Current HIV/AIDS Reports

, Volume 9, Issue 4, pp 364–374 | Cite as

Housing Status and the Health of People Living with HIV/AIDS

  • M.-J. Milloy
  • Brandon D. L. Marshall
  • Julio Montaner
  • Evan Wood
Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Abstract

Individuals who are homeless or living in marginal conditions have an elevated burden of infection with HIV. Existing research suggests the HIV/AIDS pandemic in resource-rich settings is increasingly concentrated among members of vulnerable and marginalized populations, including homeless/marginally-housed individuals, who have yet to benefit fully from recent advances in highly-active antiretroviral therapy (HAART). We reviewed the scientific evidence investigating the relationships between inferior housing and the health status, HAART access and adherence and HIV treatment outcomes of people living with HIV/AIDS (PLWHA.) Studies indicate being homeless/marginally-housed is common among PLWHA and associated with poorer levels of HAART access and sub-optimal treatment outcomes. Among homeless/marginally-housed PLWHA, determinants of poorer HAART access/adherence or treatment outcomes include depression, illicit drug use, and medication insurance status. Future research should consider possible social- and structural-level determinants of HAART access and HV treatment outcomes that have been shown to increase vulnerability to HIV infection among homeless/marginally-housed individuals. As evidence indicates homeless/marginally-housed PLWHA with adequate levels of adherence can benefit from HAART at similar rates to housed PLWHA, and given the individual and community benefits of expanding HAART use, interventions to identify HIV-seropositive homeless/marginally-housed individuals, and engage them in HIV care including comprehensive support for HAART adherence are urgently needed.

Keywords

HIV/AIDS Antiretroviral therapy Homelessness People living with HIV/AIDS (PLWHA) Adherence CD4+ Plasma HIV-1 RNA Viral load Highly-active antiretroviral therapy (HAART) Behavior aspects of HIV/AIDS 

Notes

Acknowledgments

We thank Deborah Graham, Carmen Rock, and Peter Vann for their administrative assistance. M-J Milloy is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. This work was supported by the National Institutes of Health (R01DA021525.)

This work was also supported by grants from the National Institutes of Health, the Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine which supports Dr. Evan Wood.

Disclosure

Milloy: post-doctoral fellowships with Canadian Institutes of Health Research and Michael Smith Foundation for Health Research; Marshall: none; Montaner: none; Wood: none.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • M.-J. Milloy
    • 1
    • 2
  • Brandon D. L. Marshall
    • 3
  • Julio Montaner
    • 1
    • 4
  • Evan Wood
    • 1
    • 4
  1. 1.British Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  2. 2.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.Department of EpidemiologyBrown UniversityProvidenceUSA
  4. 4.Division of AIDS, Department of MedicineUniversity of British ColumbiaVancouverCanada

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