The Denver HIV clinic focuses on housing and food

For people with HIV, the goal is to become “undetectable,” to suppress the virus to the point where it is not transmissible and not even a blood test can identify it.

Modern medications make this possible — when a person takes them every day.

But many patients who find their way to an HIV “medical home” in an ordinary beige brick building in east Denver are unable to fill their prescriptions or take their antiretroviral pills regularly. This is because they have more pressing problems – such as where to sleep and how to get food.

About 170 of the 750 patients who receive case management services through the Vivent Health clinic, which also provides medical, dental and behavioral health care, are homeless. Another 300 people are at risk of losing their homes.

For years, the medical nonprofit has tried to help its homeless patients by connecting them with local housing agencies. But the scale was so great that two years ago, Vivent created its own housing department and voucher program, with a team of case managers who help move people off the streets and into apartments, or provide monthly rental assistance to protect them from eviction and housing. Seizure of the mortgaged property.

“We can all imagine that if we don’t know where you’re going to lay your head at night, it’s almost impossible to pursue any other medical goal, or any other goals in life,” Brooke Murray said. , Director of Housing Programs at Vivint. “You’re in constant survival mode. You’re not thinking ahead about how to make a doctor’s appointment next week or take your medications.

It is even more difficult for those living outside in camps, where their belongings are often stolen or lost in the chaos of constant movement.

“Or there’s a sweep, and everything is gone — the syringes and medications are gone,” said Lisa Toole, who runs the Colorado operations for Vivint, a nonprofit health care organization that began as an HIV and AIDS prevention and treatment clinic in Wisconsin and now operates in five locations. States: “Then they start all over again.”

The Denver office’s outreach work includes sending a team of workers to camps, where they provide syringes so people who inject drugs can use clean needles, the opioid antagonist naloxone, and HIV tests.

“They’re in white pickup trucks, working on damage control, trying to stop the spread of the disease,” Toole said. “They literally arrive at the camps and walk through the camps and help people. We pick up the syringes. We take back 80% of the syringes we distribute. In Denver, if you’re on the river at REI, and you’re not walking over syringes, it’s because my folks there are picking them up.

HIV infection rates have risen in Colorado

While an HIV diagnosis was considered a “death sentence” decades ago, the virus is now preventable, through a drug called PReP, and treatable through a combination of daily medications that suppress the virus.

After years of declining HIV infection rates, over the past five years Colorado has seen a rise in the number of people diagnosed with the virus and the rate of new cases per 100,000 people. The state has 14,903 people living with HIV, including 428 people diagnosed with the virus last year, according to data compiled by the Colorado Department of Public Health and Environment.

All Vivint patients are infected with HIV or are at risk of contracting the virus, which is transmitted through unprotected sex and drug injection. Some of them are part of the LGBTQ community, and a smaller portion are women who immigrated from African countries and contracted the virus from their husbands.

Among those who have become chronically homeless, many have given up on treatment — and given up on housing.

“Not everyone is ready for housing the moment you come in and offer them housing,” Murray said. “They’ve built this community, this trust, this way of life in places not normally meant for human habitation.

“When a lot of our clients were first diagnosed, it was like a death sentence, so their lives became just surviving until they died. And we really step in and say, ‘No, you can thrive, and we’re here to help you get to that point.’

Unstable housing reduces the likelihood of viral suppression by 51 percentage points, according to a 2018 study. Vivent has a viral suppression rate of between 93% and 96% for people in its housing programs who have been in housing for at least three months, according to the organization’s unscheduled data. Profitability. This is close to Vivent’s overall undetectable rate of 96%-98% for patients, both resident and non-resident, who come to the health clinic for at least six months. About 2,000 people visit the Denver office to schedule medical appointments.

Since Murray created Vivint’s housing department, the team has housed 65 people in two years. Not only does the team follow up with inspections to ensure apartments are clean and safe, they also check in with clients every few months to ensure they are adhering to their rental agreements.

For one client who had lived abroad for years, Murray’s team created a chart to determine what a person needed to clean daily, weekly and monthly.

