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Precarious Housing Associated with Unsuppressed Viral load, sub-optimal Access to HIV Treatment and Unmet Health care Needs, Among Women Living with HIV in Metro Vancouver, Canada


We investigated associations between (1) housing status (four categories measuring housing stability) and outcomes along the HIV care continuum (not currently on antiretroviral therapy [ART]; sub-optimal ART adherence [< 95% in the last 3–4 weeks]; unsuppressed viral load [> 200 copies/ml], median CD4 < 200 in the last six months), and (2) housing status and unmet primary, dental and mental health care needs in the last six months among WLWH. Housing status was defined according to the Canadian Definition of Homelessness and had four categories: unsheltered (i.e., living in ≥ 1 unsheltered location [e.g., street, abandoned buildings]), unstable (i.e., living in ≥ 1 unstable location [e.g., shelter, couch surfing]), supportive housing (i.e., only living in supportive housing), and stable housing (i.e., only living in one’s own housing; reference). At baseline, in the last six months, 47.3% of participants reported unstable housing, followed by 24.4% unsheltered housing, 16.4% stable housing, and 11.9% supportive housing. Overall, 19.1% of the full sample (N = 336, 2010–2019) reported not currently on ART; among participants on ART, 28.0% reported sub-optimal ART adherence. Overall, 32.1% had recent unsuppressed viral load. Among a subsample (n = 318, 2014–2019), 15.7% reported unmet primary care needs, 26.1% unmet dental care needs, and 16.4% unmet mental health care needs. In adjusted models, being unsheltered (vs. stable housing) was associated with not currently on ART, unsuppressed viral load, and unmet primary and dental care needs. Housing and health services need to be developed with and for WLWH to address structural inequities and fulfill basic rights to housing and health.

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  1. In this study, quality of care was measured by six indicators of non-compliance with treatment initiation guidelines. At baseline, not having drug resistance testing before treatment; starting on a non-recommended regimen; starting therapy at CD4 < 200. During first-year follow-up, receiving < 3 CD4 tests; receiving < 3 viral load tests; not having viral load suppression within six months

  2. HIV care following guidelines: suppressed viral load, CD4 > 200, no gaps in ART > 3 months, and no gaps in CD4 or viral load measurement > 6 months [18].

  3. Sub-optimal HIV care: unsuppressed viral load, CD4 < 200 on 2 consecutive visits, ≥ 1 gap in ART > 3 months, or ≥ 1 gap in CD4 or viral load measurement > 12 months [18].


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Zhao, Y., Shannon, K., Buxton, J.A. et al. Precarious Housing Associated with Unsuppressed Viral load, sub-optimal Access to HIV Treatment and Unmet Health care Needs, Among Women Living with HIV in Metro Vancouver, Canada. AIDS Behav (2023).

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  • women
  • housing
  • houselessness
  • HIV care continuum
  • care access