Abstract
In the early 1990s, HIV seroprevalence was highest at the Miami homeless clinic among 16 homeless sites participating in a nationwide sentinel survey. To examine dynamic seroprevalence patterns in Miami's homeless clients in relation to demographics and risk behaviors over six years, we analyzed data from an unlinked (blinded) serosurvey of clients attending the principal primary care clinic serving Miami's homeless. Data were from 3,797 medical encounters with homeless persons who, on their initial clinic visit within an annual survey period, received routine serologic testing and a risk behavior survey. Overall HIV seroprevalence was 15.9% and infection rates for men (16.4%) and women (14.5%) did not differ. Seroprevalence for blacks (19.9%) was significantly higher than for Hispanics (9.1%) or whites (8.3%) (p < 0.0001). Seroprevalence was 12.6% (35 times the national rate) for clients reporting heterosexual contact as their only risk. Significant increases in seroprevalence, above this heterosexual-contact-only 'baseline', were found for clients disclosing high-risk behaviors: male-to-male sex, drug injection, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner (p < 0.0001). Seroprevalence declined over six years from 23.2 to 7.2% (p < 0.0001). Significant downward trends were observed for men and women, blacks and Hispanics, men who have sex with men, and clients reporting heterosexual contact. The proportion of clients reporting high-risk behaviors decreased sharply (p < 0.0001). Elevated HIV seroprevalence in Miami's homeless clients was strongly associated with high-risk behaviors. Expansion of HIV prevention and HIV/drug treatment services for homeless persons is strongly recommended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen, D. M., Lehman, J. S., Green, T. A., Lindegren, M. L., Onorato, I. M. & Forrester, W. (1994). HIV infection among homeless adults and runaway youth, United States, 1989– 1992, AIDS 8: 1593–1598.
APHA Caucus on Homelessness (1997). Supporting a national priority to eliminate homelessness (position paper), The Nation's HealthSeptember: 20–22.
Breakey, W. R, Fischer, P. J. (1990). Homelessness: The extent of the problem, Journal of Social Issues 46(4): 31–47.
Brickner, P. W., Scharer, L. K., Conanan, B. A., Savarese, M. & Scanlan, B. C., eds. (1990). Under the safety net: The health and social welfare of the homeless in the United States. New York: Norton and Company.
Burt, M. (1996). Practical methods for counting homeless people. Washington, DC: The Urban Institute.
Centers for Disease Control and Prevention (1997). HIV/AIDS Surveillance Report 8(2): 8–9.
Dean, A. G., Dean, J. A., Coulombier, D., et al. (1994). Epi-Info, Version 6: A word processing, database, and statistics program for epidemiology on micro computers. Atlanta, GA: Centers for Disease Control and Prevention.
Dondero, T. J., Pappianoanou, M. & Curran, J. W. (1988). Monitoring the levels and trends of HIV infection: The Public Health Service's HIV surveillance program, Public Health Report 103: 213–220.
Edlin, B. R, Irwin, K. L., Faruque S., McCoy, C. B, et al. (1994). Intersecting epidemics – crack cocaine use and HIV infection among inner-city young adults, New England Journal of Medicine 331: 1422–1427.
Fischer, P. J. & Breakey, W. R. (1991). The epidemiology of alcohol, drug abuse and mental disorders among homeless persons, American Psychology 46(11): 1115–1128.
Fournier, A. M, Tyler, R., Iwasko, N., LaLota, M., Shultz, J. M., & Greer, P. J. (1996). Human immunodeficiency virus among the homeless in Miami: A new direction for the HIV epidemic, American Journal of Medicine 100(5): 582–584.
Froner, G. (1988). AIDS and homelessness, Journal of Psychoactive Drugs 20: 197–202.
Inciardi, J. A., Lockwood, D., Pottieger, A. E. (1993). Women and crack cocaine. New York: Macmillan.
Interagency Council on Homelessness (1992). Outcomes on Main Street: Report of the Federal Task Force on Homelessness and Severe Mental Illness. Washington, DC.
Karon, J. M., Rosenberg, P. S., McQuillan, G., Khare,M., Gwinn, M. & Peterson, L. A. (1996). Prevalence of HIV infection in the United States, 1984 to 1992, JAMA 276(2): 126–131.
Layton, M. C., Cantwell, M. F., Dorsinville, G. J., Valway, S. E., Onorato, I. M. & Frieden, T. R. (1995). Tuberculosis screening among homeless persons with AIDS living in singleroom occupancy hotels, American Journal of Public Health 85(11): 1556–1559.
Link, B. G., Susser, E., Steuve, A., Phelan, J., Moore, R. E. & Struening, E. (1994). Lifetime and five-year prevalence of homeless in the United States, American Journal of Public Health 82(12): 1907–1912.
Metsch, L. R., McCoy, C. B., McCoy, H. V. C. B., Shultz, J. M., Lai, S., Weatherby, N. L., McAnany, H., Correa, N. & Anwyl, R. S. (1995). HIV-related risk behaviors and seropositivity among homeless drug-abusing women in Miami, Florida, Journal Psychoactive Drugs 27(4): 435–446.
