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)


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.


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 



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.


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


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Breakey WR, Fischer PJ, Kramer M, Nestadt G, Romanoski AJ, Ross A, et al. Health and mental health problems of homeless men and women in Baltimore. JAMA. 1989;262:1352–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000;283:2152–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Fischer PJ, Breakey WR. The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol. 1991;46:1115–28.PubMedCrossRefGoogle Scholar
  4. 4.
    Plevneshi A, Svoboda T, Armstrong I, Tyrrell GJ, Miranda A, Green K, et al. Population-based surveillance for invasive pneumococcal disease in homeless adults in Toronto. PLoS One. 2009;4:e7255.PubMedCrossRefGoogle Scholar
  5. 5.
    Mohtashemi M, Kawamura LM. Empirical evidence for synchrony in the evolution of TB cases and HIV + contacts among the San Francisco homeless. PLoS One. 2010;5:e8851.PubMedCrossRefGoogle Scholar
  6. 6.
    • Kerker BD, Bainbridge J, Kennedy J, Bennani Y, Agerton T, Marder D, et al. A population-based assessment of the health of homeless families in New York City, 2001–2003. Am J Public Health. 2011;101:546–53. Using data from homeless shelter registries linked to mortality, HIV, and tuberculosis registries in New York City, the authors estimated population-based rates among homeless families, low-income families, and NYC residents overall, identifying high levels of substance and HIV-related mortality among homeless residents.PubMedCrossRefGoogle Scholar
  7. 7.
    Culhane DP, Gollub E, Kuhn R, Shpaner M. The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilization in Philadelphia. J Epidemiol Commun Health. 2001;55:515–20.CrossRefGoogle Scholar
  8. 8.
    • Gelberg L, Robertson MJ, Arangua L, Leake BD, Sumner G, Moe A, et al. Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in los angeles. Public Health Rep. 2012;127:407–21. This study, resulting from a seroprevalence survey for hepatitis C (HCV) infection among homeless adults in Los Angeles' Skid Row area, found high levels of HCV infection and low levels of treatment.PubMedGoogle Scholar
  9. 9.
    Gomez R, Thompson SJ, Barczyk AN. Factors associated with substance use among homeless young adults. Subst Abus. 2010;31:24–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Hwang SW, Colantonio A, Chiu S, Tolomiczenko G, Kiss A, Cowan L, et al. The effect of traumatic brain injury on the health of homeless people. CMAJ. 2008;179:779–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Teruya C, Longshore D, Andersen RM, Arangua L, Nyamathi A, Leake B, et al. Health and health care disparities among homeless women. Women Health. 2010;50:719–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11 Suppl 2:101–15.PubMedCrossRefGoogle Scholar
  13. 13.
    Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002;92:778–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001;285(2):200–6.PubMedCrossRefGoogle Scholar
  15. 15.
    The 2009 annual homeless assessment report to Congress. Washington, DC: United States Department of Housing and Urban Development. 2009.Google Scholar
  16. 16.
    Zolopa AR, Hahn JA, Gorter R, Miranda J, Wlodarczyk D, Peterson J, et al. HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. JAMA. 1994;272:455–61.PubMedCrossRefGoogle Scholar
  17. 17.
    •• Bruneau J, Daniel M, Abrahamowicz M, Zang G, Lamothe F, Vincelette J. Trends in human immunodeficiency virus incidence and risk behavior among injection drug users in montreal, Canada: a 16-year longitudinal study. Am J Epidemiol. 2011;173:1049–58. The long-term study of HIV seroconversion among individuals who use injection drugs in Montreal identified living in unstable housing as a strong and consistent risk factor for seroconversion.PubMedCrossRefGoogle Scholar
  18. 18.
    Robertson MJ, Clark RA, Charlebois ED, Tulsky J, Long HL, Bangsberg DR, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94:1207–17.PubMedCrossRefGoogle Scholar
  19. 19.
    Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9:251–65.PubMedCrossRefGoogle Scholar
  20. 20.
    Courtenay-Quirk C, Pals SL, Kidder DP, Henny K, Emshoff JG. Factors associated with incarceration history among HIV-positive persons experiencing homelessness or imminent risk of homelessness. J Community Health. 2008;33:434–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. JAIDS. 2008;49:451–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Stein JA, Nyamathi AM, Zane JI. Situational, psychosocial, and physical health-related correlates of HIV/AIDS risk behaviors in homeless men. Am J Men Health. 2009;3:25–35.CrossRefGoogle Scholar
  23. 23.
    Vella S, Schwartländer B, Sow SP, Eholie SP, Murphy RL. The history of antiretroviral therapy and of its implementation in resource-limited areas of the world. AIDS. 2012;26:1231–41.PubMedCrossRefGoogle Scholar
  24. 24.
    The Antiretroviral Therapy Cohort Collaboration. Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries. Int J Epidemiol. 2009;38:1624–33.CrossRefGoogle Scholar
  25. 25.
    Obel N, Omland LH, Kronborg G, Larsen CS, Pedersen C, Pedersen G, et al. Impact of Non-HIV and HIV Risk Factors on Survival in HIV-Infected Patients on HAART: a population-based nationwide cohort study. Myer L, editor. PLoS One. 2011;6:e22698.PubMedCrossRefGoogle Scholar
  26. 26.
    World Health Organization, UNAIDS, UNICEF. Global HIV/AIDS Response. Geneva: United Nations; 2011. p. 1–233.Google Scholar
  27. 27.
    Geddes JR, Fazel S. Extreme health inequalities: mortality in homeless people. Lancet. 2011;377:2156–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Kidder DP, Wolitski RJ, Royal S, Aidala A, Courtenay-Quirk C, Holtgrave DR, et al. 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 Behav. 2007;11(6 Suppl):149–61.PubMedCrossRefGoogle Scholar
  29. 29.
    Hwang SW. Homelessness and health. CMAJ. 2001;164:229–33.PubMedGoogle Scholar
  30. 30.
    • Chen NE, Meyer JP, Avery AK, Draine J, Flanigan TP, Lincoln T, et al. Adherence to HIV treatment and care among previously homeless jail detainees. AIDS Behav. 2011. The study by Chen et al. illustrates the important relationship between incarceration and poor housing status and how they combine to disrupt adherence to HIV treatment and care. doi: 10.1007/s10461-011-0080-2
  31. 31.
    Doshi RK, Vogenthaler NS, Lewis S, Rodriguez A, Metsch L, Rio CD. Correlates of antiretroviral utilization among hospitalized HIV-infected crack cocaine users. AIDS Res Hum Retrovir. 2012;28(9):807–14.Google Scholar
  32. 32.
    Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97:2238–45.PubMedCrossRefGoogle Scholar
  33. 33.
    • Milloy M-J, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, et al. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDS. 2012;26:60–7. This study, the first to use longitudinal data to estimate the effect of homelessness on HIV-1 RNA viral suppression following ART initiation, found poorer housing to be a structural barrier to effective HIV treatment.PubMedCrossRefGoogle Scholar
  34. 34.
    Palepu A, Milloy M-J, Kerr T, Zhang R, Wood E. Homelessness and adherence to antiretroviral therapy among a cohort of HIV-infected injection drug users. J Urban Health. 2011;88:545–55.PubMedCrossRefGoogle Scholar
  35. 35.
    • Sayles JN, Rurangirwa J, Kim M, Kinsler J, Oruga R, Janson M. Operationalizing treatment as prevention in Los Angeles County: antiretroviral therapy use and factors associated with unsuppressed viral load in the Ryan White System of Care. AIDS Patient Care STDS. 2012;26(8):463–70. Using data from a large provider of publicly-funded HIV treatment for poor and indigent individuals in Los Angeles, this study found that poorer housing status was associated with lower likelihoods of viral suppression. Google Scholar
  36. 36.
