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

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.

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Available from: Richard J Wolitski, Jul 31, 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; DOI:10.1007/s10389-014-0633-8 · 2.30 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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    • "While the majority of studies have focused primarily on the individual, social and drug-related factors that predict engagement in sexual risk behaviour, less is known about the environmental influences that may impact the risk factors for HIV and STI transmission among youth. However, a growing body of literature has documented the association between homelessness and HIV transmission among adults and the link between housing status and health outcomes of people living with HIV (Wolitski et al., 2007). For example, unstable housing has been associated with elevated HIV incidence among injection drug users (Corneil et al., 2006), while a dose-response relationship between number of residences lived in and the likelihood of unprotected intercourse has been observed among incarcerated women at high risk for HIV (Weir et al., 2007). "
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    ABSTRACT: The role that environmental factors play in driving HIV and STI transmission risk among street-involved youth has not been well examined. We examined factors associated with number of sex partners using quasi-Poisson regression and consistent condom use using logistic regression among participants enroled in the At Risk Youth Study (ARYS). Among 529 participants, 253 (47.8%) reported multiple partners while only 127 (24.0%) reported consistent condom use in the past 6 months. Homelessness was inversely associated with consistent condom use (adjusted odds ratio [aOR]=0.47, p=0.008), while unstable housing was positively associated with greater numbers of sex partners (adjusted incidence rate ratio [aIRR]=1.44, p=0.010). These findings indicate the need for interventions which modify environmental factors that drive risk among young street-involved populations.
    Health & Place 02/2009; 15(3):753-60. DOI:10.1016/j.healthplace.2008.12.005 · 2.44 Impact Factor
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