Abstract

Permanent Supportive Housing (PSH) increases housing stability and improves health outcomes among people living with HIV (PLHIV) at risk of homelessness. We conducted 24 semi-structured qualitative interviews with PLHIV at risk of homelessness living in a PSH building in Vancouver, Canada, with the aim of understanding how PSH building policies impact residents’ health. Interviews were analyzed using self-determination theory and Housing First principles. The housing provider prioritized residents’ physical safety, while participants often prioritized other needs, such as autonomy and relatedness. While building policies improved some participants’ perceived safety or autonomy, these policies simultaneously interfered with other participants’ efforts to meet alternative needs. In contrast, supportive strategies, such as the autonomy-supportive models of Housing First initiatives, appear more effective at meeting needs, with fewer unintended consequences. A shift towards autonomy-supportive housing environments for persons with complex psychosocial needs at risk of homelessness is needed, as is the deliberate alignment of resident population, tenant intake, building structure, and program model.

摘要

永久支持性住房 (PSH) 可提高住房稳定性并改善面临无家可归风险的艾滋病病毒感染者 (PLHIV) 的健康状况。我们对居住在加拿大温哥华 PSH 建筑中有无家可归风险的 PLHIV 进行了 24 次半结构化定性访谈，目的是了解 PSH 建筑政策如何影响居民的健康。使用自决理论和住房第一原则分析访谈。住房提供者优先考虑居民的人身安全，而参与者通常优先考虑其他需求，例如自主性和相关性。虽然制定政策提高了一些参与者的安全感或自主性，但这些政策同时干扰了其他参与者满足替代需求的努力。相比之下，支持策略，例如“住房优先”倡议的自治支持模式，似乎更能有效满足需求，而且意外后果更少。需要为面临无家可归风险的具有复杂社会心理需求的人转向支持自主的住房环境，同时需要有意识地调整常住人口、租户人数、建筑结构和项目模型。