The challenge

Though homelessness and HIV/AIDS have always been related, the two issues have become particularly intertwined in recent years. This is for two reasons: the HIV/AIDS epidemic has disproportionately affected low-income young adults, women, African Americans, and Latinos; and, as people with the infection or the disease live longer, the need for housing grows. “The good news is that people are living longer and death rates are 50 percent of what they were five years ago. The bad news is that we have not kept pace with subsidized housing units,” says Betsy Lieberman. Nationwide, the Centers for Disease Control and Prevention estimate that more than 200,000 people living with HIV/AIDS – or over 20 percent of the infected population – need housing assistance. Without stable housing, infected individuals often cannot adhere to new drug treatment plans. Primary healthcare providers and people living with HIV/AIDS repeatedly cite lack of affordable housing as the single most important barrier to accessing health care. In the Seattle-King County region, the average waiting period for those seeking permanent housing assistance is 18-24 months. “The focus of federal low income housing policy is on home ownership,” says Betsy Lieberman. “That’s great for working folks with two incomes and additional resources, but that policy doesn’t work for people on Social Security Disability – the majority of whom are living on less than $600 or $700 a month.” She believes that only by embracing multiple approaches to the dual problems of homelessness and HIV/AIDS “will we be able to make a serious impact on either of them.”


Seeds of commitment

Betsy Lieberman was raised with a sense of social justice. “I grew up in a family that was about principles and learning. My father, a former corporate CEO who now gives most of his time to non-profit and philanthropy work in New Jersey, has always been an inspiration to me, and my mother has worked in social services most of her life,” she says. The value of service was so ingrained in Lieberman that she never considered any other kind of work. “I’ve only had two jobs since I finished graduate school in 1977. One was administrator for a community health center for primary care for the elderly; the second job was as founding director of AIDS Housing of Washington.” AIDS also touched her personally. “I lost my first close friend to AIDS in 1985.”


Accomplishments

In 1987, Lieberman was hired by the Seattle-King County public health department to develop a plan for meeting the long-term care needs of people with AIDS. She convened a nine-month planning effort that engaged health professionals, AIDS organizations and public officials who identified the need for a skilled nursing facility and day health program. No existing organization wanted to take on this challenge. To fill the vacuum, AIDS Housing of Washington was founded, and the board asked Lieberman to be its executive director. The experience was daunting. “I would have never imagined that in a place like Seattle, known for its openness to diverse groups, there would have been so much fear, stigma, and organized opposition to the city's first AIDS housing project,” she says. Despite the support of 5,000 individual donors, two years of battles followed – among communities, political factions, and state officials. The deadlock ended when Lieberman forged an alliance between ACT-UP Seattle and a lobbyist for Seattle’s powerful Boeing Company. Bailey-Boushay House finally opened its doors. “Frankly, I believed my job was over at that point.” Her work was just beginning.

Today, AIDS Housing of Washington has greatly expanded its reach and responsibilities. Bailey-Boushay House provides 35 skilled nursing beds and day health services for those with late-stage illnesses. The Lyon Building provides 64 units of supportive housing for persons living with AIDS who have extensive histories of homelessness, mental illness and chemical dependency. Additionally, there are 38 scattered-site apartment units in four suburban cities and Seattle for individuals and families living with AIDS. To achieve this, AIDS Housing of Washington maintains partnerships with a range of mainstream housing providers and AIDS service organizations. In addition, Lieberman oversees 25 units of housing in various stages of development.

Housing development is only one strand of her work. In 1993, with funding from the Robert Wood Johnson Foundation, she established a National Technical Assistance Program “It started with my idea to write a book to document the process we used to build Bailey-Boushay House so that others could follow our lead. This would become Breaking New Ground: Developing Innovative AIDS Care Residences,” she says. To research the book, she and co-author Donald P. Chamberlain, who is the organization’s director of technical assistance, visited 90 AIDS housing programs across the country. From these visits, they discerned three critical gaps in the field: most providers lacked formal training or experience as housing developers or operators; they tended to be isolated from mainstream housing agencies and other AIDS housing providers; and there were no federal policies on AIDS housing. “Addressing these gaps became the core goal of our technical assistance work,” says Lieberman. Today, AIDS Housing of Washington continues a two-pronged mission: to create housing units for people living with HIV/AIDS in Seattle and greater King County, and to offer technical assistance to AIDS housing providers and local government agencies nationwide. Last year, Lieberman created the first National AIDS Housing Leadership Institute for AIDS housing directors; a second Institute will be held October, 2001, in Colorado.



How she leads

Lieberman has a remarkable record of success not only in Seattle, but also across the nation, much of it due to the alliances she has built. Her organization’s staff has grown from four to a staff of 20, still small by most standards. But the power of AIDS Housing of Washington is measured not in the number of its staff, but in the bridges it builds. When Lieberman first makes contact with a community, she begins her efforts with education about AIDS and AIDS housing. In neighborhood after neighborhood, she eliminates the potential for NIMBYism (the common impulse to react negatively to AIDS housing in one’s own back yard) by strengthening local ties to the project and addressing fears about AIDS. She and her staff are able to combine a range of financing mechanisms, such as low-income housing tax credits and bond financing, not normally available to small-scale projects. She has mastered two technical languages and strategies – those of health care and housing. When helping design a new project, Lieberman challenges people to articulate a vision that can be sustained long after her organization has completed its work. “Bridging boundaries is what AIDS Housing of Washington is all about,” says Lieberman, “and it reflects my own belief that nonprofit organizations working together will always create more lasting solutions than by working apart." One community supporter says of Lieberman, "She is humble but strategic, her work is one of strengthening the fabric of good will."


The future

Betsy Lieberman believes the future for AIDS housing is in helping people with the disease stay in their communities. “People want to stay where their case managers, support systems, friends and family are. This is a challenge related to all low-income folks, particularly those who live in regions with higher real estate costs. Along the West Coast and Northeast Corridor, people must move farther and farther out to afford housing, which makes access to their support systems more and more difficult.” As HIV/AIDS reaches a more diverse population spread over wider geographic areas, affordable housing will increasingly become an issue of public health. But to Lieberman and the many other leaders who work on the HIV/AIDS front, the issue remains more personal than geographic. Recently, visitors to Seattle met a 51-year-old man, who had never had permanent housing of any sort until he was provided a unit at the Lyon Building. After six weeks of counseling, the staff finally convinced him that they would not throw him out – and that it was, in fact, okay for him to unpack his clothes, put pictures on the wall and food in the refrigerator. His health has stabilized and his life has improved since finding a place he finally could call home.


More about Besty Lieberman

"She is never happy. On the board, we often want to say, ‘Stifle it Lieberman, we're doing all we can do.’ She's constantly challenging all of us to do more. I'm a volunteer; I have a full-time job, a family. I say, ‘I've given all I can.’ She then explains how I can make more of a difference. I know by the end of the conversation I will say ‘yes’ and mean it…. When we start each campaign, she is the first to open her own purse…. A ripple locally is moving internationally. It's her vision."
– Micki Flowers, health specialist, KIRO News Channel 7, Seattle

“She is not just talk; she walks the walk."
– Carla Javits, President and Chief Executive Officer, Corporation for Supportive Housing

"We all believe that Betsy Lieberman's leadership has, quite literally, changed the world. She is proof positive of the amazing impact that can result from the efforts of a single individual in pursuit of a specific cause. We consider her something of a national treasure.”
– Norm Rice, Former Mayor, City of Seattle