Deborah Williams, 56, has been waiting six years for an apartment in one of Chicago’s subsidized, low-income housing complexes, and time is running out. “I don’t know how long I’ll be able to afford to live here,” she says of the place she shares on the north side of the city with her 5-year-old goddaughter, Daysha, and a friend. Williams will do whatever it takes not to relive the five homeless years that followed her 1985 HIV diagnosis, but rent eats up half her monthly disability check.

It’s a story that resonates with a disproportionate number of African Americans with HIV, according to a new report released in anticipation of World AIDS Day this Friday. African Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America demands a closer look at the way housing troubles foment the black HIV crisis, both the rising tide of new cases and treatment gaps between the races.

“So many people who are positive are also suffering from lack of housing,” says Damon Dozier, director of government relations and public policy at the Washington, DC-based National Minority AIDS Council (NMAC), the group behind the report. “People of color are dying at rates that we’ve never seen before. What are our legislators prepared to do?”

The report, a joint effort by some of the country’s top black health experts and lawmakers, calls on the feds to expand the Housing Opportunities for Persons With AIDS (HOPWA) program, a 14-year-old program that activists charge has become woefully underfunded during the Bush years.

The National AIDS Housing Coalition (NAHC) estimates that about half of all Americans living with HIV/AIDS—about 550,000 people—will need some form of housing assistance during the course of their lifetime. But NAHC executive director Nancy Bernstine says only about 71,000 of them are served at HOPWA’s current funding level. “We’re just meeting a fraction of the need,” she says.

Housing is highlighted as one of five key areas of concern in the new report, which also recommends distributing condoms in prisons and more programs to support black MSMs (men who have sex with men) coupled with a commitment to fight homophobia in the black community. Substance abuse and prevention education are the fourth and fifth topics addressed.

It will come as no surprise to readers of this report that being without a steady home is bad for your health—not to mention your best efforts to adhere to a treatment regimen. “When people have a place where they can lay their head at night, they can devote time to their treatment,” says Bernstine.

But secure housing also helps prevent new infections. Homeless people are ten times as likely to become infected with HIV, according to Robert Cordero at New York City’s Housing Works. Sometimes, says Cordero, “You’re having to trade sex for housing.”  

In Deborah Williams’ case, it was her HIV status that pushed her into this precarious position and her inability to work that has kept her there. (Besides HIV, she also suffers from chronic obstructive pulmonary disease.)

Williams is, however, lucky to be on a waiting list at all. Bernstine says that subsidized housing becomes available so infrequently that waiting lists are a thing of the past at some agencies. “Many places have just stopped keeping them,” she says.