Attention to the relevance and health impacts of eviction for poor Americans has increased in recent years [11, 13]. However, there is a gap in our knowledge regarding both the extent of landlord-related forced moves (that are inclusive of, but not restricted to, legal evictions) and the impact of landlord-related forced moves on HIV risk. In the current study, we examined the prevalence of landlord-related forced moves (both through legal eviction and other types of landlord-related forced moves) and whether the disruption of a landlord-related forced move was associated with HIV sexual risk among a sample of low-income residents in New Haven, Connecticut. We found that landlord-related forced moves were common for our participants. Furthermore, consistent with expectations, we found robust associations between landlord-related forced moves and HIV sexual risk across a broad range of outcomes. We elaborate on key findings and their implications below.
Approximately one in five participants (21%) reported a landlord-related forced move in the past two years. Similar to existing literature , we found that legal eviction represented only a portion of those who experienced a landlord-related forced move. The findings serve as a reminder that a narrow focus on eviction fails to capture the broad ways in which landlords may exert power over their tenant(s). This is of critical importance in a housing scarce environment in which many low-income tenants have limited negotiating power . Collectively, the findings from this growing body of research point to the importance of broadening conceptualization of landlord-related forced moves so that we may fully understand not only the scope of the problem but also its impacts.
Furthermore, our findings suggest that the social and economic impacts of landlord-related forced moves may have consequences for sexual vulnerability. That is, as hypothesized, we found that forced moves were consistently and positively associated with sexual risk across all but one outcome. Specifically, individuals who experienced a landlord-related forced move were more likely to report unprotected sex, concurrent sex, and transactional sex (i.e., providing sex for money, drugs, or housing). There are multiple pathways through which forced moves might impact these sexual practices . For example, the stress of a landlord-related forced move may decrease psychological well-being and/or negatively impact negotiating power within a relationship, thereby affecting one’s ability to use and/or interest in using protection when having sex. A landlord-related forced move may also negatively impact partnership stability, which may in turn lead an individual to seek out housing with someone else who might become a sexual partner out of necessity. This may increase their likelihood of reporting multiple partners (concurrency) and/or exchanging sex for a place to stay. Future research might examine whether psychological well-being and social network disruptions are explanatory mediators of the association between landlord-related forced moves and sexual risk.
Our finding that landlord-related forced moves are associated with HIV sexual risk builds on prior work examining the impact of eviction on HIV risk and/or poor HIV outcomes. For example, in a prior ecological study conducted by our team, county-level eviction rates were associated with county-level rates of both chlamydia and gonorrhea . A prospective cohort study with drug-using Canadian youth also found eviction to be associated with increased risk of syringe sharing . Finally, and similarly, another prospective cohort study in Vancouver with people who inject drugs (PWID) found residential eviction to be associated with increased risk of violence, increased odds of methamphetamine initiation or relapse, and increased odds of detectable HIV-1 RNA viral load (among HIV positive PWID) [5,6,7].
There are several limitations to the current analyses. First, the cross-sectional design limits our ability to infer a causal relationship between landlord-related forced moves and HIV risk. While the exposure to landlord-related forced moves covered the prior two years and the sexual risk behaviors were reported for the past six months, it is possible that in some cases, the sexual risk behavior preceded the landlord-related forced move. Future longitudinal studies are needed to ascertain the temporal relationship and the pathways through which landlord-related forced moves impact sexual risk. Additionally, and relatedly, future longitudinal studies should examine whether the same issues that cause the landlord-related forced move, such as severe drug problems, also drive sexual risk.
Second, some items in our measurement of landlord-related forced moves did not specifically reference the landlord (e.g., I was forced to move because I was accused of illegal drug activities). However, we included these due to the high likelihood that these items are landlord related . Furthermore, sensitivity analysis indicated the findings were consistent even with the exclusion of these items in the creation of the landlord-related forced move variable. Nonetheless, qualitative research can help to better understand low-income individuals’ experiences with landlord-related forced moves.
Third, our self-reported measures of sexual behavior are imperfect markers of HIV risk. For example, unsafe sex is only risky in terms of HIV acquisition within specific relationship contexts. For example, with regards to HIV, unprotected sex is not risky in a fully monogamous relationship in which both partners are HIV negative. Additionally, our measure of partner concurrency is based on respondents’ assessment of their partners’ behavior and may either under or over report partner concurrency. Of note, in longitudinal qualitative interviews with our participants, participants were able to recognize when their partner was engaging in other sexual relationships. Despite these limitations, unsafe sex and perceived partner concurrency have each been associated with HIV and/or STI acquisition across numerous studies (e.g., [27, 32,33,34] and are both common measures of HIV risk in the absence of costly seroincidence data. Moreover, a major strength of our findings is the consistency of the associations observed across multiple individual markers of HIV sexual risk using our HIV sexual risk composite. Nonetheless, future studies might examine whether the association between landlord-related forced moves and HIV sexual risk varies within specific relationship contexts.
By focusing on landlord-related forced moves as a specific form of housing instability, while simultaneously expanding the definition of eviction to include landlord-related forced moves, our study contributes to understanding the potential impacts of housing instability on HIV sexual risk. Most of the extant research on forced moves to date focuses on legal eviction even though there are multiple other ways in which landlords may force tenants out before undertaking a legal eviction. Further, most research exploring the relationship between housing and HIV/AIDS in greater depth has focused on unstable housing more broadly [36,37,38,39,40], rather than on the impacts of evictions and other landlord-related forced moves, specifically.
Based on our findings, housing interventions that reduce evictions and/or other landlord-related forced moves may impact HIV sexual risk. Specifically, eviction prevention programs that provide tailored support to individuals and/or households facing a landlord-related forced move may prevent forced moves and decrease HIV sexual risk. Such programs may include tenants-right workshops, advocacy, legal representation, and/or emergency funding [41, 42]. Evidence from studies like ours can be used by eviction prevention leaders and community-based groups to demonstrate the potential health consequences of landlord-related forced moves in their efforts to advocate for protections against forced moves . Finally, in cases where a forced move is unavoidable, interventions might provide individuals and/or households with access to and/or referrals for rapid rehousing, counseling, social services, and other resources.
Of course, while services for those facing housing crises are critical for maintaining existing housing, minimizing the disruption of a forced move, or avoiding homelessness, such efforts do not address one of the largest underlying drivers of landlord-related forced moves. That is, most evictions occur because of non-payment of rent, which is primarily a result of a shortage of affordable housing for low-income Americans [2, 3]. As such, broader policy approaches, such as expanding rental subsidies to offset the severe rent burden that many low-income households face, or addressing zoning policies that place undue burdens on cities to provide affordable housing, may have even more substantial and lasting health impacts.