Acquired immunodeficiency syndrome (AIDS), a disease caused by the human immunodeficiency virus (HIV), weakens the immune system, leaving individuals with the disease susceptible to infections. As of 2013, HIV, including AIDS, had been diagnosed and reported in an estimated 953,245 individuals living in the 50 states, the District of Columbia, and the territories. These estimates do not include those who have not yet been diagnosed as HIV positive but are currently living with the disease. Currently there is no cure for HIV/AIDS, and in the early years of the AIDS epidemic, individuals infected with AIDS often died quickly. In recent years, however, medications have allowed persons living with HIV and AIDS to live longer and to remain in better health. Despite improvements in health outcomes, affordable housing remains important to many who live with HIV/AIDS. This report describes research that shows how housing and health status are related and the effects of stable housing on patient health. It also describes the Housing Opportunities for Persons with AIDS (HOPWA) program, the only federal program that provides housing and services specifically for persons who are HIV positive or who have AIDS, together with their families. In addition, the report describes how a small portion of funds appropriated through the Ryan White HIV/AIDS program may be used by states and local jurisdictions to provide short-term housing assistance for persons living with HIV/AIDS. The availability of adequate, affordable housing for persons living with HIV and AIDS has been an issue since AIDS was first identified in U.S. patients in the early 1980s. The inability to afford housing and the threat of homelessness confront many individuals living with HIV/AIDS. From the early years of the epidemic, individuals who are infected with HIV/AIDS have faced impoverishment as they become unable to work, experience high medical costs, or lose private health insurance coverage. The incidence of HIV/AIDS has also grown among low-income individuals who were economically vulnerable even before onset of the disease. Not surprisingly, researchers have found a co-occurrence between HIV/AIDS and homelessness. Homeless persons have a higher incidence of HIV/AIDS infection than the general population, while many individuals with HIV/AIDS are at risk of becoming homeless. Studies of the relationship between HIV and homelessness have found prevalence among homeless populations that range from 2% to 22%. Further, homelessness has been found to be associated with greater likelihood of participation in the risk factors that might lead to HIV/AIDS (multiple sexual partners, sex exchange, drug use, and diagnosis of a sexually transmitted infection), as well as lowered adherence to anti-retroviral therapy. In 1988, Congress established the National Commission on AIDS as part of the Health Omnibus Extension Act ( P.L. 100-607 ) to "promote the development of a national consensus on policy concerning acquired immune deficiency syndrome (AIDS); and to study and make recommendations for a consistent national policy concerning AIDS." In April 1990, in its second interim report to the President, the commission recommended that Congress and the President provide "[f]ederal housing aid to address the multiple problems posed by HIV infection and AIDS." About the same time that the commission released its report, in March of 1990, the House Committee on Banking, Finance, and Urban Affairs held a hearing about the need for housing among persons living with HIV/AIDS. Witnesses as well as committee members discussed various barriers to housing for persons living with HIV/AIDS. Among the issues confronting persons living with HIV/AIDS discussed at the hearing were poverty, homelessness, and discrimination in attempting to secure housing. Another issue discussed was the eligibility for subsidized housing for persons living with the disease. A question raised during the hearing, but left unresolved, was whether persons living with HIV or AIDS met the definition of "handicap" in order to be eligible for the Section 202 Supportive Housing for the Elderly program (which also provided housing for persons with disabilities). Another concern was that persons living with HIV/AIDS often had difficulty obtaining subsidized housing through mainstream HUD programs such as Public Housing and Section 8 due to the length of waiting lists; individuals often died while waiting for available units. In the 101 st Congress, at least two bills were introduced that contained provisions to create a housing program specifically for persons living with AIDS. These proposed programs were called the AIDS Housing Opportunity Act (which was part of the Housing and Community Development Act of 1990, H.R. 1180 ) and the AIDS Opportunity Housing Act ( H.R. 3423 ). The bills were similar, and both proposed to fund short-term and permanent housing, together with supportive services, for individuals living with AIDS and related diseases. The text from one of the bills, H.R. 1180 , which included the AIDS Housing Opportunity Act, was incorporated