AIDS and Behavior

, Volume 11, Supplement 2, pp 101–115 | Cite as

Housing Need, Housing Assistance, and Connection to HIV Medical Care

  • Angela A. Aidala
  • Gunjeong Lee
  • David M. Abramson
  • Peter Messeri
  • Anne Siegler
Original Paper


HIV infection has become a chronic condition that for most persons can be effectively managed with regular monitoring and appropriate medical care. However, many HIV positive persons remain unconnected to medical care or have less optimal patterns of health care utilization than recommended by good clinical practice standards. This paper investigates housing status as a contextual factor affecting access and maintenance in appropriate HIV medical care. Data provided from 5,881 interviews conducted from 1994 to 2006 with a representative sample of 1,661 persons living with HIV/AIDS in New York City demonstrated a strong and consistent relationship between housing need and remaining outside of or marginal to HIV medical care. In contrast, housing assistance increased access and retention in medical care and appropriate treatment. The relationship between housing and medical care outcomes remain controlling for client demographics, health status, insurance coverage, co-occurring mental illness, and problem drug use and the receipt of supportive services to address co-occurring conditions. Findings provide strong evidence that housing needs are a significant barrier to consistent, appropriate HIV medical care, and that receipt of housing assistance has an independent, direct impact on improved medical care outcomes.


