Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco

Riley, Elise D.; Vittinghoff, Eric; Koss, Catherine A.; Christopoulos, Katerina; Clemenzi-Allen, Angelo; Dilworth, Samantha E.; Carrico, Adam W.

doi:10.1007/s10461-019-02601-w

Cited by 31 publications

(19 citation statements)

References 73 publications

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“…A key to ecosocial theory is that health disparities reflect power distributions in society and societal systems, and thus the deficits reported by rural people who use drugs are actually health inequities, since the lack of employment, housing and food options are avoidable [ 35 ]. Thus, interventions should target root causes of health inequities associated with overdose, such as providing affordable housing, living-wage jobs, and food supports [ 68 , 69 ]. Importantly, stable housing that is not contingent on substance use or mental health treatment is effective and does not increase alcohol or drug use [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Walters

Bolinski

Almirol

et al. 2022

Addict Sci Clin Pract

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Background Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. Methods The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. Results Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. Conclusion The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3

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Section: Discussionmentioning

confidence: 99%

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Walters

Bolinski

Almirol

et al. 2022

Addict Sci Clin Pract

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“…Viral suppression, defined as having less than 200 copies of HIV/mL of blood, is critical to prevent drug resistance, slow an individual’s disease progression, and reduce the risk of further community transmission [ 9 , 10 ], contributing to the strategy of treatment as prevention. It is well established that homelessness is associated with non-viral suppression and an increased risk of falling out of care [ 11 , 12 ]. For WLH in the face of homelessness, prevention and treatment challenges that contribute to disparities along the HIV care continuum include, but are not limited to, poverty, stigma, care taking responsibilities, living in unsafe environments, a mistrust of health care systems, and lacking access to relevant HIV services and interventions that address unique and complex needs while living in homeless and unstable situations [ 6 , 7 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing

Fernández

Lopez

Ibarra

et al. 2022

IJERPH

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Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.

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“…Homelessness has been documented as a cause of, contributing factor to, and/or consequence of substance use among PLWH [ 56 , 57 ], and a fundamental cause of HIV disease progression [ 57 ]. It is also a potentially modifiable risk factor, and “housing first” interventions have great potential to serve as a foundation for improved HIV health and better management of substance use and mental health symptoms [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

African American/Black and Latino Adults with Detectable HIV Viral Load Evidence Substantial Risk for Polysubstance Substance Use and Co-occurring Problems: A Latent Class Analysis

et al. 2021

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Substance use problems are highly prevalent among persons living with (PLWH) in the United States and serve as serious barriers to engagement in HIV care. Yet, in contrast to studies of single substances, little is known about patterns of polysubstance use in this population. Moreover, other risk factors (e.g., financial hardship, incarceration, homelessness, and mental health distress) are also prevalent and complicate HIV management. The present study drew on a cross-sectional survey with African American/Black and Latino (AABL) adult PLWH from low socioeconomic status backgrounds in New York City who were insufficiently engaged in HIV care and evidenced detectable HIV viral load ( N = 512). We used latent class analysis (LCA) to explore patterns of polysubstance use and their relationships to financial hardship, incarceration, homelessness, and mental health. LCA yielded three substance use classes: Class 1, a high polysubstance use/high-risk substance use class (9%); Class 2, a polysubstance use/moderate substance use risk class (18%); and Class 3, a moderate polysubstance use/moderate-to-low-risk substance use class (74%). Mental health symptoms were prevalent in all classes, but Class 1 had greater mental health distress than the other two classes. Current homelessness was more prevalent in Classes 1 and 2. We cannot end the HIV epidemic without engaging and treating AABL PLWH who have serious barriers to engagement along the HIV care continuum, and who evidence polysubstance use along with co-occurring risk factors. Clinical settings can develop outreach and engagement approaches to bring this subpopulation of PLWH into care settings, and further, specialized services are needed to successfully screen, treat, and retain them.

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Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco

Cited by 31 publications

References 73 publications

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing

African American/Black and Latino Adults with Detectable HIV Viral Load Evidence Substantial Risk for Polysubstance Substance Use and Co-occurring Problems: A Latent Class Analysis

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