AIDS and Behavior

, Volume 13, Issue 6, pp 1119–1128 | Cite as

Intentional Abstinence Among Homeless and Unstably Housed Persons Living with HIV/AIDS

  • Cari Courtenay-QuirkEmail author
  • Jun Zhang
  • Richard J. Wolitski
Original Paper


Some persons living with HIV/AIDS (PLWHA) engage in periods of sexual abstinence. Baseline data from a larger study of homeless/unstably housed PLWHA indicated that 20% (125/644) intentionally abstained from sex in the past 90 days. Reasons included: (1) ‘not interested’ (n = 78); (2) did not want to infect someone (n = 46); and (3) did not have a partner (n = 37). Abstinence was less likely among all who had a main partner. Among men who have sex with men (MSM), abstinence was less likely among those with a detectable viral load. It was more likely among heterosexual men who were experiencing current housing problems and who had at least a high school education. Among women, abstinence was less likely among African Americans and those whose social networks were more aware of their HIV status. Better understanding of motivations to abstain may improve how programs serving PLWHA address this issue.


HIV infection Sexual behavior Abstinence Homelessness 



Funding for the research study was provided by the Centers for Disease Control and Prevention to RTI International under contract 200-2001-0123, Task 9; and funding for tenant-based permanent supportive rental housing assistance was provided by the Department of Housing and Urban Development. We thank the HUD grantee agencies in the participating cities and the following persons for their many contributions to the research: Angela Aidala (Columbia University), Paul Dornan (HUD), David Harre, David R. Holtgrave (Johns Hopkins University), Fred Licari (RTI), Scott Royal (RTI), William Rudy (HUD), Ron Stall (University of Pittsburgh), Esther Sumartojo (CDC), David Vos (HUD), Kirk Henny (CDC), Sherri L. Pals (CDC), and Daniel Kidder (CDC).