Housing Homelessness HIV/AIDS Medical care Socioeconomic factors 


  1. Abramson, D., Messeri, P., Sanger, N., & Aidala, A. (2003). The CHAIN retrospective: 1994—2002. Community health advisory and information network report. Columbia University: Mailman School of Public Health. Retrieved from Scholar
  2. Aday, L. (2001). At risk in America: The health and health needs of vulnerable populations in the United States. San Francisco, CA: Jossey-Bass Publishers.Google Scholar
  3. Aidala, A., Abramson, D., & Lekas, M. (1999). The unconnected revisited: Persons living with HIV who are outside the medical and social services system. Community Health and Advisory Information Network Briefing Paper #1. Columbia University: Mailman School of Public Health.Google Scholar
  4. Aidala, A., Messeri, P., Abramson, D., & Healton, C. (1995). The “Unconnected”—Service needs of HIV positive persons who are outside or marginal to the service delivery system. Community Health Advisory and Information Network Technical Report #9. Columbia University: Mailman School of Public Health.Google Scholar
  5. Aidala, A., Needham-Waddell, E., & Sotheran, J. (2005). Delayers, Drop-outs, the unconnected, and “Unmet Need.” Community Health Advisory and Information Network Report 2005–03. Columbia University: Mailman School of Public Health.Google Scholar
  6. Arno, P. S., Bonuck, K. A., Green, J., Bennett, C. L., Fahs, M. C., Maffeo, C., et al. (1996). The impact of housing status on health care utilization among persons with HIV disease. Journal of Health Care Poor Underserved, 7(1), 36–49.Google Scholar
  7. Berk, M. L., Maffeo, C., & Schur, C. L. (1993). Research Design and Analysis Objectives. AIDS Cost and Services Utilization Survey (ACSUS) Reports, No. 1. AHCPR Publication No. 93-0019. Rockville, MD: Agency for Health Care Policy and Research.Google Scholar
  8. Bhandari, A., & Wagner T. (2006). Self-reported utilization of health care services: Improving measurement and accuracy. Medical Care Research and Review, 63(2), 217–235.PubMedCrossRefGoogle Scholar
  9. Conover, C. J., & Whetten-Goldstein, K. (2002). The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage. AIDS Care, 14(Suppl. 1), S59–S71.PubMedCrossRefGoogle Scholar
  10. Conviser, R., & Pounds, M. B. (2002). Background for the studies on ancillary services and primary care use. AIDS Care, 14(Suppl. 1), S7–S14.PubMedCrossRefGoogle Scholar
  11. Cunningham, W. E., Sohler, N. L., Tobias, C., Drainoni, M., Bradford, J., Davis, C., et al. (2006). Health service utilization for people with HIV infection: Comparison of a population targeted for outreach with the US population in care. Medical Care, 44(11), 1038–1047.PubMedCrossRefGoogle Scholar
  12. Cunningham, C. O., Sohler, N. L., Wong, M. D., Relf, M., Cunningham, W. E., Drainoni, M., et al. (2007). Utilization of health care services in hard-to-reach marginalized HIV-infected individuals. AIDS Patient Care and STDs, 21(3), 177–186.PubMedCrossRefGoogle Scholar
  13. D’Amore, J., Hung, O., Chiang, W., & Goldfrank, L. (2001). The epidemiology of the homeless population and its impact on an urban emergency department. Academic Emergency Medicine, 8(11), 1051–1055.PubMedCrossRefGoogle Scholar
  14. Douaihy, A. B., Stowell, K. R., Bui, T., Daley, D., & Salloum, I. (2005). HIV/AIDS and homelessness, Part 1: Background and barriers to care. The AIDS Reader, 15(10), 516–520, 527.Google Scholar
  15. Douglass, R., Torres, R., Surfus, P., Krinke, B., & Dale, L. (1999). Health care needs and service utilization among sheltered and unsheltered Michigan homeless. Journal of Health Care for the Poor and Underserved, 10(1), 5–18.PubMedGoogle Scholar
  16. Ewing, J. A. (1984). Detecting Alcoholism: The CAGE questionnaire. The Journal of American Medical Association, 252, 1905–1907.CrossRefGoogle Scholar
  17. Frankel, M. R., Shapiro, M. F., Duan, N., Morton, S. C., Berry, S. H., Brown, J. A., et al. (1999). National probability samples in studies of low prevalence diseases, part II: Designing and implementing the HIV Cost and Services Utilization Study. Health Services Research, 34(5), 969–992.PubMedGoogle Scholar
  18. Gelberg, L., & Siecke, N. (1997). Accuracy of homeless adults’ self-reports. Medical Care, 35(3), 287–290.PubMedCrossRefGoogle Scholar
  19. Gelberg, L., Gallacher, T., Andersen, R., & Koegel, P. (1997). Competing priorities as a barrier to medical care among homeless adults in Los Angeles. American Journal of Public Health, 87(2), 217–220.PubMedCrossRefGoogle Scholar
  20. Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.PubMedGoogle Scholar
  21. Goldman, D., & Bao, Y. (2004). Effective HIV treatment and the employment of HIV+ adults. Health Services Research, 39(6), 1691–1712.PubMedCrossRefGoogle Scholar
  22. Health Resources and Services Administration (HRSA) (2006). Ryan White HIV/AIDS treatment modernization act. HRSA: HIV/AIDS Bureau. Accessed 30 March 2007.Google Scholar
  23. Hudson Planning Group (2005). An assessment of the housing needs of persons with HIV/AIDS: New York City Eligible Metropolitan Statistical Area. Final Report, January 2005. New York City Department of Health and Mental Hygiene.Google Scholar
  24. Ikard, K., Janney, J., Hsu, L. C., Isenberg, D. J., Scalco, M. B., & Schwarcz, S., et al. (2005). Estimation of unmet need for HIV primary medical care: A framework and three case studies. AIDS Education and Prevention, 17(6 Suppl. B), 26–38.PubMedCrossRefGoogle Scholar
  25. Kim, T. W., Kertesz, S. G., Horton, N. J., Tibbetts, N., & Samet, J. H. (2006). Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Services Research, 6(19), 1–10.Google Scholar
  26. Kuhn, R., & Culhane, D. P. (1998). Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: Results from the analysis of administrative data. American Journal of Community Psychology, 26(2), 207–232.PubMedCrossRefGoogle Scholar
  27. Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors associated with the health care utilization of homeless persons. Journal of the American Medical Association, 285, 200–206.PubMedCrossRefGoogle Scholar
