Skip to main content

Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder

AIDS and Behavior volume 24, pages 3252–3263 (2020)Cite this article

Abstract

Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a “quick stable housing” pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09–1.20) or unplaced (1.19;1.13–1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03–1.44) or unplaced (1.26, 1.03–1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.

Resumen

Unas 958 personas de bajos recursos y quienes viven con VIH y enfermedades mentales o bien presentan problemas de abuso de sustancias solicitaron a un programa de vivienda complementada con servicios de apoyo. Entre ellas, se evaluó los impactos de la colocación en viviendas sobre la estabilidad en la misma, así como la participación en los cuidados médicos para el VIH, y la supresión de la carga viral. Las bases de datos administrativas y del registro de vigilancia brindaron información médica y domiciliar, incluyendo información sobre vivienda estable (por ejemplo, asistencia de pago de renta a largo plazo, o vivienda complementada con servicios de apoyo) y vivienda inestable (por ejemplo, alojamiento de emergencia temporal) subsidiada por el gobierno. El método “análisis de secuencia” permitió identificar una pauta caracterizada por estabilidad domiciliar conseguida de modo ligero (es decir, de forma oportuna) en el 67% de las personas quienes fueron colocadas por este programa dentro de un lapso de dos años, comparado con 28% de las personas quienes no fueron colocadas. En comparación con las personas quienes no fueron colocadas y no lograron estabilidad de vivienda de modo ligero, las personas quienes lograron estabilidad de vivienda de modo ligero tuvieron una mayor probabilidad de participar en cuidados médicos, ya sea que fueran colocadas (según regresión de Poisson, cociente de riesgo ajustado: 1.14; intervalo de confianza de 95%: 1.09-1.20) o no fueran colocadas (1.19, 1.13-1.25) por este programa, así como de lograr la supresión de la carga viral, ya sea que fueran colocadas (1.22, 1.03-1.44) o no fueran colocadas (1.26, 1.03-1.56) por este programa. Los programas que facilitan la colocación en o el pago de vivienda y apoyo en el mismo pueden ayudar a las personas con VIH y sin hogar obtener vivienda estable de modo ligero, controlar su infección, y prevenir la transmisión.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Denning PH, DiNenno EA, Wiegand RE. Characteristics associated with HIV infection among heterosexuals in urban areas with high AIDS prevalence—24 cities, United States, 2006–2007. Morb Mortal Wkly Rep. 2011;60(31):1045–9.

    Google Scholar 

  2. Gillies P, Tolley K, Wolstenholme J. Is AIDS a disease of poverty? AIDS Care. 1996;8(3):351–64.

    CAS  PubMed  Google Scholar 

  3. Joint Center of Housing Studies of Harvard University. The state of the nation's housing, 2016. Cambridge: Joint Center for Housing Studies of Harvard University; 2016.

    Google Scholar 

  4. New York City Department of Homeless Services. Daily report. 2016; https://www1.nyc.gov/assets/dhs/downloads/pdf/dailyreport.pdf. Accessed 9 Aug 2017.

  5. Aidala AA, Wilson MG, Shubert V, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016;106(1):e1–e23.

    PubMed  PubMed Central  Google Scholar 

  6. Wolitski RJ, Kidder DP, Pals SL, 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.

    PubMed  Google Scholar 

  7. 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):S675–680.

    PubMed  PubMed Central  Google Scholar 

  8. Towe VL, Wiewel EW, Zhong Y, Linnemayr S, Johnson R, Rojas J. A randomized controlled trial of a rapid re-housing intervention for homeless persons living with HIV/AIDS: impact on housing and hiv medical outcomes. AIDS Behav. 2019;23(9):2315–25.

    PubMed  Google Scholar 

  9. Muthulingam D, Chin J, Hsu L, Scheer S, Schwarcz S. Disparities in engagement in care and viral suppression among persons with HIV. J Acquir Immune Defic Syndr. 2013;63(1):112–9.

    PubMed  Google Scholar 

  10. Weiser SD, Yuan C, Guzman D, et al. Food insecurity and HIV clinical outcomes in a longitudinal study of urban homeless and marginally housed HIV-infected individuals. AIDS. 2013;27(18):2953–8.

    PubMed  PubMed Central  Google Scholar 

  11. Williams CT, Kim S, Meyer J, et al. Gender differences in baseline health, needs at release, and predictors of care engagement among HIV-positive clients leaving jail. AIDS Behav. 2013;17(Suppl 2):S195–202.

    PubMed  Google Scholar 

  12. Milloy MJ, Marshall BD, Montaner J, Wood E. Housing status and the health of people living with HIV/AIDS. Curr HIV/AIDS Rep. 2012;9(4):364–74.

