Patterns of Homelessness and Implications for HIV Health After Release from Jail
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This empirical study examines the association between substance abuse, mental illness, health behaviors and different patterns of homelessness among recently released, HIV-infected jail detainees. Using longitudinal data from a 10-site study, we examine correlates of homelessness, transitions to and from stable housing and the effect of housing on HIV treatment outcomes. Based on our analysis, we found evidence that the transitions from homelessness are closely associated with a reduction in the use of alcohol and illicit drugs, a decline in drug addiction severity, and an improvement in mental health. In addition, we found evidence that disparities in the housing status contributed substantially to the observed gap in the HIV treatment outcomes between homeless and non-homeless patients, including in achievement of virological suppression over time.
KeywordsHIV Jail Incarceration Homelessness Substance abuse Case management Longitudinal cohort study
Enhancing Linkages to HIV Primary Care Services Initiative is a HRSA-funded Special Project of National Significance. Funding for this research was also provided through career development grants from the National Institute on Drug Abuse (K24 DA017072, FLA), research grants from the National Institute on Alcohol Abuse and Alcoholism (R01 AA018944, FLA). Assistance was also provided by Emory Center for AIDS Research (CFAR, P30 AI050409, ACS). The funding sources played no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit the paper for publication.
- 5.Chen NE, Meyer JP, Avery AK, Draine J, Flanigan TP, Lincoln T, Spaulding AC, Springer SA, Altice FL. Adherence to HIV treatment and care among previously homeless jail detainees. AIDS Behav. 2011. doi: 10.1007/s10461-011-0080-2.
- 9.Hopper K. Reckoning with homelessness. Ithaca: Cornell University Press; 2002.Google Scholar
- 17.Metraux S, Caterina R, Cho R. Incarceration and homelessness. In: Dennis D, Locke G, Khadduri L editors. Toward understanding homelessness: the 2007 national symposium on homelessness research. Washington, DC: US Department of Housing & Urban Development; 2008.Google Scholar
- 20.Wolitski RJ, Kidder DP, Pals SL, Royal S, Aidala A, Stall R, Holtgrave DR, Harre D, Courtenay-Quirk C. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS Behav. 2010;14(3):493–503.PubMedCrossRefGoogle Scholar
- 24.Tull T. The “housing first” approach for families affected by substance abuse. In: The source. vol 13. University of California, Berkeley: The National Abandoned Infants Assistance Resource Center; 2004.Google Scholar
- 25.Wang EA, Hong CS, Samuels L, Shavit S, Sanders R, Kushel MB. Transitions clinic: creating a community-based model of health care for recently released California prisoners. Public Health Rep. 2010;125:171–177.Google Scholar
- 28.Althoff AL, Zelenev A, Meyer JP, Fu J, Brown SE, Vagenas P, Avery AK, Cruzado-Quiñones J, Spaulding AC, Altice FL. Correlates of retention in HIV care after release from jail: results from a multi-site study. AIDS Behav 2012. doi: 10.1007/s10461-012-0372-1.
- 29.Krishnan A, Wickersham JA, Chitsaz E, Springer SA, Jordan AO, Zaller N, Altice FL. Post-release substance abuse outcomes among HIV-infected jail detainees: results from a multisite study. AIDS Behav. 2012. doi: 10.1007/s10461-012-0362-3.
- 35.Calsyn DA, Saxon AJ, Bush KR, Howell DN, Baer JS, Sloan KL, et al. The Addiction Severity Index medical and psychiatric composite scores measure similar domains as the SF-36 in substance-dependent veterans: concurrent and discriminant validity. Drug Alcohol Depend. 2004;76(2):165–71.PubMedCrossRefGoogle Scholar
- 38.Jaeger M. On testing the missing at random assumption. Machine learning: ECML 2006, No. 4212. Berlin: Springer; 2006.Google Scholar
- 40.Wooldridge JM. Econometric analysis of cross section and panel data. Cambridge: MIT Press; 2002.Google Scholar
- 41.Guo S, Fraser M. Propensity score analysis: statistical methods and applications. Thousand Oaks: Sage; 2009.Google Scholar
- 46.Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 1985;39:33–8.Google Scholar
- 48.Cochran W, Rubin D. Controlling bias in observational studies. Sankhyā. 1973;35:417–46.Google Scholar
- 50.Stata: Release 12. [Computer program]. College Station, TX: StataCorp LP.; 2011.Google Scholar
- 51.Maslow AH. Toward a psychology of being. 3rd ed. New York: Wiley; 1998.Google Scholar