  1. Adam, B. D., & Sears, A. (1994). Negotiating sexual relationships after testing HIV-positive. Medical Anthropology, 16, 63–77.PubMedCrossRefGoogle Scholar
  2. Aidala, A. A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251–265. doi: 10.1007/s10461-005-9000-7.CrossRefPubMedGoogle Scholar
  3. Aidala, A. A., Lee, G., Garbers, S., & Chiasson, M. A. (2006). Sexual behaviors and sexual risk in a prospective cohort of HIV-positive men and women in New York City, 1994–2002: Implications for prevention. AIDS Education and Prevention, 18, 12–32. doi: 10.1521/aeap.2006.18.1.12.CrossRefPubMedGoogle Scholar
  4. Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults—Evaluation of a short-form of the CES-D. American Journal of Preventive Medicine, 10, 77–84.PubMedGoogle Scholar
  5. Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS (London, England), 14, 357–366. doi: 10.1097/00002030-200003100-00008.Google Scholar
  6. Beckett, M., Burnam, A., Collins, R. L., Kanouse, D. E., & Beckman, R. (2003). Substance use and high-risk sex among people with HIV: A comparison across exposure groups. AIDS and Behavior, 7(2), 209–219. doi: 10.1023/A:1023906610710.CrossRefPubMedGoogle Scholar
  7. Bogart, L. M., Collins, R. L., Kanouse, D. E., Cunningham, W., Beckman, R., Golinelli, D., et al. (2006). Patterns and correlates of deliberate abstinence among men and women with HIV/AIDS. American Journal of Public Health, 96, 1078–1084. doi: 10.2105/AJPH.2005.070771.CrossRefPubMedGoogle Scholar
  8. Buchacz, K., van der Straten, A., Saul, J., Shiboski, S. C., Gomez, C. A., & Padian, N. (2001). Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. Journal of Acquired Immune Deficiency Syndromes, 28(3), 289–297.PubMedGoogle Scholar
  9. Centers for Disease Control and Prevention. (2001). Prevalence of risk behaviors for HIV infection among adults—United States, 1997. Morbidity and Mortality Weekly Report, 50, 262–265.Google Scholar
  10. Colfax, G., Vittinghoff, E., Husnick, M. J., McKirnan, D., Buchbinder, S., Koblin, B., et al. (2004). Substance use and sexual risk: A participant- and episode-level analysis among a cohort of men who have sex with men. American Journal of Epidemiology, 159(10), 1002–1012. doi: 10.1093/aje/kwh135.CrossRefPubMedGoogle Scholar
  11. Courtenay-Quirk, C., Pals, S. L., Colfax, G., McKirnan, D., Gooden, L., & Eroglu, D. (2008). Factors associated with sexual risk behavior among persons living with HIV: Gender and sexual identity group differences. AIDS and Behavior, 12, 685–694. doi: 10.1007/s10461-007-9259-y.CrossRefPubMedGoogle Scholar
  12. Crepaz, N., Hart, T. A., & Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior—A meta-analytic review. Journal of the American Medical Association, 292, 224–236. doi: 10.1001/jama.292.2.224.CrossRefPubMedGoogle Scholar
  13. Galvao, M. T. G., & Marcondes-Machado, J. (2001). Use of a condom in sex relations by HIV carriers. Revista da Sociedade Brasileira de Medicina Tropical, 34, 181–186.PubMedGoogle Scholar
  14. Guzman, R., Buchbinder, S., Mansergh, G., Vittinghoff, E., Marks, G., Wheeler, S., et al. (2006). Communication of HIV viral load to guide sexual risk decisions with serodiscordant partners among San Francisco men who have sex with men. AIDS Care, 18, 983–989. doi: 10.1080/09540120500497908.CrossRefPubMedGoogle Scholar
  15. Harawa, N. T., Williams, J. K., Ramamurthi, H. C., & Bingham, T. A. (2006). Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: Implications for heterosexual transmission. Journal of Urban Health, 83, 682–694. doi: 10.1007/s11524-006-9067-0.CrossRefPubMedGoogle Scholar
  16. Heckman, T. G., Kelly, J. A., & Somlai, A. M. (1998). Predictors of continued high-risk sexual behavior in a community sample of persons living with HIV/AIDS. AIDS and Behavior, 2(2), 125–135. doi: 10.1023/A:1022194829791.CrossRefGoogle Scholar
  17. Henny, K. D., Kidder, D. P., Stall, R., & Wolitski, R. J. (2007). Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior, 11, 842–853. doi: 10.1007/s10461-007-9251-6.CrossRefPubMedGoogle Scholar
  18. Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.Google Scholar
  19. Kalichman, S. C. (1999). Psychological and social correlates of high-risk sexual behaviour among men and women living with HIV/AIDS. AIDS Care, 11(4), 415–427. doi: 10.1080/09540129947794.CrossRefPubMedGoogle Scholar
  20. Kalichman, S. C., Kelly, J. A., & Rompa, D. (1997). Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychology, 16(4), 369–373. doi: 10.1037/0278-6133.16.4.369.CrossRefPubMedGoogle Scholar
  21. Keegan, A., Lambert, S., & Petrak, J. (2005). Sex and relationships for HIV-positive women since HAART: A qualitative study. AIDS Patient Care and STDs, 19, 645–654. doi: 10.1089/apc.2005.19.645.CrossRefPubMedGoogle Scholar
  22. Kidder, D. P., Wolitski, R. J., Royal, S., Aidala, A., Courtenay-Quirk, C., Holtgrave, D. R., et al. (2007). Access to housing as a structural intervention for homeless and unstably housed people living with HIV: Rationale, methods, and implementation of the housing and health study. AIDS and Behavior, 11, S149–S161. doi: 10.1007/s10461-007-9249-0.CrossRefGoogle Scholar
  23. Kilmarx, P. H., Hamers, F. F., & Peterman, T. A. (1998). Living with HIV—Experiences and perspectives of HIV-infected sexually transmitted disease clinic patients after posttest counseling. Sexually Transmitted Diseases, 25, 28–37. doi: 10.1097/00007435-199801000-00007.CrossRefPubMedGoogle Scholar