    Weiser SD, Fernandes K, Brandson E, Lima V, Anema A, Bangsberg D, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. JAIDS. 2009;52:342–50.PubMedCrossRefGoogle Scholar
  37. 37.
    Knowlton A, Arnsten J, Eldred L, Wilkinson J, Gourevitch M, Shade S, et al. Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. JAIDS. 2006;41:486–92.PubMedCrossRefGoogle Scholar
  38. 38.
    Walley AY, Cheng DM, Libman H, Nunes D, Horsburgh CR, Saitz R, et al. Recent drug use, homelessness and increased short-term mortality in HIV-infected persons with alcohol problems. AIDS. 2008;22:415–20.PubMedCrossRefGoogle Scholar
  39. 39.
    • Schwarcz SK, Hsu LC, Vittinghoff E, Vu A, Bamberger JD, Katz MH. Impact of housing on the survival of persons with AIDS. BMC Public Health. 2009;9:220. Using data from HIV/AIDS and housing registries, the study found that individuals with AIDS who obtained supportive housing survived longer than those who did not.PubMedCrossRefGoogle Scholar
  40. 40.
    Lieb S, Brooks RG, Hopkins RS, Thompson D, Crockett LK, Liberti T, et al. Predicting death from HIV/AIDS: a case–control study from Florida public HIV/AIDS clinics. JAIDS. 2002;30:351–8.PubMedGoogle Scholar
  41. 41.
    Cunningham CO, Sohler NL, McCoy K, Heller D, Selwyn PA. Health care access and utilization patterns in unstably housed HIV-infected individuals in New York City. AIDS Patient Care STDS. 2005;19:690–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Henry R, Richardson JL, Stoyanoff S, García GP, Dorey F, Iverson E, et al. HIV/AIDS health service utilization by people who have been homeless. AIDS Behav. 2008;12:815–21.PubMedCrossRefGoogle Scholar
  43. 43.
    Tommasello AC, Gillis LM, Lawler JT, Bujak GJ. Characteristics of homeless HIV-positive outreach responders in urban US and their success in primary care treatment. AIDS Care. 2006;18:911–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Préau M, Protopopescu C, Raffi F, Rey D, Chêne G, Marcellin F, et al. Satisfaction with care in HIV-infected patients treated with long-term follow-up antiretroviral therapy: the role of social vulnerability. AIDS Care. 2012;24:434–43.PubMedGoogle Scholar
  45. 45.
    Wohl AR, Carlos J-A, Tejero J, Dierst-Davies R, Daar ES, Khanlou H, et al. Barriers and unmet need for supportive services for HIV patients in care in Los Angeles County, California. AIDS Patient Care STDS. 2011;25:525–32.PubMedCrossRefGoogle Scholar
  46. 46.
    Wenzel SL, Rhoades H, Tucker JS, Golinelli D, Kennedy DP, Zhou A, et al. HIV risk behavior and access to services: what predicts HIV testing among heterosexually active homeless men? AIDS Educ Prev. 2012;24:270–9.PubMedCrossRefGoogle Scholar
  47. 47.
    • Knowlton AR, Arnsten JH, Eldred LJ, Wilkinson JD, Shade SB, Bohnert AS, et al. Antiretroviral use among active injection-drug users: the role of patient–provider engagement and structural factors. AIDS Patient Care STDS. 2010;24421–8. The authors identified a range of individual, inter-personal, and structural factors associated with exposure to HAART among individuals who use drugs. Stable housing was independently associated with HAART uptake. Google Scholar
  48. 48.
    Berg KM, Demas PA, Howard AA, Schoenbaum EE, Gourevitch MN, Arnsten JH. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Intern Med. 2004;19:1111–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009;13:841–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Bangsberg D, Tulsky JP, Hecht FM, Moss AR. Protease inhibitors in the homeless. JAMA. 1997;278:63–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14:357–66.PubMedCrossRefGoogle Scholar
  52. 52.