Unlike other voucher programs, Vivent will house people who don’t live in the country legally and who struggle with addiction, Murray said. “All people deserve housing, regardless of their employment or past,” they said. “Housing should be a human right, and that’s what we’re trying hard to do.”

From September 2022 through August, Vivent paid $818,338 in payments and housing vouchers to protect 390 people in Denver from homelessness.

“You don’t have time to take some medicine.”

A patient named Sherri, who goes by the nickname “Touch,” said she did not take HIV medication while she was living on the streets. “You don’t have time to take medicine,” she said. “You don’t have anywhere to take it. What were you going to do? Grab it with some soda at the corner store?”

Thatch, who wears pink slippers and a long, thick braid over one shoulder, lives in an apartment near Vivent’s office with her black cat, Snowball. She commutes to the clinic every day or two in her electric wheelchair — to appointments, the pharmacy or the on-site food bank.

At the food bank, people can fill their bags and backpacks with apples and pears, fresh vegetables provided by Colorado farmers, and bread donated by King Soopers. There’s a refrigerator stocked with meat and shelves stocked with pancake mix, soup, toilet paper and laundry detergent. Next to the toothpaste are a set of business cards for Vivent Dental Clinic, a collection of exam rooms and laboratories in one corner of the building.

This food bank has much fewer rules than most banks. People can come as many times each week as they want. They can shop for what they want, and it’s up to them to decide what they consider their family. There is no requirement for someone to provide proof of the number of people in their household.

“Family is family,” Murray said. “Especially within the LGBT community, typically with our seniors who have felt a lot of stigma about having a same-sex partner, so we don’t ask for proof of that.”

Between the check-in desk in the waiting room and the food bank doors, there’s a rack of free snacks — bags of goldfish and fruit bars that entice people to approach the food bank. Everyone is welcome to shop there, but it often takes several visits to the snack stand for them to feel comfortable enough to enter.

Because Thatch uses a wheelchair and can only carry home what she puts in a bag strapped to the back of the chair, she shops at the food pantry about every other day. Her home was better now than any she’d had in decades, not like the apartment the rats had lived in on Detroit Street or the years of living with whatever man had given her a place to sleep.

“I’ve been homeless so many times, it’s pathetic,” she said before visiting Vivint Pharmacy last week. “It was drugs until I stopped fighting it. There are all kinds of ways. They are the men you choose to be with, who lie back and watch women do everything. They have no work, no hustle. These things reflect back on you.”

For Thatch, housing was key to getting off drugs and taking care of her health.

“When you’re jumping from couch to couch and floor to floor like that, you’ll never get off drugs. I hate fighting to get rid of the problem, it’s been hard for me,” Thatch said. “You have to calm yourself down until you feel better. “

Federal and state HIV programs support the clinic

Vivent has multiple housing programs, including one for people who have homes but are at risk of losing them because they struggle to pay their rent or mortgage. The housing situation has deteriorated in the past few years as rent in Denver has risen – now the average price of a one-bedroom apartment is about $2,000 per month. Through Vivent, people can enroll in a program in which they pay about 30% of their income for rent and the rest is subsidized.

The nonprofit also created its own housing voucher program, funded through Housing Opportunities for People with AIDS, which is part of the U.S. Department of Housing and Urban Development, or HUD. Vivent’s housing team will help people find apartments and landlords who accept the voucher.

Vivent also offers “crisis housing,” which is temporary hotel rooms for people living on the streets with HIV.

Operating at a loss, Vivent Medical Home is funded through a combination of federal, state and local dollars, including from the Colorado Department of Public Health and Environment and the county health department. During last year’s monkeypox outbreak, which spread primarily among gay men but also in homeless camps where people shared beds, Denver’s Vivint Clinic treated 30% of the city’s monkeypox cases and administered more monkeypox vaccines than any other clinic in Vivint.

Federal funds supporting Vivent come not only from HUD but from the Ryan White Program of the U.S. Health Resources and Services Administration. However, the instability of these funding sources has led Vivint’s housing team to connect patients with other government housing vouchers, just in case.

“In the federal budget, there is constant fluctuation in the amount of funding that goes to these things, especially as we get to a world where HIV is no longer viewed as a health crisis,” Murray said. “We always want to make sure our customers stay in their homes for the long term.”