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

Abstract

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.

Prevalência e vulnerabilidade à infecção pelo HIV de moradores de rua em São Paulo, SP

“…In other words, living on the streets and insecurity related to having no housing 7,11,20,28 are per se factors that bring about situations of greater exposure to HIV such as violence and no access to services. 14,26,29 These same particularities may largely explain the study fi nding that young, female and homeless individuals engaging in homosexual sex are more vulnerable to HIV infection. We found that, among those engaging in homosexual sex, at least one out of 10 are living with HIV.…”

Transforming Social Structures And Environments To Help In HIV Prevention

“…28 A number of studies have shown that people who lack stable housing are more likely than those with stable housing to delay HIV treatment and less likely to receive optimal antiretroviral therapy. [29][30][31][32] One large study found that homeless HIV-infected participants had lower CD4 cell counts (cells that are part of the human immune system) than their stably housed counterparts and were less likely to report having an undetectable viral load; both of these are indicators of more advanced HIV disease. 31 Stable housing increases the ability of HIV-infected people receiving treatment to consistently adhere to their antiretroviral drug regimens, which in turn improves their health, minimizes their hospital visits-and the associated costsand decreases their mortality.…”

An investigation of the determinants of adherence to highly active anti-retroviral therapy in Aboriginal men in the Downtown Eastside of Vancouver.

“…Sleepiness can also be secondary to HIV itself or comorbid conditions. A distorted sleep pattern is also common in those who are homeless where it may lead them to patients sleeping through medication time (Laws et al, 2000;Wolitski et al, 2007).…”

“…Homelessness and inadequate housing make it more difficult for people to manage and live with HIV/AIDS. Homelessness contributes to non-adherence to HAART (Wolitski et al, 2007) and is associated with several risk factors for non-adherence. High levels of social isolation and low levels of social support are seen in homeless Aboriginal people (Reading, 2010).…”

“…), or unsafe (presence of drugs, gangs and other predators) (Spaxman, 2009). Also, research has shown that proven HIV risk reduction 115 interventions, as well as adherence improvement, are less effective among persons who are homeless/ unstably housed than among their housed counterparts -including counselling, needle exchange, and other behavioural interventions (Wolitski et al, 2007). The VNHS, however, through its programs continues to work hard to help patients get housing units by helping them make applications and set up appointments to BC housing and various other organizations (VNHS, 2010).…”