  28. Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine, 21(1), 71–77.PubMedCrossRefGoogle Scholar
  29. Lee, G. & Abramson, D. A. (2005). Baseline summary of NYC II Cohort. Community health advisory and information network report 2004–03. Columbia University: Mailman School of Public Health. Retrieved from Scholar
  30. Lim, Y. W., Andersen, R., Leake, B., Cunningham, W., & Gelberg, L. (2002). How accessible is medical care for homeless women? Medical Care, 40(6), 510–520.PubMedCrossRefGoogle Scholar
  31. Mariller, M., Abramson, D., & Sobieszczyk, M. (2004). The validity of self-reported clinical markers and medication regimens: A pilot study. Community Health Advisory and Information Network Report 2004–06. Columbia University: Mailman School of Public Health.Google Scholar
  32. Masson, C. L., Sorensen, J. L., Phibbs, C. S., & Okin, R. L. (2004). Predictors of medical service utilization among individuals with co-occurring HIV infection and substance abuse disorders. AIDS Care, 16(6), 744–755.PubMedCrossRefGoogle Scholar
  33. McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical & mental health constructs. Medical Care, 31, 247–263.PubMedCrossRefGoogle Scholar
  34. Messeri, P., Aidala, A., Abramson, D., Healton, C., Jones-Jessop, D., & Jetter, D. (1995). Recruiting rare & hard to reach populations: A sampling strategy for surveying NYC residents living with HIV/AIDS using agency recruiters. American Statistical Association, Proceedings of the Section on Survey Research Methods,, Vol. II, pp. 1064–1068.Google Scholar
  35. Messeri, P., Abramson, D., Aidala, A., Lee, F., & Lee, G. (2002). The impact of ancillary HIV services on engagement in medical care in New York City. AIDS Care, 14(Suppl. 1), S15–S30.PubMedCrossRefGoogle Scholar
  36. Messeri, P., Lee, G., Abramson, D., Aidala, A., Chiasson, M., & Jessop, D. (2003). Antiretroviral therapy and declining AIDS Mortality in New York City. Medical Care, 41(4), 512–521.PubMedCrossRefGoogle Scholar
  37. Messeri, P., & Hart, B. (2007). Employment and economic well-being. Community Health Advisory and Information Network Report 2006–06. Columbia University: Mailman School of Public Health.Google Scholar
  38. Meyerson, B. E., Klinkenberg, W. D., Perkins, D. R., & Laffoon, B. T. (2007). Who’s in andwho’s out: Use of primary medical care among people living with HIV. American Journal of Public Health, 97(4), 744–749.PubMedCrossRefGoogle Scholar
  39. Mkanta, W. M., & Ubhold, C. R. (2006). Theoretical and methodological issues in conducting research related to health care utilization among individuals with HIV infection. AIDS Patient Care and STDs, 20(4), 293–303.PubMedCrossRefGoogle Scholar
  40. New York State AIDS Institute (1995). Protocols for the Primary Care of HIV/AIDS in Adults and Adolescents. Albany, NY: New York State Department of Health.Google Scholar
  41. New York State AIDS Institute (2003). Criteria for the medical care of adults with HIV infection. Albany, NY: New York State Department of Health.Google Scholar
  42. New York State AIDS Institute (2007). The primary care approach to the HIV-infected patient. Albany, NY: New York State Department of Health.Google Scholar
  43. Pelletiere, D., Wardrip, K., & Crowley, P. (2006). Out of Reach 2006. Washington, DC: National Low Income Housing Coalition.Google Scholar
  44. Phelan, J. C., & Link, B. G. (1999). Who are the homeless? Reconsidering the stability and composition of the homeless population. American Journal of Public Health, 89(9), 1334–1338.PubMedGoogle Scholar
  45. Pulvirenti, J. J., Glowacki, R., Muppiddi, U., Surapaneni, N., Gail, C., Kohl, B., et al. (2003). Hospitalized HIV-infected patients in the HAART era: A view from the inner city. AIDS Patient Care and STDs, 17(11), 565–573.PubMedCrossRefGoogle Scholar
  46. Rabkin, J. G., McElhiney, M., Ferrando, S. J., Van Gorp, W., & Lin, S. H. (2004). Predictors of Employment of Men With HIV/AIDS: A longitudinal study. Psychosomatic Medicine, 66, 72–78.PubMedCrossRefGoogle Scholar
  47. Robertson, M., & Cousineau, M. (1986). Health status and access to health services among the urban homeless. American Journal of Public Health, 76, 561–563.PubMedGoogle Scholar
  48. Shinn, M. (1997). Family homelessness: State or trait? American Journal of Community Psychology, 25(6), 753–769.CrossRefGoogle Scholar
  49. Smith, M. Y, Rapkin, B. D, Winkel, G., Springer, C., Chhabra, R., & Feldman, I. (2000). Housing status and health care service utilization among low-income persons with HIV/AIDS. Journal of General Internal Medicine, 15, 731–738.PubMedCrossRefGoogle Scholar
  50. Song, J. (1999). HIV/AIDS and homelessness: Recommendations for clinical practice and public policy. Nashville, TN: Healthcare for the Homeless Clinician Network, National Health Care for the Homeless Council Inc.Google Scholar
  51. Stewart, K. E., Cianfrini, L. R., & Walker, J. F. (2005). Stress, social support and housing are related to health status among HIV-positive persons in the deep south of the United States. AIDS Care, 17(3), 350–358.PubMedCrossRefGoogle Scholar
  52. US Department of Housing and Urban Development (HUD) (2006). Housing Opportunities for Persons with AIDS Factsheet. HUD Office of HIV/AIDS Housing, November 2006. Retrieved from Scholar
  53. Uphold, C. R., & Mkanta, W. N. (2005). Use of health services among persons living with HIV infection: State of the science and future directions. AIDS Patient Care and STDs, 19(8), 473–485.PubMedCrossRefGoogle Scholar
  54. Weissman, J. S., Levin, K., Chasan-Taber, S., Massagli, M. P., Seage, G. R. IIIrd, & Scampini, L. (1996). The validity of self-reported health-care utilization by AIDS patients. AIDS, 10, 775–783.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Angela A. Aidala
    • 1
  • Gunjeong Lee
    • 1
  • David M. Abramson
    • 2
  • Peter Messeri
    • 1
  • Anne Siegler
    • 3
  1. 1.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.National Center for Disaster Preparedness, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Heilbrunn Department for Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkUSA

Personalised recommendations