Housing Status and HIV Risk Behaviors: Implications for Prevention and Policy

Abstract

This paper examines housing as a contextual factor affecting drug and sexual risk behaviors among HIV positive people using pooled interview data from 2149 clients presenting for services at 16 medical and social service agencies participating in a multi-site evaluation study. The odds of recent drug use, needle use or sex exchange at the baseline interview was 2-4 times as high among the homeless and unstably housed compared to persons with stable housing. Follow-up data collected 6-9 months after baseline showed that change in housing status was associated with change in risk behaviors. Persons whose housing status improved between baseline and follow-up significantly reduced their risks of drug use, needle use, needle sharing and unprotected sex by half in comparison to individuals whose housing status did not change. In addition, for clients whose housing status worsened between baseline and follow-up, their odds of recently exchanging sex was over five times higher than for clients whose housing status did not change. The provision of housing is a promising structural intervention to reduce the spread of HIV.

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

“…For example, providing interim or supportive housing has been shown to strengthen engagement in HIV care, lead to fewer hospitalizations, and improve HIV treatment outcomes. [68][69][70][71][72][73] For non-HIV infected populations, federally funded food assistance programs (e.g., the Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children) have been shown to have a protective effect on pregnancy outcomes among women, 74,75 birthweight outcomes for infants, 76 and nutritional outcomes for young children. 77,78 Limited research has examined health-care utilization among program participants.…”

There's no place like (a) home: Ontological security among persons with serious mental illness in the United States

“…(Culhane 2001;Gladwell, 2006;Mangano, 2003). This group, afflicted by substance abuse and/or mental illness, is considered among the hardest-to-reach and engage into services (Aidala, Cross, Stall, Harre & Sumartojo, 2005;Rowe, Fisk, Frey & Davidson, 2002;Ware, Tugenburg & Dickey, 2004).…”

Injecting drug use and unstable housing: Scope for structural interventions in harm reduction

“…One study shows that at baseline clients who were homeless or housed in unstable accommodation were two to four times more likely to engage in recent drug use, needle and syringe sharing and/or exchange sex than those housed in stable housing 52 . However, after the six to nine month follow up period, the risk of drug use, needle and syringe sharing, and unprotected sex fell by half in those whose housing status improved, compared to those whose status remained the same.…”

“…This highlights a potential for health gain associated with structural interventions with a focus on the creation of stable housing or 'safer housing environments' for vulnerable populations 4,41,52,76 . There is increasing recognition in the UK that the provision of temporary accommodation hostels (hereafter referred to as 'hostels') for the homeless may offer a 'safe haven' from a hostile street environment 53,54 .…”