    Moss AR, Hahn JA, Perry S, Charlebois ED, Guzman D, Clark RA, et al. Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study. Clin Infect Dis. 2004;39:1190–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Friedman MS, Marshal MP, Stall R, Kidder DP, Henny KD, Courtenay-Quirk C, et al. Associations between substance use, sexual risk taking, and HIV treatment adherence among homeless people living with HIV. AIDS Care. 2009;21:692–700.PubMedCrossRefGoogle Scholar
  54. 54.
    Das-Douglas M, Riley ED, Ragland K, Guzman D, Clark R, Kushel MB, et al. Implementation of the Medicare Part D prescription drug benefit is associated with antiretroviral therapy interruptions. AIDS Behav. 2009;13:1–9.PubMedCrossRefGoogle Scholar
  55. 55.
    • Riley ED, Moore KL, Haber S, Neilands TB, Cohen J, Kral AH. Population-level effects of uninterrupted health insurance on services use among HIV-positive unstably housed adults. AIDS Care. 2011;23:822–30. This analysis of data from a representative sample of homeless/marginally-housed individuals living with HIV/AIDS in San Francisco demonstrated how access to uninterrupted health insurance was associated with better patterns of health care.PubMedGoogle Scholar
  56. 56.
    Weiser SD, Riley ED, Ragland K, Hammer G, Clark R, Bangsberg DR. Brief report: factors associated with depression among homeless and marginally housed HIV-infected men in San Francisco. J Gen Intern Med. 2006;21:61–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Riley ED, Wu AW, Perry S, Clark RA, Moss AR, Crane J, et al. Depression and drug use impact health status among marginally housed HIV-infected individuals. AIDS Patient Care STDS. 2003;17:401–6.PubMedCrossRefGoogle Scholar
  58. 58.
    •• Riley ED, Moore K, Sorensen JL, Tulsky JP, Bangsberg DR, Neilands TB. Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. Am J Epidemiol. 2011;174:515–22. This study of a representative sample of homeless/marginally-housed female PLWHA showed how basic subsistence needs drive overall health status.PubMedCrossRefGoogle Scholar
  59. 59.
    • Riley ED, Neilands TB, Moore K, Cohen J, Bangsberg DR, Havlir D. Social, structural and behavioral determinants of overall health status in a cohort of homeless and unstably housed HIV-infected men. PLoS One. 2012;7:e35207. This study of a representative sample of homeless/marginally-housed male PLWHA demonstrated the importance of a range of social, structural, and behavioral factors on health status.PubMedCrossRefGoogle Scholar
  60. 60.
    Bangsberg DR, Ragland K, Monk A, Deeks SG. A single tablet regimen is associated with higher adherence and viral suppression than multiple tablet regimens in HIV + homeless and marginally housed people. AIDS. 2010;24:2835–40.PubMedCrossRefGoogle Scholar
  61. 61.
    Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry. 2010;67:1282–90.PubMedCrossRefGoogle Scholar
  62. 62.
    Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99 Suppl 3:S675–80.PubMedCrossRefGoogle Scholar
  63. 63.
    Wolitski RJ, Kidder DP, Pals SL, Royal S, Aidala A, Stall R, et al. 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
  64. 64.
    Parashar S, Palmer AK, O’Brien N, Chan K, Shen A, Coulter S, et al. Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among individuals living with HIV who are unstably housed. AIDS Behav. 2011;15:1612–22.PubMedCrossRefGoogle Scholar
  65. 65.
    Cameron A, Lloyd L, Turner W, Macdonald G. Working across boundaries to improve health outcomes: a case study of a housing support and outreach service for homeless people living with HIV. Health Soc Care Community. 2009;17:388–95.PubMedCrossRefGoogle Scholar
  66. 66.
