Inside Joseph's House

Two decades ago on Dec. 1, the first World AIDS Day drew attention to the global epidemic. Within two years, D.C. family doctor David Hilfiker, who had been working and living with the homeless, opened Joseph's House in the Columbia Heights neighborhood of Washington, D.C., after noticing that an increasing number of them had been diagnosed with HIV.
Theresa Vargas
Washington Post Staff
Tuesday, December 2, 2008

Michael Tyree will tell you that on the day Robert Wylie and another man died, the doves that had settled outside the window flew away.

For two weeks the birds had made a nest outside Joseph's House -- a gray-brick rowhouse in Northwest Washington where the homeless go to die -- but they had left by the time Wylie slipped away on a living room sofa in the arms of a volunteer. They were gone when his body was laid on the hardwood floor, bathed and dressed in his best, a pack of cigarettes tucked in his pocket. They hadn't returned a week later when his memorial service was held among that same faded furniture.

Tyree said he can't help but think at least "a little bit" that the birds knew what had happened. He too, avoided the memorial service, shuffling by the door several times but not stopping.

"I don't like funerals," he said, his words muffled by his own illness. "I want to remember him the way he was."

Here in Joseph's House, it is not unusual for death to play out in one room while life defiantly goes on in another. At the dining room table, the healthy pass biscuits to the unhealthy, and frail, slow hands clear place mats so that young, able ones won't have to. People die and then cookies are baked.

Twenty years ago on Dec. 1, the first World AIDS Day drew attention to the global epidemic. Within two years, family doctor David Hilfiker, who had been working and living with the homeless, opened the house after noticing that an increasing number of them had received HIV diagnoses. He, his wife and their three children moved into the third floor and filled the second with its first residents: a man who had spent most his life in prison for shooting a relative, another who had burglarized homes for almost two decades and a recovering drug addict with a suburban, middle-class upbringing.

"We saw ourselves as a community for rich and poor, black and white, sick and well," Hilfiker said. "At that point we took people in when they were well. . . . Our vision was really community, not a hospice."

Hilfiker's family moved out of the house in 1993, but he remained involved in managing the home's finances until March. About 50 percent of the funding comes from the federal and local government and the rest from grants and private donations.

Over the years, the house has evolved into one where a sense of community has remained but the frailty of its residents has increased. Even as medications have lengthened the life span of those with HIV, many residents have not consistently taken those drugs, facing barriers such as addictions, mental illnesses or a shelter life inconsistent with medicine that must be taken regularly and sometimes kept refrigerated.

Washington has among the largest AIDS and homeless populations in the nation, but officials say it is impossible to know how many people live at the intersection of those two statistics. What is known is that 3 to 10 percent of all homeless people are HIV-positive, which is 10 times the rate of the general population, said Nancy Bernstein, executive director of the National AIDS Housing Coalition. She added that the HIV death rate among the homeless is seven to nine times higher than that of the general population. In the District last December, there were at least 400 people known to be homeless and living with the illness, according to the D.C. Department of Health's HIV/AIDS Administration. And although officials say that number is incomplete, it draws a picture of who is most vulnerable. Most (75 percent) were men, and almost all (83 percent) were black.

Priscilla Norris, who has been a nurse at Joseph's House for eight years, said access to medication is not the problem, with most people at the house qualifying for Medicaid or other help. "But their lives are so totally out of control for one reason or another, or 14 reasons, that they can't take advantage of access" until coming to the hospice, Norris said.

She added that for every person who moves into the house, she doesn't doubt there are others who are dying in emergency rooms or on the street.

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