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Permanent Supportive Housing (PSH) increases housing stability and improves health outcomes among people living with HIV (PLHIV) at risk of homelessness. We conducted 24 semi-structured qualitative interviews with PLHIV at risk of homelessness living in a PSH building in Vancouver, Canada, with the aim of understanding how PSH building policies impact residents’ health. Interviews were analyzed using self-determination theory and Housing First principles. The housing provider prioritized residents’ physical safety, while participants often prioritized other needs, such as autonomy and relatedness. While building policies improved some participants’ perceived safety or autonomy, these policies simultaneously interfered with other participants’ efforts to meet alternative needs. In contrast, supportive strategies, such as the autonomy-supportive models of Housing First initiatives, appear more effective at meeting needs, with fewer unintended consequences. A shift towards autonomy-supportive housing environments for persons with complex psychosocial needs at risk of homelessness is needed, as is the deliberate alignment of resident population, tenant intake, building structure, and program model.

Supportive housing building policies and resident psychological needs: a qualitative analysis using self-determination theory