Nettlemen, M. D. (1993). Use of BCG vaccine in shelters for the homeless, Chest 103(4): 1087–1090.
Pappianou, M., Dondero, T. J., Petersen, L. R., et al. (1990). The family of HIV seroprevalence surveys: objectives, methods, and uses of sentinel surveillance for HIV in the United States, Public Health Report 105: 113–119.
Pianteri, O., Vicic, W., Byrd, R., Brammer, S. & Michael, M. (1990). Hypertension screening and treatment in the homeless, pp. 250–260, in: P. W. Brickner, L. K. Scharer, B. A. Conanan, M. Savarese & B. C. Scanlan (eds.), Under the safety net: The health and social welfare of the homeless in the United States. New York: Norton and Company.
Saez, H., Valencia, E., Conover, S. & Susser, E. (1996). Tuberculosis and HIV among mentally ill men in a New York City shelter, American Journal of Public Health 86(9): 1318–1319.
St. Lawrence, J. & Brasfield, T. L. (1995). HIV risk behavior among homeless adults, AIDS Educational Preview 7(1): 22–31.
Scanlan, B. C. & Brickner, P. W. (1990). Clinical concerns in the care of homeless persons, pp. 69–81, in: P.W. Brickner, L. K. Scharer, B. A. Conanan, M. Savarese & B. C. Scanlan (eds.), Under the safety net: The health and social welfare of the homeless in the United States. New York: Norton and Company.
Scharer, L. K., Berson, A. & Brickner, P.W. (1990). Lack of housing and its impact on human health: a service perspective, Bulletin of the New York Academy of Medicine 66(5): 515–525.
Shultz, J. M., Damoulaki-Sfakianaki, E., Metellus, G., Gnesda, D. & McCoy, C. B. (1995). Acquired immunodeficiency syndrome in Miami/Dade County, Florida: The first 10,000 cases, Miami Medicine 66: 17–22.
Shultz, J. M., Elliott, L., McCoy, C. B., Simmons, J. R., Lieb, S., LaLota, M. & Hopkins, R. S. (1991). Acquired immunodeficiency syndrome – Dade County, Florida, 1981–1990, MMWR Morb Mortal Weekly Report40: 489–493.
Shultz, J. M., McCoy, C. B., Metsch, L. R., Chitwood, D. D., Weatherby, N. L., Correa, R. & Weiss, M. (1998). HIV risk behaviors among street homeless, offstreet homeless and nonhomeless male substance abusers in Miami/Dade County, Florida, International Journal of Addiction (in press).
Shultz, J. M., Perez-Stable, A., Greer, P. J., James, T. & Becerra, A. (in preparation). Project SafeStreet: HIV street-based outreach to homeless and impoverished persons in Miami, Florida.
Shultz, J.M., Weatherby, N. L., McCoy, C. B., et al. (1991). Characteristics and risk behaviors of homeless black men seeking services from the Community Homeless Assistance Plan – Dade County, Florida, August, 1991, MMWR Morb Mortal Weekly Report 40: 865–868.
Smereck, G. A. & Hockman, E. M. (1998). Prevalence of HIV infection and HIV risk behaviors associated with living place: On-the-street homeless drug users as a special target population for public health intervention, American Journal of Drug and Alcohol Abuse 24(2): 299.
Smith, P. C. & Page, J. B. (1996). Homeless adults and crack, pp. 104–114, in: D. Chitwood, J. Rivers & J. Inciardi (eds.), The American pipe dream: Crack cocaine and the inner city. Fort Worth, TX: Hartcourt Brace College Publishers.
Susser, E., Miller, M., Valencia, E., Colson, P., Roche, B. & Conover, S. (1996). Injection drug use and risk of HIV transmission among homeless men with mental illness, American Journal of Psychiatry 153(6): 794–798.
Weatherby, N. L., Shultz, J. M., Chitwood, D. D., McCoy, H. V., McCoy, C. B., Ludwig, D. D. & Edlin, B. R. (1992). Crack cocaine use and sexual activity in Miami, Florida, Journal of Psychoactive Drugs 24: 373–380.
Wenzel, S., Ebener, P., Koegel, P., Gelberg L. (1996). Drug-abusing homeless clients in California's substance abuse treatment system, Journal of Psychoactive Drugs 28(2): 147–159.
Wright, J. D. (1990). The health of homeless people: evidence from the National Health Care for the Homeless Program, pp. 15–31, in: P. W. Brickner, L. K. Scharer, B. A. Conanan, M. Savarese & B. C. Scanlan (eds.), Under the safety net: The health and social welfare of the homeless in the United States. New York: Norton and Company.
Wright, J. D. & Weber, E. (1987). Homelessness and health.Washington, DC: McGraw-Hill's Health Care Information Center.
Rights and permissions
About this article
Cite this article
Shultz, J.M., Greer, P.J., Lalota, M. et al. HIV seroprevalence and risk behaviors among clients attending a clinic for the homeless in Miami/Dade County, Florida, 1990–1996. Population Research and Policy Review 18, 357–372 (1999). https://doi.org/10.1023/A:1006232827339
Issue Date:
DOI: https://doi.org/10.1023/A:1006232827339