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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

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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.

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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).

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Authors and 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

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  1. Ellen W. Wiewel
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  2. Tejinder P. Singh
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Correspondence to Ellen W. Wiewel.

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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

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