The Power of Prevention: An Analysis of Federal HIV Housing Investments

This study employed a longitudinal panel design analyzing data from all 50 U.S. states over six years (2015–2020), yielding 300 state-year observations, to examine the impact of the Housing Opportunities for Persons with AIDS (HOPWA) program on new HIV diagnoses and state-level expenditures. The research question asked: Are higher levels of federal HIV housing investment associated with fewer new HIV diagnoses at the state level, and do these investments “stick” – that is, do they exhibit a flypaper effect, meaning federal funds remain additive to state budgets rather than displacing state spending? Fixed-effects (FE) regression models with robust standard errors were used to test this relationship. Findings reveal that each additional $1 million in HOPWA funding is associated with approximately 24 fewer new HIV cases annually per state. HOPWA funding was also linked to increased state health and total spending – evidence of the flypaper effect. Although homelessness did not emerge as a consistent mediator, HOPWA’s association with reduced HIV diagnoses underscores the cost-effectiveness of housing as an HIV prevention strategy. Future research should assess HOPWA’s impact on viral suppression rates amongst participants and investigate how specific categories of HOPWA expenditures (e.g., vouchers, facility-based housing, and case management) differentially influence HIV outcomes.