Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review

Aidala, Angela A.; Wilson, Michael G.; Shubert, Virginia; Gogolishvili, David; Globerman, Jason; Rueda, Sergio; Bozack, Anne K.; Cabán, María; Rourke, Sean B.

doi:10.2105/ajph.2015.302905

Cited by 320 publications

(217 citation statements)

References 174 publications

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“…Among 152 studies compiled by Aidala et al, 144 showed that housing status was associated with poorer medical care or health outcomes, and 5 studies found that homelessness was associated with an increased risk of premature mortality for PLWHIV [40]. Lieb reported an almost 10-fold increase in the mortality risk (HR = 9.98; 95% CI: 2.34, 42.5) for patients who reported homelessness in the 12 past months, compared to the others [41].…”

Section: Discussionmentioning

confidence: 99%

High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV

et al. 2017

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ContextFrench Guiana is a South American French territory, where HIV prevalence consistently exceeds 1% in the adult population. In the only correctional facility, HIV prevalence fluctuates at around 4%.AimsAfter describing the population of HIV-positive inmates, we aimed to evaluate mortality after release from the correctional facility, and to identify its predictive factors.RationaleOutside North American settings, data on treatment outcome and vital status of HIV-positive former inmates are scarce. There were no data in French Guiana. Filling this gap represents a basis for potential improvements.MethodsAll HIV-infected adults released from an incarceration of 30 days or more, between 2007 and 2013, were enrolled in a retrospective cohort study. Mortality was described over time, one to seven years following release, using Kaplan-Meier estimates. Factors associated with mortality were identified through a non-parametric survival regression model.Results147 former inmates were included. The male to female ratio was 4.4. The median age was 37.3 years. The majority were migrants, 25.8% were homeless, 70.1% suffered from substance abuse, with 34.0% of crack-cocaine users. On admission, 78.1% had an early HIV-stage infection (CDC-stage A), with a median CD4 count of 397.5/mm3, 34.0% had one comorbidity, mainly hypertension. Upon release, 50.3% were on ART. Reasons for not being treated were not fulfilling the criteria for 74.6%, and refusing for 15.1%. Before release, 84.5% of the patients on ART had a viral load≤200cp/ml. After release, 8.2% of the cohort had died, with a crude incidence of 33.8/1000 person-years. All recorded deaths were males, with an incidence of 42.2/1000 person-years. Comparing with the age-specific mortality rates for males in French Guiana, the standardized mortality ratio was 14.8. In multivariate analysis, factors associated with death were age and CD4 count before release.ConclusionDespite access to ART while incarcerated, with good virological outcome, the post-release mortality was very high for males, almost 15 times what is observed in the general male population living in French Guiana, after age standardization. Access to ART in correctional facilities may be a necessary, but not sufficient condition to protect male inmates from death after release.

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Section: Discussionmentioning

confidence: 99%

High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV

et al. 2017

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“…Lack of stable, secure and adequate housing has been found to be a significant barrier to HIV medical care, access and adherence to ART, sustained viral suppression, as well as transmission risk among people living with HIV. 140 Housing is an important structural barrier to optimal HIV outcomes, for MSM and others living with HIV.…”

Section: Mental Health and Hiv Prevention Engagement And Carementioning

confidence: 99%

Mental health in 2020 for men who have sex with men in the United States

et al. 2017

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Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.

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“…Data are not widely available for PrEP uptake by PWUD, but one study of 304 PWID in Washington, DC, reported that none of the participants had taken PrEP (Kuo et al, 2016). PWUD meeting clinical guidelines for PrEP may have significant problems with adherence because of factors that define substantial risk, including high levels of substance use, homelessness, depression, and other circumstances and traits that may interfere with daily pill-taking (Aidala et al, 2015). A report from an international PWUD organization described several concerns about PrEP for PWUD, including the feasibility of PrEP; the ethics of PrEP, given suboptimal coverage of the community with ART; and advocacy for PrEP potentially undermining advocacy for harm reduction (Guise, Albers, & Strathdee, 2016; International Network of People who Use Drugs, 2015).…”

Section: Evidence-based Interventions For Pwudmentioning

confidence: 99%

Continuing Links Between Substance Use and HIV Highlight the Importance of Nursing Roles

Deren¹,

Naegle

Hagan³

et al. 2017

Journal of the Association of Nurses in AIDS Care

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Links between HIV and substance use were identified early in the U.S. HIV epidemic. People who use drugs are at risk of HIV infection through shared injection equipment and risky sexual behaviors. In addition, substance use has negative health consequences for people living with HIV. The prescription opioid misuse epidemic, linked to injection drug use, hepatitis C infection, and HIV, poses a new threat to declining HIV rates. We reviewed evidence-based interventions that decrease HIV risk in people who use drugs (needle/syringe programs, medication-assisted treatment, engagement in HIV care, and PrEP/PEP). The critical roles of nurses in HIV prevention/care for this population are described, including applying the principles of harm reduction, screening for substance use, and undertaking implementation and research efforts. As the nation’s largest health care profession, nurses are positioned to contribute to the quality of HIV-related prevention/care for people who use drugs and to lead practice initiatives.

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Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review

Cited by 320 publications

References 174 publications

High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV

High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV

Mental health in 2020 for men who have sex with men in the United States

Continuing Links Between Substance Use and HIV Highlight the Importance of Nursing Roles

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