Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems

Abstract

Background: Because individuals with HIV/AIDS often have complex medical and social needs, the impact of housing status on medical service utilization is difficult to isolate from the impact of conditions that may worsen during periods of homelessness such as depression and substance abuse. We examine whether episodes of homelessness are independently associated with suboptimal medical utilization even when accounting for concurrent addiction severity and depression.

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

“…Previous studies consistently demonstrated a linear relationship between the degree of housing instability and increased acute care use. 61,62 Our study further supports this literature by showing that individuals who lived on the street or in a homeless shelter had higher odds of recent ED visits. The high prevalence of ED visits among homeless and marginally housed HIV-infected persons seen in this study is also consistent with previous research.…”

“…31 In related literature, housing instability shows no consistent relationship with increased or reduced ambulatory visits. 61,[65][66][67] These inconsistent findings may be explained by the fact that outpatient clinic visits are the product of the need for care (which is likely increased by food insecurity) and ability to obtain care when needed (which is likely decreased by food insecurity). While available data preclude a definitive conclusion, the predominant mechanism by which mild/moderate food insecurity impacted outpatient care in the current study may have been via worsening morbidity rather than a compromised ability to access to health care.…”

Utilization of Medical Treatments and Adherence to Antiretroviral Therapy among HIV-Positive Adults with Histories of Childhood Sexual Abuse

“…59 Other studies have also observed suboptimal treatment utilization in minority groups. 2,36,60,61 These findings reinforce the importance of eliminating health disparities by increasing services to provide early and equal access to health care for low-income persons living with HIV=AIDS. 62 The results of this study must be interpreted in light of the following limitations.…”

HIV-Related Neurocognitive Disorders and Drugs of Abuse: Mired in Confound, Surrounded by Risk

“…Patients with both conditions often show greater deficits in visual-spatial perception, verbal reasoning, episodic memory, motor, and reaction times than individuals with either HIV infection or alcoholism alone, and this has suggested a synergistic effect [62,[64][65][66]. Alcohol-use disorders are common in those living with HIV and in injection drug users (IDUs) and, as is well documented, heavy alcohol use has many adverse effects on people living with HIV, including increased risk of HIV transmission to others by increased risk behaviors, poor retention in care, poor adherence to treatment, impaired ability to suppress HIV, and acceleration of hepatic fibrosis, especially if there is co-infection with HCV and in the setting of prescribed ART [67][68][69][70].…”