    Hawk M, Davis D. The effects of a harm reduction housing program on the viral loads of homeless individuals living with HIV/AIDS. AIDS Care. 2012;24:577–82.PubMedCrossRefGoogle Scholar
  67. 67.
    Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376:367–87.PubMedCrossRefGoogle Scholar
  68. 68.
    Krusi A, Wood E, Montaner J, Kerr T. Social and structural determinants of HAART access and adherence among injection drug users. Int J Drug Policy. 2010;21:4–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Milloy M-J, Marshall B, Kerr T, Buxton J, Rhodes T, Montaner J, et al. Social and structural factors associated with HIV disease progression among illicit drug users: a systematic review. AIDS. 2012.Google Scholar
  70. 70.
    Milloy MJ, Montaner J, Wood E. Barriers to HIV treatment among people who use injection drugs: implications for 'treatment as prevention'. Curr Opin HIV AIDS. 2012;7:332–8.PubMedCrossRefGoogle Scholar
  71. 71.
    Milloy M-J, Kerr T, Buxton J, Rhodes T, Guillemi S, Hogg R, et al. Dose–response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. J Infect Dis. 2011;203:1215–21.PubMedCrossRefGoogle Scholar
  72. 72.
    Milloy M-J, Kerr T, Buxton J, Rhodes T, Krusi A, Guillemi S, et al. Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy. JAIDS. 2012;59:393–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Kilbourne AM, Herndon B, Andersen RM, Wenzel SL, Gelberg L. Psychiatric symptoms, health services, and HIV risk factors among homeless women. J Health Care Poor Underserved. 2002;13:49–65.PubMedGoogle Scholar
  74. 74.
    Surratt HL, Inciardi JA. HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA. AIDS Care. 2004;16:594–604.PubMedCrossRefGoogle Scholar
  75. 75.
    Kushel MB, Hahn JA, Evans JL, Bangsberg DR, Moss AR. Revolving doors: imprisonment among the homeless and marginally housed population. Am J Public Health. 2005;95:1747–52.PubMedCrossRefGoogle Scholar
  76. 76.
    Wood E, Kerr T, Marshall BDL, Li K, Zhang R, Hogg RS, et al. Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study. BMJ. 2009;338:b1649–9.PubMedCrossRefGoogle Scholar
  77. 77.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.PubMedCrossRefGoogle Scholar
  78. 78.
    Riley ED, Bangsberg DR, Guzman D, Perry S, Moss AR. Antiretroviral therapy, hepatitis C virus, and AIDS mortality among San Francisco's homeless and marginally housed. JAIDS. 2005;38:191–5.PubMedCrossRefGoogle Scholar
  79. 79.
    Tsui JI, Bangsberg DR, Ragland K, Hall CS, Riley ED. The impact of chronic hepatitis C on health-related quality of life in homeless and marginally housed individuals with HIV. AIDS Behav. 2007;11:603–10.PubMedCrossRefGoogle Scholar
  80. 80.
    Hansen L, Penko J, Guzman D, Bangsberg DR, Miaskowski C, Kushel MB. Aberrant behaviors with prescription opioids and problem drug use history in a community-based cohort of HIV-infected individuals. J Pain Symptom Manage. 2011;42:893–902.PubMedCrossRefGoogle Scholar
  81. 81.
    Kushel MB, Colfax G, Ragland K, Heineman A, Palacio H, Bangsberg DR. Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clin Infect Dis. 2006;43:234–42.PubMedCrossRefGoogle Scholar
  82. 82.
    Weiser SD, Frongillo EA, Ragland K, Hogg RS, Riley ED, Bangsberg DR. Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2009;24:14–20.PubMedCrossRefGoogle Scholar
  83. 83.
    Tsai AC, Karasic DH, Hammer GP, Charlebois ED, Ragland K, Moss AR, et al. Directly Observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial. Am J Public Health. 2012. doi: 10.2105/AJPH.2011.300422

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

Personalised recommendations