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‘No-barrier’ program will expand housing options in face of Twin Cities’ HIV/AIDS outbreak at encampments

A $1 million award from the federal government will help a Twin Cities HIV/AIDS housing nonprofit serve unhoused Minnesotans with substance use disorder.

Clare Housing is a Minneapolis-based nonprofit that provides a range of affordable and supportive housing options for people living with HIV/AIDS.
Clare Housing is a Minneapolis-based nonprofit that provides a range of affordable and supportive housing options for people living with HIV/AIDS.
Courtesy of Clare Housing

Unhoused Minnesotans with substance use disorder and HIV/AIDS will soon have a new housing option, thanks to a $1 million federal award earmarked to fund the purchase and renovation of a property to be called Clare Digs.

Clare Housing, a Minneapolis-based nonprofit that provides a range of affordable and supportive housing options for people living with HIV/AIDS, will turn Clare Digs into a “no-barrier” program, meaning residents will be able to avoid completing the complicated paperwork usually required for subsidized housing. There will be no sobriety requirements for residency. 

Phoebe Trepp
Phoebe Trepp
This approach is key for the potential residents of this program, said Phoebe Trepp, Clare Housing executive director. Many of the requirements that typically come with subsidized housing can be insurmountable barriers for people struggling with addiction and homelessness, she explained. The idea behind Clare Digs is that having a stable home will help improve residents’ health and maybe even reduce their need for addictive substances.  

“When people are moving in and out of shelters or living outside, it is hard to maintain any kind of stability with your medication or your overall health,” Trepp said. “It is hard to focus on anything except where you are going to sleep the next night.”  Once a person moves into their own apartment, Trepp said, “We see their health stabilize really quickly. Over 90% of our residents become undetectable with their HIV. Their medications are working so well, they are no longer able to transmit HIV to others.” 

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No-barrier housing is rare in Minnesota, Trepp said: “We haven’t found a place that mirrors it exactly. The only barrier we have is that we would require someone to have HIV status to be a resident of the program.” 

The hope is that this approach will make Clare Digs feel more open and accepting for residents. 

In a no-barrier program, Trepp said, “People get to decide who they want to live with, how long they want to be there. They don’t need funding attached to them.” And because the program accepts that there will be some substance use, she explained, “There will be staff there to provide support in case of an overdose.”

Leah Cameron, Clare housing director of supportive housing, said that there has been an outbreak of HIV/AIDS among IV drug users living in encampments around the Twin Cities. The federal funding will allow Clare Housing to purchase and renovate a 4-6-unit property that could house up to 16 residents. 

Leah Cameron
Leah Cameron
“It’s not a lot of people but it is something,” Cameron said.  “Ideally, we would house the entire world. But I think this is a good starting point. It would be about 10% of the people covered by the current HIV outbreak in the encampments.”

Staff members at Clare Housing have been aware of this outbreak for some time, Trepp said. The idea for the no-barrier Clare Digs grew out of this reality: “We knew that this has been going on for three years and new cases are happening all the time. Something else needs to be done. This is at least one thing to try.” 

Once the federal funding comes through, Clare Housing staff, who worked with US Senator Tina Smith’s office for two years to secure the funding in an omnibus spending bill, will begin searching for a building or buildings to purchase and remodel: “Our hope is to find one to two fourplexes that will be co-located,” Trepp said. “We will have onsite staff who will be there as resources.” 

The funding’s approval came more quickly than Trepp and her colleagues expected. “We’re really excited and surprised that it went through,” she said, “compared to the number of steps and amount of time it usually takes to get any government funding for housing. This will allow us to move on this project so much more quickly.” 

Understanding harm reduction

While Trepp and her Clare Housing colleagues believe that IV drug use has led to bad health outcomes,  they also know that helping all people — even those struggling with substance use disorder —  find safe, stable housing is good for their overall health and the health of their community. 

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Believing that too many requirements to live in subsidized housing can drive potential residents away led Trepp and her team to adapt the harm-reduction model, she said: “When someone is potentially placing themselves or others in harm’s way by using drugs, we’re not saying, ‘We won’t serve you if you are engaging in that behavior.’” 

Instead, Trepp explained, Clare Housing staff say, “‘We know you are engaging in that behavior. Not serving you is not going to make it stop. So instead we can provide you with things that reduce the harm from the things you are doing. We can provide you with a safe place to sleep. Our housing is structured in a way that you can do what you’re doing as long as you’re not causing harm to the property.’” 

Because there will not be a requirement for abstinence at Clare Digs, Cameron said that instead staff will look at how residents’ behaviors are impacting themselves and others.  With this perspective, they will work to meet residents where they are at — and provide them with the support they need to maintain their health. 

“What we do see is that the percentage of people who come into our housing who are using IV drugs as well as those who aren’t are both able to achieve undetectable HIV,” Trepp said. “You don’t have to be sober to make your HIV medication work. But stable housing is a huge step toward getting healthy.” 

While it would be better if all people with substance use disorder were able to achieve sobriety, that isn’t a realistic goal, Trepp said, and it shouldn’t limit the scope of her organization’s work: “People who are working in the field with people who are struggling with substance use know that harm reduction does work. It doesn’t mean we are making it easier for them to use. But we are allowing them the dignity of housing if they do use.” 

A no-barrier distinction should encourage people who’ve avoided housing because they couldn’t meet the requirements or felt limited by restrictions to consider a new kind of living arrangement, Cameron said. The new program should have an open-door feel, something she and her colleagues have been working toward for years:  “We picture going into the encampments, asking a few questions and then being able to say, ‘Come on in. We will house you.’” 

History of helping

Clare Housing began providing housing to people with AIDS in 1987, running community care homes that offered compassionate end-of-life care. Over the years, the program expanded. Today, the organization operates a continuum of housing options for residents that range in age from their early 20s to their 80s. 

Clare Housing offers a variety of living options, Cameron said: “I look at it like a spectrum of housing. We have 73 units of scattered-site housing out in the community. We provide rental subsidy and support. We have four apartment buildings. No. 5 is coming on board in the next couple of weeks. We provide a mixture of independent living for people with HIV/AIDS  who are mostly coming out of experiencing homelessness.”  

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Many of the program’s housing options are independent, but others offer a range of supports, including 24-hour staffing, and a care home for residents who need help with daily living, like making and eating meals and help with bathing and taking medications.

For many Clare Housing residents, supports are essential, because managing HIV medications takes organization and planning. “Most people, when they are managing their HIV, are taking multiple meds daily,” Trepp said. “We have one resident who has over 50 medications that they are taking throughout one week, not just for HIV, but for other health conditions.” 

This is why having a home to call your own is so key to maintaining your health, she added:  “When you think about taking a medication that has to be taken every day to maintain your health, that alone is a lot when you are unsheltered.”

Having a safe place to live is a basic human right, Trepp said. Clare Housing programs like Clare Diggs are built to help people achieve that — even if they’ve encountered roadblocks in the past that have made housing seem out of reach. 

“We believe that people really do want to be well and healthy,” she said. “Having stable housing is foundational to reaching that goal. With our programs, our goal is to make housing obtainable for as many people as possible.”