Journal of General Internal Medicine

, Volume 15, Issue 10, pp 731–738

Housing status and health care service utilization among low-income persons with HIV/AIDS


    • Derald H. Ruttenberg Cancer CenterMount Sinai School of Medicine
  • Bruce D. Rapkin
    • Department of PsychiatryMemorial Sloan-Kettering Cancer Center
  • Gary Winkel
    • Derald H. Ruttenberg Cancer CenterMount Sinai School of Medicine
  • Carolyn Springer
    • Department of PsychiatryMemorial Sloan-Kettering Cancer Center
  • Rosy Chhabra
    • Department of PsychiatryMemorial Sloan-Kettering Cancer Center
  • Ira S. Feldman
    • AIDS InstituteNew York State Department of Health
Populations At Risk

DOI: 10.1046/j.1525-1497.2000.91003.x

Cite this article as:
Smith, M.Y., Rapkin, B.D., Winkel, G. et al. J GEN INTERN MED (2000) 15: 731. doi:10.1046/j.1525-1497.2000.91003.x


OBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults.

DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997.

MAIN RESULTS: Six percent of study participants were homeless, 24.5% were “doubled-up,” and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physician regularly (P=.0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P=.02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit (P=.007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After multivariate adjustment, doubled-up participants were found to make more emergency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeless were shown to use slightly more outpatient care than the stably housed.

CONCLUSION: Our study documents differences in health care utilization patterns across stably housed, doubled-up, and homeless HIV-infected persons after controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and hence may be more likely to experience adverse clinical outcomes.

Key Words

housinghomelessnessdoubled-uphuman immunodeficiency virus (HIV)health care services utilization

Copyright information

© Society of General Internal Medicine 2000