into the Cranston-Gonzalez National Affordable Housing Act ( S. 566 ) when it was debated and passed by the House on August 1, 1990. In conference with the Senate, the name of the housing program was changed to Housing Opportunities for Persons with AIDS (HOPWA). In addition, the several separate housing assistance programs that had been proposed in H.R. 1180 —one for short-term housing, one for permanent housing supported through Section 8, and one for community residences—were consolidated into one formula grant program in which recipient communities could choose which activities to fund. The amended version of S. 566 was signed into law on November 28, 1990, and became P.L. 101-625 , the Cranston-Gonzalez National Affordable Housing Act. The HOPWA program is administered by the Department of Housing and Urban Development (HUD) and remains the only federal program solely dedicated to providing housing assistance to persons living with HIV/AIDS and their families. The program addresses the need for reasonably priced housing for thousands of low-income individuals (those with incomes at or below 80% of the area median income). HOPWA was last reauthorized by the Housing and Community Development Act of 1992 ( P.L. 102-550 ). Although authorization of appropriations for HOPWA expired after FY1994, Congress continues to fund the program through annual appropriations. HOPWA program funding is distributed both by formula allocations and competitive grants. HUD awards 90% of appropriated funds by formula to states and eligible metropolitan statistical areas (MSAs) that meet the minimum HIV and AIDS case requirements according to data reported to the Centers for Disease Control and Prevention (CDC) in the previous year. (For the amounts distributed to eligible states and MSAs in recent years, see Appendix .) HOPWA formula funds are available through HUD's Consolidated Plan process. Jurisdictions applying for funds from four HUD formula grant programs, including HOPWA, submit a single consolidated plan to HUD. The plan includes an assessment of community housing and development needs and a proposal that addresses those needs, using both federal funds and community resources. Communities that participate in the Consolidated Plan may receive HOPWA funds if they meet formula requirements. Some of the formula requirements were recently changed as part of the Housing Opportunities Through Modernization Act (HOTMA, P.L. 114-201 ) and are to take effect when FY2017 funding is awarded. For more information, see " The New HOPWA Formula Enacted in P.L. 114-201 ." Formula funds are allocated in two ways: First, 75% of the total available formula funds, sometimes referred to by HUD as "base funding," is distributed —starting in FY2017, to the largest cities within metropolitan statistical areas (MSAs) with populations exceeding 500,000 and with more than 2,000 individuals living with HIV or AIDS (through FY2016, funds were distributed to MSAs with more than 1,500 cumulative AIDS cases), and —starting in FY2017, to states with more than 2,000 individuals living with HIV or AIDS in the areas outside of that state's eligible MSAs (through FY2016, funds were distributed to states with more than 1,500 cumulative AIDS cases). Second, 25% of total available formula funds—sometimes referred to by HUD as "bonus funding"—is to be distributed to states and MSAs, starting in FY2017, using a method developed by the HUD Secretary that takes account of housing costs as represented by fair market rents, as well as poverty. Prior to enactment of P.L. 114-201 , bonus funding was distributed based on AIDS incidence (newly diagnosed AIDS cases). In addition, states had not previously been eligible for bonus funding. Although HOPWA funds are allocated to the largest city within an MSA, the recipient cities are required to allocate funds "in a manner that addresses the needs within the metropolitan statistical area in which the city is located." While the distribution of the balance of state funds is based on HIV and AIDS cases outside of eligible, states may use funds for projects in any area of the state, including those that receive their own funds. According to HUD guidance, states should serve clients in areas outside of eligible MSAs, but the state may operate anywhere in the state because it "may be coordinating the use of all resources in a way that addresses needs more appropriately throughout the state." In FY2016, 98 MSAs (including the District of Columbia) received funds, while 40 states and Puerto Rico received funds based on the number of AIDS cases outside of recipient MSAs. HUD jurisdictions that receive HOPWA funds may administer housing and services programs themselves or may allocate all or a portion of the funds to subgrantee private nonprofit organizations. HOPWA formula funds remain available for obligation for two years. As a result of language included in every HUD appropriations law between FY1999 ( P.L. 105-276 ) and FY2016, states did not lose formula funds if their reported AIDS cases dropped below 1,500, as long as they received funding in the previous fiscal year.