  24. Kipke, M. D., Weiss, G., & Wong, C. F. (2007). Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS and Behavior, 11, S56–S69. doi: 10.1007/s10461-006-9204-5.CrossRefGoogle Scholar
  25. Klinkenberg, W. D., Sacks, S., & HIV/AIDS Treatment Adherence, Health Outcomes, Cost Study Group. (2004). Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care, 16(Suppl 1), S22–S42. doi: 10.1080/09540120412331315303.CrossRefPubMedGoogle Scholar
  26. Lazo, M., Gange, S. J., Wilson, T. E., Anastos, K., Ostrow, D. G., Witt, M. D., et al. (2007). Patterns and predictors of changes in adherence to highly active antiretroviral therapy: Longitudinal study of men and women. Clinical Infectious Diseases, 45, 1377–1385. doi: 10.1086/522762.CrossRefPubMedGoogle Scholar
  27. Leigh, B. C., Temple, M. T., & Trocki, K. F. (1993). The sexual-behavior of United-States adults—Results from a national survey. American Journal of Public Health, 83, 1400–1408.CrossRefPubMedGoogle Scholar
  28. Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes, 39, 446–453. doi: 10.1097/01.qai.0000151079.33935.79.CrossRefPubMedGoogle Scholar
  29. Moatti, J. P., Prudhomme, J., Traore, D. C., Juillet-Amari, A., Akribi, H. A. D., Msellati, P., et al. (2003). Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS (London, England), 17, S69–S77. doi: 10.1097/00002030-200317003-00010.Google Scholar
  30. O’Leary, A., Wolitski, R. J., Remien, R. H., Woods, W. J., Parsons, J. T., Moss, S., et al. (2005). Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men. AIDS (London, England), 19(Suppl 1), S67–S75.Google Scholar
  31. Raj, A., Silverman, J. G., & Amaro, H. (2004). Abused women report greater male partner risk and gender-based risk for HIV: Findings from a community-based study with Hispanic women. AIDS Care, 16, 519–529. doi: 10.1080/09540120410001683448.CrossRefPubMedGoogle Scholar
  32. Reilly, T., & Woo, G. (2001). Predictors of high-risk sexual behavior among people living with HIV/AIDS. AIDS and Behavior, 5, 205–217. doi: 10.1023/A:1011384408761.CrossRefGoogle Scholar
  33. Remien, R. H., Exner, T. M., Morin, S. F., Ehrhardt, A. A., Johnson, M. O., Correale, J., et al. (2007). Medication adherence and sexual risk behavior among HIV-Infected adults: Implications for transmission of resistant virus. AIDS and Behavior, 11, 663–675. doi: 10.1007/s10461-006-9201-8.CrossRefPubMedGoogle Scholar
  34. Reynolds, N. R. (2004). Adherence to antiretroviral therapies: State of the science. Current HIV Research, 2, 207–214. doi: 10.2174/1570162043351309.CrossRefPubMedGoogle Scholar
  35. Salazar, L. F., Crosby, R. A., Holtgrave, D. R., Head, S., Hadsock, B., Todd, J., et al. (2007). Homelessness and HIV-associated risk behavior among African American men who inject drugs and reside in the urban south of the United States. AIDS and Behavior, 11, S70–S77. doi: 10.1007/s10461-007-9239-2.CrossRefGoogle Scholar
  36. Senn, T. E., Carey, M. P., Vanable, P. A., Coury-Doniger, P., & Urban, M. A. (2006). Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic. Journal of Consulting and Clinical Psychology, 74, 720–731. doi: 10.1037/0022-006X.74.4.720.CrossRefPubMedGoogle Scholar
  37. Siegel, K., & Scrimshaw, E. W. (2003). Reasons for the adoption of celibacy among older men and women living with HIV/AIDS. Journal of Sex Research, 40, 189–200.PubMedCrossRefGoogle Scholar
  38. US Census Bureau. (2004). Housing data between the Censuses: The American Housing Survey. Rep. AHS/R/04-1, US Census Bureau, Washington, D.C.Google Scholar
  39. Wagner, G. J., Rabkin, J. G., & Rabkin, R. (1993). Sexual activity among HIV-seropositive gay men seeking treatment for depression. The Journal of Clinical Psychiatry, 54, 470–475.PubMedGoogle Scholar
  40. Ware, J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version 2 of the SF-36(r) health survey. Lincoln, RI: QualityMetric Inc.Google Scholar
  41. Wenzel, S. L., Tucker, J. S., Elliott, M. N., & Hambarsoomians, K. (2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS and Behavior, 11, S9–S20. doi: 10.1007/s10461-006-9193-4.CrossRefGoogle Scholar
  42. Wight, R. G., Rotheram-Borus, M. J., Klosinski, L., Ramos, B., Calabro, M., & Smith, R. (2000). Screening for transmission behaviors among HIV-infected adults. AIDS Education and Prevention, 12, 431–441.PubMedGoogle Scholar
  43. Wiktor, S. Z., Biggar, R. J., Melbye, M., Ebbesen, P., Colclough, G., DiGioia, R., et al. (1990). Effect of knowledge of human immunodeficiency virus-infection status on sexual-activity among homosexual men. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 3, 62–68.Google Scholar
  44. Wolitski, R. J., Kidder, D. P., & Fenton, K. A. (2007). HIV, homelessness, and public health: Critical issues and a call for increased action. AIDS and Behavior, 11, S167–S171. doi: 10.1007/s10461-007-9277-9.CrossRefGoogle Scholar
  45. Wolitski, R. J., Pals, S. L., Kidder, D. P., Courtenay-Quirk, C., & Holtgrave, D. R. (2008). The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS and Behavior. doi: 10.1007/s10461-008-9455-4.

Copyright information

© GovernmentEmployee: Centers for Disease Control and Prevention 2008

Authors and Affiliations

  • Cari Courtenay-Quirk
    • 1
    Email author
  • Jun Zhang
    • 2
  • Richard J. Wolitski
    • 1
  1. 1.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Business Computer ApplicationsAtlantaUSA

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