Service priorities and unmet service needs among people living with HIV/AIDS: Results from a nationwide interview of HIV/AIDS housing organizations

Abstract

Housing for people living with HIV/AIDS has been linked to a number of positive physical and mental health outcomes, in addition to decreased sexual and drug-related risk behavior. The current study identified service priorities for people living with HIV/AIDS, services provided by HIV/AIDS housing agencies, and unmet service needs for people living with HIV/AIDS through a nationwide telephone survey of HIV/AIDS housing agencies in the United States. Housing, alcohol/drug treatment, and mental health services were identified as the three highest priorities for people living with HIV/AIDS and assistance finding employment, dental care, vocational assistance, and mental health services were the top needs not being met. Differences by geographical region were also examined. Findings indicate that while housing affords people living with HIV/AIDS access to services, there are still areas (e.g., mental health services) where gaps in linkages to care exist.

Effect of HIV Housing Services on Engagement in Care and Treatment, New York City, 2011

“…‘Near perfect’ adherence to antiretroviral treatment (ART) is required to ensure success at the final stage of the continuum (viral suppression), which is key both to individual health and survival and to the prevention of onward HIV transmission at the population level [ 9 ]. Homeless or unstably housed PLWHA face particular barriers to achieving and maintaining optimal HIV care outcomes, in that (1) they tend to have lower CD4 cell counts and higher viral loads at diagnosis (key biomarkers of HIV disease progression and predictors of mortality) [ 10 ]; (2) they have higher rates of comorbid infections like hepatitis, tuberculosis, and Pneumocystis carinii pneumonia than those who are stably housed [ 11 ]; (3) they are less likely to adhere even with access to ART because immediate subsistence needs like food and shelter are not met [ 5 , 12 , 13 ]; and (4) providers may not prescribe ART as readily to unstably housed individuals, due to concerns that those patients will not be adherent [ 14 , 15 ]. Despite substantial federal and local investments in HIV-related housing services and in promoting HIV care and treatment engagement, few studies have examined the effects of housing-related services on outcomes along the HIV care continuum.…”

Identifying the appropriate comparison group for HIV-infected individuals

“…Differences in lifestyle factors include an increased prevalence of hepatitis C (HCV) infection in PLWH [50] and HCV is associated with a greater comorbidity burden [51, 52]. Finally, PLWH are more likely to experience socioeconomic factors such as social isolation [53], unstable housing [54], and food insecurity [55], which may be associated with age-related comorbidities. PLWH may also experience better screening for age-related comorbidities due to their frequent interaction with the healthcare system.…”

Capacity of AIDS service organisations in Connecticut to respond to intimate partner violence

“…While the AIDS care system recognises and addresses issues that relate directly to HIV risk, such as risky sexual behaviour and substance use, it does not routinely address IPV, despite its detrimental consequences for these women's health (Lennon et al . ). Failure of ASOs to address IPV represents a missed opportunity to support women in accessing crucial care and making empowered health decisions.…”

“…The majority of ASOs in the United States offer supportive services rather than fee-for-service or billable treatment, meaning that the majority of funding for ASOs comes through competitive government or private grants and contracts, and other fund-raising activities. While the AIDS care system recognises and addresses issues that relate directly to HIV risk, such as risky sexual behaviour and substance use, it does not routinely address IPV, despite its detrimental consequences for these women's health (Lennon et al 2013). Failure of ASOs to address IPV represents a missed opportunity to support women in accessing crucial care and making empowered health decisions.…”