Article

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

Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
AIDS and Behavior (Impact Factor: 3.49). 12/2007; 11(6 Suppl):85-100. DOI: 10.1007/s10461-007-9246-3
Source: PubMed

ABSTRACT

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.

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    • "Unstable housing results in a chaotic life and an inability to adhere to a medical care plan. A systematic review of studies examining housing and HIV health status found a consistent positive association between housing instability and poor health-related outcomes (Leaver et al., 2007). "
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    • "Yet, systems-level approaches are needed to redress the fragmentation in systems of care in communities that present challenges to linking and maintaining PLWH in care (Mugavero et al., 2011; Philbin et al., 2014). For example, access to ancillary services like transportation is associated with greater care engagement (Andersen et al., 2007; Messeri, Abramson, Aidala, Lee, & Lee, 2002; Philbin et al., 2014), and access to stable housing is associated with reduced viral load (Hawk & Davis, 2012; Leaver, Bargh, Dunn, & Hwang, 2007). In addition, the healthcare system structure and the ease with which individuals can access and navigate services facilitate care access (Kempf et al., 2010; Mugavero et al., 2011; Philbin et al., 2014; Sprague & Simon, 2014). "
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    • "The consequences of homelessness and housing instability for people living with HIV/AIDS (PLWHA), as well as the HIV risks associated with being homeless, are well-documented and indicate increased risk behaviors (Culhane, Gollub, Kuhn, & Shpaner, 2001), poorer health outcomes, and reduced adherence to antiretrovirals and medical care. For example, PLWHA who lack stable housing are more likely to delay entry into HIV care, have poorer access to primary care, are less likely to receive antiretroviral therapy, and are less likely to adhere to the complex treatment regiments required of antiretroviral therapy, which is key in fending off drug resistance and opportunistic infections and is instrumental in curbing transmission of HIV (Aidala, Lee, Abramson, Messeri, & Siegler, 2007; Friedman et al., 2009; Kidder, Wolitski, Campsmith , & Nakamura, 2007; Leaver, Bargh, Dunn, & Hwang, 2007). Even homeless PLWHA receiving HIV treatment are more likely to have stopped taking these medications compared with their housed counterparts (Kidder et al., 2007), demonstrating a clear need to improve access to antiretroviral medications and provide further assistance with medication adherence. "

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