People living with HIV experiencing homelessness are more likely to have higher viral loads. The POP-UP model at the Ward 86 HIV clinic in San Francisco was designed to address barriers to care engagement. Researchers found an improvement in the 12-month HIV viral suppression from 0% to 44%. However, many patients were not virally suppressed. Researchers suggest that POP-UP clinics are promising to improve care engagement and HIV viral suppression among people experiencing homelessness.

This brief on the Home Safe program summarizes key findings from the UCSF Benioff Homelessness and Housing Initiative’s (BHHI) interim evaluation of the program. It includes a brief description of the program, an overview of the evaluation’s design, and an assessment of the Governor’s 2021-22 budget proposal to expand Home Safe eligibility.

Since their introduction in 2009 under President Barack Obama, vulnerability surveys have aimed to assess the eligibility of homeless individuals for housing assistance. However, recent findings suggest that these surveys may inadvertently perpetuate racial disparities, particularly affecting Black homeless populations. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "If you’re a White person, the more likely you are to rank higher than if you’re a Black person, so you’re more likely to get selected for housing."

When encampments are cleared without the right supports, people have no option but to return to the streets—this time without the items that helped protect their health. Tents, blankets...

More than twice as many people experiencing homelessness in San Francisco died during the first year of the COVID-19 pandemic compared with previous years, and the leading cause of death was drug overdose. No deaths were attributed to the virus itself. "Death from the COVID-19 pandemic may have been avoided, but deaths from other factors known to impact this population disproportionately—drug use and violence—have increased," said Maria Raven, MD, MPH, Chief of Emergency Medicine at UCSF, who co-leads the program on adults with complex needs at the UCSF Benioff Homelessness and Housing Initiative. "Mitigating death among people experiencing homelessness will require a multi-faceted approach and a willingness to invest significant resources."

Homeless encampment cleanup activities do not appear to have long-term effects on the number of people living on the streets, a new study by Rand Corp has found. Another study by the Benioff Homelessness and Housing Initiative at UC San Francisco found that far more than the general population, people living on the streets and in shelters are victimized by violence and discrimination. Anita Hargrave, MD, assistant professor at UCSF and lead author on the impact of Intimate Partner Violence on Homelessness study, said, "There is so much tendency in the ongoing discourse on homelessness to dehumanize. When you read through people’s stories when they came to that point when they could no longer be housed, it’s such a powerful way of creating empathy."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was interviewed about how the shortage of housing in California is structural problem for a state that has the largest population of people experiencing homelessness in the country. Dr. Kushel also described how sanctioned encampments have been somewhat controversial.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed how low-wage workers and their families are at particularly high risk during the pandemic. “The type of work that (homeless) people do is the type of work that we have seen to be at highest risk because it has been the type of work that you can’t do from home.”

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted in an article about how unhoused people in San Francisco and nationwide are contracting the coronavirus at about the same rate as housed people. Isolating people in hotels and thinning out shelters helped—and for those left outside, the fresh open air was a greater protector than experts anticipated. "There’s no question that the hotel rooms and downsizing the shelters helped a lot," said Dr. Kushel.

Across San Francisco, there are 8,000 unhoused people on a given day and upward of 20,000 over the course of a year. With rising housing costs, some individuals have transitioned to living RVs on Winston Drive. However, new street parking restrictions will force people living in RVs to leave the area. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "People told us they preferred vehicles to shelters, but they would have preferred housing."

Body camera footage of pregnant homeless woman puts Kentucky's street camping ban in the spotlight. Kentucky is among several states that passed bans on street camping and it recently got a glimpse of how it works in a video showing police giving a citation to a homeless woman going into labor. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "You add the stresses of homelessness, the sleep deprivation, the fear, the shame, the stigma, the lack of access to health care and you really are escalating the risk for the mom."

Homelessness among older adults is increasing; almost half of those aged 50 or older first became homeless after age 50. Benioff researcher found that individuals with late onset homelessness had very different stories compared to indviduals with early onset homelessness. Many individuals struggled with multiple chronic health problems, such as heart disease, chronic lung disease, and cancer. Ending homelessness among older adults will require increasing the supply of affordable housing, targeted prevention efforts, and expanding permanent supportive housing, adapted to older adult needs.

Homelessness is detrimental to health, and clinicians can play an essential role in mitigating the deleterious effects of homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discusses this and more with JAMA Senior Editor Karen E. Lasser, MD, MPH. Dr. Kushel said, "When you are an individual provider, in a room, you are trying to understand the difficult environmental conditions that your patient has and do things to decrease that part."

On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, researchers highlight the structural and individual risk factors that lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations.

The UC Berkeley Social Science Matrix hosted Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, for an in-depth discussion of homelessness in the Bay Area, emphasizing the causal factors of a chronic shortage of low-income housing and structural racism. “Homelessness is not caused by mental health and substance use problems,” Kushel explained. “The more we blame this problem on highly stigmatized medical conditions, the more it lets us off the hook for solving the fundamental problems that have brought us to this point.”

Billions have been spent to solve the homelessness crisis in California. However, while zoning laws, law enforcement and services for mental health and addiction all play a part in the solution, several state and local leaders believe only an enormous investment from the federal government can help solve this crisis; more funds are needed for rental assistance or other direct aid. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said "I fear that it’s going to require Congress to move on the big picture."

Governor Gavin Newsom’s executive order allowing state and local officials to dismantle homeless encampments has drawn mixed reactions from homelessness experts within California. he executive order calls for state agencies to remove homeless encampments from state lands, such as state parks, beaches, agency buildings, highways, and the areas beneath them. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "A lot of harm can come from sweeps, and ultimately, if you don’t offer people a real outcome, they’re just going to have to move someplace else because they can’t dematerialize; they will show up someplace else."

Incarceration is a recognized risk factor for homelessness. However, most research focuses on the relationship between homelessness and prison incarceration. This study examines the occurrence of housing loss after jail incarceration among individuals without prior evidence of homelessness and the associated risk of reincarceration.

This opinion piece characterizes homelessness in California and discusses how people can help, including by recognizing homeless people's humanity. Margot Kushel, MD, describes how home...

The number of homeless people in L.A. County living on the street dropped last year, bucking trends elsewhere in the U.S. Ayesha Rascoe and Nick Gerda talk with experts about

In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, explains how homelessness is not just a housing issue, but a health care issue. She outlined the pertinent health needs of people experiencing homelessness and the barriers of treating illness against a background of homelessness. Dr. Raven writes, "The health care system in general, and emergency departments specifically, cannot solve this problem — we can only respond to its consequences." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, explains how homelessness is not just a housing issue, but a health care issue. She outlined the pertinent health needs of people experiencing homelessness and the barriers of treating illness against a background of homelessness. Dr. Raven writes, "The health care system in general, and emergency departments specifically, cannot solve this problem — we can only respond to its consequences." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Tom Murphy, the Senior Director of Communications for the National Alliance to End Homelessness, brings attention to the frontline professionals who respond to homelessness. He highlights the demanding work and economic disparity among the frontline workers who engage with unhoused individuals. "If we truly want to end homelessness, we must honor frontline workers with a living wage" Mr. Murphy writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.