Antiretroviral Therapy Adherence Among People Living With HIV While Experiencing Homelessness

Abstract

Introduction Social determinants of health have immense influence on the overall health outcomes of individuals. Homelessness, when set within the context of the socioecological model, includes relevant individual/personal factors like such as substance use and depression, social/interpersonal factors such as stigma, and structural factors including subsistence needs and access to health care or utilization of health care. These 3 types of factors influence adherence levels to antiretroviral therapy. Objective To identify associations between homelessness and antiretroviral therapy adherence and relationships between other modifying variables associated with housing status and treatment adherence. Methods A literature search was conducted using PubMed from 2000 to 2023. A total of 10 articles from this search were identified as appropriate for inclusion, with an additional 2 articles added from parsing references in already approved articles. Results The literature supports a negative association between homelessness and adherence to antiretroviral therapy. Additionally, a variety of factors were found to modify adherence levels in people living with HIV experiencing homelessness, with increased access and reduced barriers to health care mitigating the effect of homelessness on adherence, while unfulfilled subsistence needs reduce adherence levels. An identified intervention in the literature was supportive housing, which entails the provision of housing to those experiencing homelessness to improve their HIV-related health outcomes. Conclusions Among urban populations in the United States, homelessness and other relevant factors had a significant association with reduced adherence levels to antiretroviral therapy in people living with HIV.

Systematic Review: HIV, Aging, and Housing—A North American Perspective, 2012–2023

“…The presence of the terms barrier, stigma, and housing in our LSA top twenty terms in our corpus sheds insight and answers our research questions, in that stigma and discrimination levels (based on HIV status and sexuality) are prevalent and act as barriers to subsidized housing, long-term care, and HIV care facilities, and antiretroviral treatment adherence [15,17,19,22,35,36]. A structural barrier that impedes persistent viral suppression, adherence to anti-retroviral therapy, and access to vital HIV medical services (holistic care) is housing instability [49]. The implications for interventions include removing structural barriers to care at the individual (financial, food, and housing insecurities), community (stigma, discrimination, transportation logistics), and healthcare (stigma/discrimination, provider competency) levels.…”