    PubMed  PubMed Central  Google Scholar 

  13. King WD, Larkins S, Hucks-Ortiz C, et al. Factors associated with HIV viral load in a respondent driven sample in Los Angeles. AIDS Behav. 2009;13(1):145–53.

    PubMed  Google Scholar 

  14. 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(12):2238–45.

    PubMed  PubMed Central  Google Scholar 

  15. Bowen EA, Canfield J, Moore S, Hines M, Hartke B, Rademacher C. Predictors of CD4 health and viral suppression outcomes for formerly homeless people living with HIV/AIDS in scattered site supportive housing. AIDS Care. 2017;29(11):1458–62.

    PubMed  Google Scholar 

  16. Galarraga O, Rana A, Rahman M, et al. The effect of unstable housing on HIV treatment biomarkers: an instrumental variables approach. Soc Sci Med (1982). 2018;214:70–82.

    Google Scholar 

  17. Marcus R, Groot AD, Bachman S, et al. Longitudinal determinants of housing stability among people living with HIV/AIDS experiencing homelessness. Am J Public Health. 2018;108(S7):S552–S56060.

    PubMed  PubMed Central  Google Scholar 

  18. Lim S, Nash D, Hollod L, Harris TG, Lennon MC, Thorpe LE. Influence of jail incarceration and homelessness patterns on engagement in HIV care and HIV viral suppression among New York City adults living with HIV/AIDS. PLoS ONE. 2015;10(11):e0141912.

    PubMed  PubMed Central  Google Scholar 

  19. Levanon Seligson A, Lim S, Singh T. New York/New York III supportive housing evaluation: interim utilization and cost analysis. New York: New York City Department of Health and Mental Hygiene; 2013.

    Google Scholar 

  20. U.S. Housing and Urban Development. Housing First in permanent supportive housing. 2014.

  21. Lee CT, Winquist A, Wiewel EW, et al. Long-term supportive housing is associated with decreased risk for new HIV diagnoses among a large cohort of homeless persons in New York City. AIDS Behav. 2018;22(9):3083–90.

    PubMed  Google Scholar 

  22. Hall G, Singh T, Lim SW. Supportive housing promotes AIDS-free survival for chronically homeless HIV positive persons with behavioral health conditions. AIDS Behav. 2019;23:776–83.

    PubMed  Google Scholar 

  23. Lim S, Singh TP, Gwynn RC. Impact of a supportive housing program on housing stability and sexually transmitted infections among New York City young adults aging out of foster care. Am J Epidemiol. 2017;186:297–304.

    PubMed  Google Scholar 

  24. Lim S, Gao Q, Stazesky E, Singh TP, Harris TG, Levanon SA. Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness. BMC Health Serv Res. 2018;18(1):15.

    PubMed  PubMed Central  Google Scholar 

  25. IBM InfoSphere QualityStage [computer program]. Armonk, NY;2011.

  26. Arcaya MC, Graif C, Waters MC, Subramanian SV. Health Selection into neighborhoods among families in the moving to opportunity program. Am J Epidemiol. 2016;183(2):130–7.

    PubMed  Google Scholar 

  27. Levenshtein VI. Binary codes capable of correcting deletions, insertions, and reversals. Doklady Akademii Nauk SSSR. 1965;163(4):845–8.

    Google Scholar 

  28. Ward JH Jr. Hierarchical grouping to optimize an objective function. J Am Stat Assoc. 1963;58:236–44.

    Google Scholar 

  29. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.

    PubMed  Google Scholar 

  30. HIV/AIDS Services Administration. HASA facts, August 2017. New York: New York City Human Resources Administration; 2017.

    Google Scholar 

  31. Kerker BD, Bainbridge J, Kennedy J, et al. A population-based assessment of the health of homeless families in New York City, 2001–2003. Am J Public Health. 2011;101(3):546–53.

    PubMed  PubMed Central  Google Scholar 

  32. Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11(6 Suppl):101–15.

    PubMed  Google Scholar 

  33. Beattie CM, Wiewel EW, Zhong Y, et al. Multilevel factors associated with a lack of viral suppression among persons living with HIV in a federally funded housing program. AIDS Behav. 2019;23(3):784–91.

    PubMed  Google Scholar 

  34. Kim C, Kerr T, Li K, et al. Unstable housing and hepatitis C incidence among injection drug users in a Canadian setting. BMC Public Health. 2009;9(1):270.

