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

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
AIDS and Behavior (Impact Factor: 3.49). 12/2007; 11(6 Suppl):167-71. DOI: 10.1007/s10461-007-9277-9
Source: PubMed


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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Available from: Richard J Wolitski, Oct 13, 2015
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    • "Physiological and psychological differences between men and women can affect risky behaviours. Homeless women have a high potential for participating in risky sexual behaviour because of the lack of proper shelter (Wolitski et al. 2007) and high rate of substance use, mainly methamphetamine, which may lead to outbreaks of various transmitted venereal diseases, including HIV, in this group. It was difficult to undertake questionnaires with homeless populations, and there were reliability issues concerning the self-reporting of answers, particularly about sexual behaviours and drug usage, i.e. answers to question regarding having sex with the same gender and having sex out of wedlock may not be reliable enough, as these relationships are both illegal and have stigmas attached to them in Iran (Mirzazadeh et al. 2014). "
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    ABSTRACT: Aim: Gender differences among homeless people may affect the frequency of their risky behaviours. This study was conducted to evaluate the behaviour patterns of homeless men and women in Tehran and compare the probable differences. Subject and methods: In this study, 593 homeless people were recruited from five centres that house homeless people in Tehran, the capital city of Iran. A researcher-designed questionnaire was used to study behavioural patterns. Results: In this study, homeless people (513 males and 80 females, all Iranian nationals) were enrolled in the study from June to August 2012. Mean age and mean duration of homelessness among women (35.46 and 12.68 months) were lower than those among men (42.74 and 56.85 months) (p=0.001). Although lifetime history of incarceration in men was higher than in women (p=0.002), mean duration of imprisonment in the last 10 years in men (21.25 months) and women (17.76 months) was not statistically different (p=0.07). Accommodation locality in the past 6 months varied between men and women. Women were current drug users more often than men were (61.53 % versus 45.26 %) (p=0.02). The type of drug consumption in women (methamphetamine) differed from that of men (opium and heroin). More men had a history of injecting drugs than did women (30.02 % versus 12.30 %) (p=0.003). Condom use at the last sexual encounter was reported to be higher in women compared to men (74.60 % versus 26.62 %) (p=0.001). Conclusion: This study showed notable differences in behaviour patterns between homeless men and women and also indicated that homeless people in Tehran exhibit many risky behaviours.
    Journal of Public Health 07/2014; 22(5). DOI:10.1007/s10389-014-0633-8 · 2.04 Impact Factor
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    • "Homelessness has been consistently found to be a risk factor for HIV acquisition, lack of HIV medical care, and low adherence to HIV medications (Aidala, Cross, Stall, Harre, & Sumartojo, 2005; Aidala, Lee, Abramson, Messeri, & Siegler, 2007; Galea & Vlahov, 2002; Wolitski, Kidder, & Fenton, 2007). Homelessness is sometimes conceptualized as not living in a neighborhood, because homeless individuals may not have a fixed residential address; however, the neighborhood or neighborhoods where they frequent may have a greater impact on their health and well-being as compared to individuals who are housed in the same neighborhood. "
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    ABSTRACT: Neighborhood factors have been linked to HIV risk behaviors, HIV counseling and testing, and HIV medical care. However, the social-psychological mechanisms that connect neighborhood factors to HIV-related behaviors have not been fully determined. In this article we review the research on neighborhood factors and HIV-related behaviors, approaches to measuring neighborhoods, and mechanisms that may help to explain how the physical and social environment within neighborhoods may lead to HIV-related behaviors. We then discuss organizational, geographic, and social network approaches to intervening in neighborhoods to reduce HIV transmission and facilitate HIV medical care with the goal of reducing morbidity and mortality and increasing social and psychological well-being. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    American Psychologist 05/2013; 68(4):210-224. DOI:10.1037/a0032704 · 6.87 Impact Factor
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    • "Homeless women may trade sex for shelter, a situation that can make them extremely vulnerable on many levels. In general, poverty can lead women to trade sex for drugs, food, or other necessities; in such situations, concerns about HIV can be less urgent than immediate survival [35, 60–62]. A recent study analyzing the effects of multiple dimensions of social instability—including housing, employment, and incarceration—on the HIV risk practices of low-income women in Baltimore, USA found that increased social stability was associated with decreased HIV risk practices related to sexual practices and drug use. "
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    ABSTRACT: Women who inject drugs face multiple gender-specific health risks and barriers to healthcare access. These gendered factors may contribute to elevated rates of HIV for this population. Though few countries systematically collect gender-disaggregated data related to injecting drug use, evidence indicates that there are large populations of women who inject drugs and who are in need of improved health services, including HIV prevention. Research on the effectiveness of interventions specifically tailored for women who inject drugs, along with the experience of programs working with this subpopulation, suggests that HIV risk practices need to be addressed within the larger context of women's lives. Multifaceted interventions that address relationship dynamics, housing, employment, and the needs of children may have more success in reducing risky practices than interventions that focus exclusively on injecting practices and condom use. Improved sexual and reproductive healthcare for women who use drugs is an area in need of development and should be better integrated into basic harm reduction programs.
    10/2012; 2012:269123. DOI:10.1155/2012/269123
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