HIV and Housing Assistance in Four U.S. Cities: Variations in Local Experience

Scott, Alison; Ellen, Jonathan M.; Clum, George A.; Leonard, Lori

doi:10.1007/s10461-007-9247-2

Cited by 16 publications

(16 citation statements)

References 15 publications

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“…We also suggest that several environmental aspects of homelessness, such as lacking a space to safely store medication, might have an effect, as could the need for homeless individuals to prioritize immediate survival over the secondary demands of medication adherence. 45,46 Our results do not contradict previous authors 45,47 who have observed that homeless individuals, given adequate adherence, can benefit from ART at levels similar to nonhomeless individuals.…”

Section: Discussionsupporting

confidence: 70%

Homelessness as a Structural Barrier to Effective Antiretroviral Therapy Among HIV-Seropositive Illicit Drug Users in a Canadian Setting

Milloy

Kerr

Bangsberg

et al. 2012

AIDS Patient Care and STDs

103

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Despite the advent of effective antiretroviral therapy (ART), HIV-seropositive injection drug users (IDU) continue to suffer from elevated levels of morbidity and mortality. Evidence is needed to identify social- and structural-level barriers to effective ART. We investigated the impact of homelessness on plasma HIV RNA response among illicit drug users initiating ART in a setting with free and universal access to HIV care. We accessed data from a long-running prospective cohort of community-recruited IDU linked to comprehensive HIV clinical monitoring and ART dispensation records. Using Cox proportional hazards with recurrent events modeling, we estimated the independent effect of homelessness on time to plasma HIV viral load suppression. Between May 1996 and September 2009, 247 antiretroviral naïve individuals initiated ART and contributed 1755 person-years of follow-up. Among these individuals, the incidence density of plasma HIV RNA suppression less than 500 copies/mm(3) was 56.7 (95% confidence interval [CI]: 46.9-66.0) per 100 person-years. In unadjusted analyses, homelessness was strongly associated with lower rates suppression (hazard ratio = 0.56, 95% CI: 0.40-0.78, p = 0.001), however, after adjustment for adherence this association was no longer significant (adjusted hazard ratio = 0.79, 95% CI: 0.56-1.11, p = 0.177). Homelessness poses a significant structural barrier to effective HIV treatment. However, since this relationship appears to be mediated by lower levels of ART adherence, interventions to improve adherence among members of this vulnerable population are needed.

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Section: Discussionsupporting

confidence: 70%

Homelessness as a Structural Barrier to Effective Antiretroviral Therapy Among HIV-Seropositive Illicit Drug Users in a Canadian Setting

Milloy

Kerr

Bangsberg

et al. 2012

AIDS Patient Care and STDs

103

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show abstract

“…Findings reported in this issue show that housing assistance enables low income persons to both preserve and establish stable housing (Dasinger and Speiglman 2007;Scott et al 2007). New HOPWA reporting tools show that homeless and unstably housed program recipients achieve high levels of stability at relatively low per-unit costs: 89% of households receiving average rental assistance of $3,750 were stably housed at one year, as were 79% of residents of supportive housing at an average annual cost of $9,000 (HUD 2006).…”

Section: A Data-driven Hiv/aids Housing Policy Agendamentioning

confidence: 99%

Moving from Fact to Policy: Housing is HIV Prevention and Health Care

Shubert¹,

Bernstine

2007

AIDS Behav

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A growing body of empirical evidence shows strong correlations between improved housing status and reduced HIV risk behaviors, improved access to health care for persons living with HIV/AIDS, and better health outcomes. These findings support the provision of housing assistance for low-income persons living with HIV/AIDS: as a basic human right; as a necessary component of systems to enable individuals to manage their HIV/AIDS care and treatment; and as an exciting new tool to end the AIDS crisis in America by reducing the number of new HIV infections. This paper provides a public policy framework for consideration of the research reported in this special issue of AIDS and Behavior, and offers suggestions for using research to move policy and practice towards a true public health response to the housing needs of persons at risk for or living with HIV/AIDS.

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“…Furthermore, housing is multidimensional and many individuals experience different forms of housing instability that increase their risk for multiple health threats (Scott et al 2007;Weir et al 2007). Many at-risk members of this population may not be reached through programs that only provide shelter or other forms of assistance to those who are currently living on the street.…”

mentioning

confidence: 99%

HIV, Homelessness, and Public Health: Critical Issues and a Call for Increased Action

2007

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Homelessness and housing instability are significant public health issues that increase the risks of HIV acquisition and transmission and adversely affect the health of people living with HIV. This article highlights the contributions of selected papers in this special issue of AIDS and Behavior and considers them within the broader context of prior research on the associations between housing status and HIV risk, use of HIV medical care, adherence to HIV treatment, and the physical health of HIV-seropositive persons. Special recognition is given to the roles of interrelated health problems, such as substance abuse, poor mental health, and physical and sexual abuse, that often co-occur and exacerbate the challenges faced by those who are homeless or unstably housed. Taken as a whole, the findings indicate a critical need for public health programs to develop strategies that address the fundamental causes of HIV risk among homeless and unstably housed persons and, for those living with HIV, contribute to their risk of disease progression. Such strategies should include "mid-stream" and "upstream" approaches that address the underlying causes of these risks. The successful implementation of these strategies will require leadership and the formation of new partnerships on the part of public health agencies. Such efforts, however, may have significant effects on the individuals and communities most affected by HIV/AIDS.

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HIV and Housing Assistance in Four U.S. Cities: Variations in Local Experience

Cited by 16 publications

References 15 publications

Homelessness as a Structural Barrier to Effective Antiretroviral Therapy Among HIV-Seropositive Illicit Drug Users in a Canadian Setting

Homelessness as a Structural Barrier to Effective Antiretroviral Therapy Among HIV-Seropositive Illicit Drug Users in a Canadian Setting

Moving from Fact to Policy: Housing is HIV Prevention and Health Care

HIV, Homelessness, and Public Health: Critical Issues and a Call for Increased Action

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