The Effect of Housing Status on Health-Related Outcomes in People Living with HIV: A Systematic Review of the Literature

Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.
AIDS and Behavior (Impact Factor: 3.49). 12/2007; 11(6 Suppl):85-100. DOI: 10.1007/s10461-007-9246-3
Source: PubMed


HIV infection is increasingly characterized as a chronic condition that can be managed through adherence to a healthy lifestyle, complex drug regimens, and regular treatment and monitoring. The location, quality, and/or affordability of a person's housing can be a significant determinant of his or her ability to meet these requirements. The objective of this systematic review is to inform program and policy development and future research by examining the available empirical evidence on the effects of housing status on health-related outcomes in people living with HIV/AIDS.
Electronic databases were searched from dates of inception through November 2005. A total of 29 studies met inclusion criteria for this review. Seventeen studies received a "good" or "fair" quality rating based on defined criteria.
A significant positive association between increased housing stability and better health-related outcomes was noted in all studies examining housing status with outcomes of medication adherence (n = 9), utilization of health and social services (n = 5), and studies examining health status (n = 2) and HIV risk behaviours (n = 1).
Healthcare, support workers and public health policy should recognize the important impact of affordable and sustainable housing on the health of persons living with HIV.

Download full-text


Available from: James R Dunn, Oct 01, 2015
104 Reads
  • Source
    • "Literature on young people living with HIV-positive adults seems to focus on HIV trajectory and epidemiology (Centers for Disease Control and Prevention [CDC], 2011; Coetzee, Kagee, & Vermeulen, 2011; on barriers to effective treatment (Scambler & Paoli, 2008)), on difficulties of obtaining housing (Leaver, Bargh, Dunn, & Hwang, 2007), on resources for treating HIV and AIDS patients, and on cross-cultural interventions (Bärnighausen, Bloom, & Humair, 2007; Sauka & Lie, 2000; Voisin & Bird, 2009). In Hamilton County, Tennessee, where over 1000 adults are HIV positive (CDC, 2011), the psychosocial challenges of young people living with these adults are not known. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The number of young people affected by HIV and AIDS in Tennessee has steadily grown over the last few years. As a response to this situation, several organizations are working hard to address the needs of families impacted by HIV and AIDS. However, a close examination of some of the services provided suggests that young people within these families are ignored. Most of the services are geared toward HIV and AIDS-infected adult members of these families. Young people within these household are not targeted, and little is known about psychosocial challenges they experience in living with HIV-positive parents or guardians. In an attempt to address this gap, this small-scale qualitative study investigated the psychosocial challenges of young people affected by HIV and AIDS as a result of living with HIV-positive parents or guardians. Perceived sense of depression, experiencing stigma, self-blame, and lack of communication and loneliness were challenges that young people faced regularly.
    AIDS Care 12/2014; 27(6):1-7. DOI:10.1080/09540121.2014.989807 · 1.60 Impact Factor
  • Source
    • "Investigators have explored unstable housing as a way to better understand a woman's risk of becoming infected with HIV as well as adherence to antiretroviral therapy (Riley, Gandhi, Bradley Hare, Cohen, & Hwang, 2007; Wenzel, Tucker, Elliott, & Hambarsoomians, 2007). Additionally, Leaver, Bargh, Dunn, and Hwang (2007) linked stable housing to important health outcomes in people living with HIV (Leaver et al., 2007). Adding to this body of research, our study found that housing stability significantly , positively affected, the social support domain of the HIV self-management scale and the chronic nature of HIV selfmanagement domain. "
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicted all domains of HIV self-management including daily health practices (F=5.40, adjusted R2=0.27, p<0.01), HIV social support (F=4.50, adjusted R2=0.22, p<0.01), and accepting the chronic nature of HIV (F=5.57, adjusted R2=0.27, p<0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women's social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population.
    Social Science [?] Medicine 06/2013; 87:147-54. DOI:10.1016/j.socscimed.2013.03.037 · 2.89 Impact Factor
  • Source
    • "Although individuals living in low-income neighbourhoods undoubtedly share some of the obstacles to care faced by women, other structurally mediated inequities are important determinants of health among these patients. Specifically, instability with respect to housing status and food security have both been documented to undermine adherence with antiretroviral therapy and to contribute to poor outcomes among people with HIV.41-44 Furthermore, despite the availability of various programs intended to mitigate the expense of cART for Ontario residents with HIV who lack alternative sources of drug coverage, individuals who do not qualify for provincially funded social assistance must assume a share of the cost of their treatment, in the form of a copayment, which may be prohibitive when evaluated against competing demands for food and housing. Finally, reduced rates of hospital admission among recent immigrants may be attributable to a “healthy immigrant” effect, whereby these patients adopt specific behaviours and practices that translate into better clinical outcomes relative to the reference population of people with HIV in Ontario.45 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Among people living with HIV infection in the era of combination antiretroviral therapy (cART), admission to hospital may indicate inadequate community-based care. As such, population-based assessments of the utilization of inpatient services represent a necessary component of evaluating the quality of HIV-related care. We used a validated algorithm to search Ontario's administrative health care databases for all persons living with HIV infection aged 18 years or older between 1992/93 and 2008/09. We then conducted a population-based study using time-series and longitudinal analyses to first quantify the immediate effect of cART on hospital admission rates and then analyze recent trends (for 2002/03 to 2008/09) in rates of total and HIV-related admissions. The introduction of cART in 1996/97 was associated with more pronounced reductions in the rate of hospital admissions among men than among women (for total admissions, -89.9 v. -60.5 per 1000 persons living with HIV infection, p = 0.003; for HIV-related admissions, -56.9 v. -36.3 per 1000 persons living with HIV infection, p < 0.001). Between 2002/03 and 2008/09, higher rates of total hospital admissions were associated with female sex (adjusted relative rate [RR] 1.15, 95% confidence interval [CI] 1.05-1.27) and low socio-economic status (adjusted RR 1.21, 95% CI 1.14-1.29). Higher rates of HIV-related hospital admission were associated with low socio-economic status (adjusted RR 1.30, 95% CI 1.17-1.45). Recent immigrants had lower rates of both total admissions (adjusted RR 0.70, 95% CI 0.61-0.80) and HIV-related admissions (adjusted RR 0.77, 95% CI 0.61-0.96). We observed important socio-economic- and sex-related disparities in rates of hospital admission among people with HIV living in Ontario, Canada.
    Open Medicine 11/2012; 6(4):e146-e154.
Show more