Randomized Trial of the Effects of Housing Assistance on the Health and Risk Behaviors of Homeless and Unstably Housed People Living with HIV

Abstract

Homelessness affects HIV risk and health, but little is known about the longitudinal effects of rental assistance on the housing status and health of homeless and unstably housed people living with HIV/AIDS. Homeless/unstably housed people living with HIV/AIDS (N = 630) were randomly assigned to immediate Housing Opportunities for People with AIDS (HOPWA) rental assistance or customary care. Self-reported data, CD4, and HIV viral load were collected at baseline, 6, 12, and 18 months. Results showed that housing status improved in both groups, with greater improvement occurring in the treatment group. At 18 months, 51% of the comparison group had their own housing, limiting statistical power. Intent-to-treat analyses demonstrated significant reductions in medical care utilization and improvements in self-reported physical and mental health; significant differential change benefiting the treatment group was observed for depression and perceived stress. Significant differences between homeless and stably housed participants were found in as-treated analyses for health care utilization, mental health, and physical health. HOPWA rental assistance improves housing status and, in some cases, health outcomes of homeless and unstably housed people living with HIV/AIDS.

Health Status, Quality of Life, Residential Stability, Substance Use, and Health Care Utilization among Adults Applying to a Supportive Housing Program

“…Similarly, in a recent study comparing homeless and unstably housed persons living with HIV/AIDS who were randomized to either rental assistance or customary care, the limited ability to detect meaningful between-group changes over time using intent-to-treat analyses was attributed to the attainment of stable housing among participants. 33 For their study, Wolitski et al (2010) observed that 51% of participants in the comparison condition obtained stable housing during the 18-month follow-up period. 33 Finally, we used self-report to assess hospitalizations, emergency room visits, psychiatric visits, and non-psychiatric medical professional visits.…”

“…33 For their study, Wolitski et al (2010) observed that 51% of participants in the comparison condition obtained stable housing during the 18-month follow-up period. 33 Finally, we used self-report to assess hospitalizations, emergency room visits, psychiatric visits, and non-psychiatric medical professional visits. In contrast, other studies have used administrative databases to obtain health care utilization data for their participants.…”

Neighborhood Disadvantage and Changes in Condom Use among African American Adolescents

“…10,11 Increasingly, researchers have begun to assess how these structural factors are associated with HIV/AIDS risk behaviors in order to create multilevel HIV/STI prevention programs that go beyond traditional, individual-level behavior change efforts. [12][13][14][15][16] Given our interest in understanding how neighborhood disadvantage may influence youth HIV/AIDS risk, we focused on youth condom use across adolescence as it is the only reproductive health technology that serves as a barrier method against HIV/STI infection during youth's exploration of their sexuality. Specifically, we examined how neighborhood disadvantage was associated with condom use in a sample of African American youth followed over the high school years.…”

Housing First and Unprotected Sex: A Structural Intervention

“…Several years later, Wolitski et al (2010) published a report of a multi-site randomized controlled trial involving homeless or precariously housed HIV positive adults. The effects of rental housing assistance and case management as the intervention were compared to participants receiving usual housing services and case management referral from agencies involved with the study.…”