuse treatment and/or mental health treatment.

Specific care should be taken to make sure that services in homeless facilities are responsive to the unique needs and conditions of the HIV/AIDS homeless population. Education regarding the spread of the diseases will need to be integrated with other services delivered.

c) Expand funding for housing subsidies and long-term rental assistance.
The most effective measure to prevent homelessness is to increase subsidies for individuals who own a home or are renters.
d) Greatly expand funding to develop residential programs.
Continue to support and build the capacity of existing housing organizations experienced in developing services specific to the AIDS affected consumer population.

Establish rehab and conversion funds to develop new residential programs to keep pace with the growing need.

Establish funds to develop group homes. Group homes for persons with similar experiences and needs may find it beneficial to live in a shared living environment.

e) Expand funding for development of joint supportive housing programs
Develop cooperative housing ventures between existing housing organizations and minority AIDS service providers.
Resources

Ongoing projects and future projects can be funded through a variety of ways. Development projects are and will continue to be supported in part by the Supportive Housing for the Handicapped Homeless (McKinney Program). All of construction and 80% of related operating costs can be secured through the HUD 811 Program. Additional sources of funding may be secured through the Missouri Housing Development Corporation, City of St. Louis CDBG, Private funding, and HOPWA. Sources for operational costs can be secured from the McKinney Program, State Cash Grant, and resident contributions. Sources for services are expected to be funded through Ryan White I, Ryan White II, State General Revenues, and HOPWA.

The overall cost to adequately meet the growing needs on housing services in the St. Louis side of the EMA is estimated to be:
$ 4,532,000 in 1995
$ 2,240,000 in 1996
$ 2,694,000 in 1997
$ 2,859,000 in 1998
$ 3,061,000 in 1999

The cost per service category for the five year period 1995-99 is estimated to be as follows:
Resource Identification, Housing Coordination, Outreach $845,000
Emergency/Transitional Housing $3,405,000
Ongoing rental/mortgage subsidies $2,115,000
Independent living residences $2,416,000
Supportive Housing $6,405,000
The cost for providing services in the Illinois side of the EMA for the five year period is estimated to be $ 2,000,000.

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