    PubMed  PubMed Central  Google Scholar 

  35. Tsemberis S, Gulcur L, Nakae M. Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. 2004;94(4):651–6.

    PubMed  PubMed Central  Google Scholar 

  36. Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community Ment Health J. 2011;47(2):227–32.

    PubMed  Google Scholar 

  37. Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing first for homeless persons with active addiction: are we overreaching? Milbank Q. 2009;87(2):495–534.

    PubMed  PubMed Central  Google Scholar 

  38. Palepu A, Patterson M, Moniruzzaman A, Frankish CJ, Somers J. Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders. Am J Public Health. 2013;103(Suppl 2):e30–36.

    PubMed  PubMed Central  Google Scholar 

  39. Larimer ME, Malone D, Garner MD, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009;301(13):1349–57.

    CAS  PubMed  Google Scholar 

  40. Lim S, Singh TP, Hall G, Walters S, Gould LH. Impact of a New York City supportive housing program on housing stability and preventable health care among homeless families. Health Serv Res. 2018;53:3437–54.

    PubMed  PubMed Central  Google Scholar 

  41. LevanonSeligson A, Johns M, Lim S, Singh T. Interim report on the New York/New York III supportive housing evaluation. New York: New York City Department of Health and Mental Hygiene; 2010.

    Google Scholar 

  42. Somers JM, Moniruzzaman A, Patterson M, et al. A randomized trial examining housing first in congregate and scattered site formats. PLoS ONE. 2017;12(1):e0168745–e01687450168745.

    PubMed  PubMed Central  Google Scholar 

  43. Stergiopoulos V, Hwang SW, Gozdzik A, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. JAMA. 2015;313(9):905–15.

    CAS  PubMed  Google Scholar 

  44. HIV Epidemiology and Field Services Program. Medical care and clinical status among persons with HIV in New York City, 2014. New York City: New York City Department of Health and Mental Hygiene; 2015.

    Google Scholar 

  45. Lim S, Harris TG, Nash D, Lennon MC, Thorpe LE. All-cause, drug-related, and HIV-related mortality risk by trajectories of jail incarceration and homelessness among adults in New York City. Am J Epidemiol. 2015;181(4):261–70.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

All authors contributed substantially to the conception, design, analysis, and/or interpretation of data for this paper. All participated in critical revisions, approved this final version, and agree to be accountable for all aspects of the work. The authors thank the New York/New York III supportive housing consumers and agencies, whose participation in the New York/New York III program and completion of applications made it possible to conduct this analysis. We thank multiple agencies that provided data and/or conducted data linkage for this program evaluation, or that provided input about the evaluation. These include the New York City Human Resources Administration, and within it, Customized Assistance Services and the HIV/AIDS Services Administration; the New York State Office of Mental Health; the New York City Department of Correction; the New York City Department of Health and Mental Hygiene, and within it, the Office of IT Informatics, Bureau of Vital Statistics, Bureau of HIV/AIDS Prevention and Control, and Bureau of Mental Health; and the New York City Department of Homeless Services. Thank you to Eleonora Jimenez-Levi and Luis Roberto Rodriguez-Porras for their assistance in preparing the Spanish language abstract.

Funding

At the time of this analysis, all authors worked for the New York City Department of Health and Mental Hygiene, which, in conjunction with New York State, funds and oversees the supportive housing being evaluated. No grants, equipment, or drugs were used for this analysis; no support was received from NIH, Wellcome, or HHMI. Early and partial versions of the findings of this manuscript were presented at the International Conference on HIV Treatment and Prevention Adherence (2016: poster 23; 2017: poster 123).

Author information

Affiliations

  1. Division of Disease Control, New York City Department of Health and Mental Hygiene, 42-09 28 th Street, CN-44, Long Island City, NY, 11101, USA

    Ellen W. Wiewel, Yaoyu Zhong, Christopher M. Beattie, Sarah L. Braunstein & John Rojas

  2. Division of Epidemiology, New York City Department of Health and Mental Hygiene, 42-09 28 th Street, CN-44, Long Island City, NY, 11101, USA

    Tejinder P. Singh, Sungwoo Lim & Sarah Walters

Authors
  1. Ellen W. Wiewel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tejinder P. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yaoyu Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher M. Beattie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sungwoo Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sarah L. Braunstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John Rojas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellen W. Wiewel.

Ethics declarations

Conflict of interest

All authors are not engaged in any financial or other contractual agreements with potential conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wiewel, E.W., Singh, T.P., Zhong, Y. et al. Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder. AIDS Behav 24, 3252–3263 (2020). https://doi.org/10.1007/s10461-020-02810-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-020-02810-8

Keywords

  • Housing
  • HIV/AIDS
  • Medical care
  • Evaluation
  • Mental health