Journal of General Internal Medicine

, Volume 15, Issue 10, pp 731–738 | Cite as

Housing status and health care service utilization among low-income persons with HIV/AIDS

  • Meredith Y. Smith
  • Bruce D. Rapkin
  • Gary Winkel
  • Carolyn Springer
  • Rosy Chhabra
  • Ira S. Feldman
Populations At Risk


OBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults.

DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997.

MAIN RESULTS: Six percent of study participants were homeless, 24.5% were “doubled-up,” and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physician regularly (P=.0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P=.02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit (P=.007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After multivariate adjustment, doubled-up participants were found to make more emergency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeless were shown to use slightly more outpatient care than the stably housed.

CONCLUSION: Our study documents differences in health care utilization patterns across stably housed, doubled-up, and homeless HIV-infected persons after controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and hence may be more likely to experience adverse clinical outcomes.

Key Words

housing homelessness doubled-up human immunodeficiency virus (HIV) health care services utilization 


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  1. 1.
    Arno PS, Bonuck KA, Green J, et al. The impact of housing status on health care utilization among persons with HIV disease. J Health Care Poor Underserved. 1996;7:36–49.PubMedGoogle Scholar
  2. 2.
    Allen DM, Lehman JS, Green TA, et al. HIV infection among homeless adults and runaway youth, United States, 1989–1992. AIDS. 1994;8:1593–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Green J, Arno PS. The “Medicaidization” of AIDS: trends in the financing of HIV-related medical care. JAMA. 1990;264:1261–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Torres RA, Mani S, Altholz J, Brickner PW. Human immunodeficiency virus infection among homeless men in a New York City shelter: association with Mycobacterium tuberculosis infection. Arch Intern Med. 1990;150:2030–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Wojtusik L, White MC. Health status, needs, and health care barriers among the Homeless. J Health Care Poor Underserved. 1998;9:140–52.PubMedGoogle Scholar
  6. 6.
    Weinreb L, Goldberg R, Perloff J. Health characteristics and medical services patterns of sheltered homeless and low income housed mothers. J Gen Intern Med. 1998;13:3890–7.CrossRefGoogle Scholar
  7. 7.
    Cousineau MR. Health status of and access to health services by residents of urban encampments in Los Angeles. J Health Care Poor Underserved. 1997;8:70–82.PubMedGoogle Scholar
  8. 8.
    Messeri P. Community Health Advisory and Information Network: Access to primary care and change in health status. Update report #6. New York: Joseph Mailman School of Public Health, Columbia University; 1996.Google Scholar
  9. 9.
    Shapiro M, Morton S, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. JAMA. 1999;281:2305–15.PubMedCrossRefGoogle Scholar
  10. 10.
    Wright BRE, Caspi A, Moffitt TE, Silva PA. Factors associated with doubled-up housing—a common precursor to homelessness. Soc Serv Rev. 1998;92–111.Google Scholar
  11. 11.
    O’Toole TP, Gibbon JL, Hanusa BH, Fine MJ. Utilization of health care services among subgroups of urban homeless and housed poor. J Health Polit Policy Law. 1999;24:91–114.PubMedGoogle Scholar
  12. 12.
    Shinn M, Knickman JR, Weitzman BC. Social relationships and vulnerability to becoming homeless among poor families. Am Psych. 1991;46:1180–7.CrossRefGoogle Scholar
  13. 13.
    Clement M, Hollander H. Natural history and management of the seropositive patient. In: Sande MA, Volberding PA, eds. The Medical Management of AIDS. 3rd ed. Philadelphia: WB Saunders; 1992:91.Google Scholar
  14. 14.
    Mor V, Fleishman JA, Dresser M, Piette J. Variation in health service use among HIV-infected patients. Med Care. 1992;1:17–29.CrossRefGoogle Scholar
  15. 15.
    Crystal S, Sambamoorthi U, Merzel C. The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts. Health Serv Res. 1995;30:593–614.PubMedGoogle Scholar
  16. 16.
    Piette JD, Mor V, Mayer K, Zierler S, Wachtel T. The effects of immune status and race on health service use among people with HIV disease. Am J Public Health. 1993;83:510–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Andersen RM, Newman J. Societal and individual determinants of medical care utilization in the United States. Mil Mem Fund Quart. 1973;51:95–124.CrossRefGoogle Scholar
  18. 18.
    Rossi P. Down and Out in America. Chicago: U Chicago Press; 1989.Google Scholar
  19. 19.
    Bozzette S, Hays R, Berry, Kanouse D, Wu A. Derivation and psychometric properties of a brief quality of life measure for HIV. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8:253–65.PubMedGoogle Scholar
  20. 20.
    Draper NR, Smith H. Applied Regression Analysis. New York: John Wiley; 1998:340–2.Google Scholar
  21. 21.
    Bonuck KA, Arno PS, Social and medical factors affecting hospital discharge of persons with HIV/AIDS. J Community Health. 1997;22:225–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Zolopa AR, Hahn JA, Gorter RG, 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
  23. 23.
    Brudney K. Homelessness and TB: a study in failure. J Law Med Ethics. 1993;21:360–7.PubMedGoogle Scholar
  24. 24.
    Bangsberg D, Tulsky JP, Hecht FM, Moss AR. Protease inhibitors in the homeless. JAMA. 1997;278:63–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Messeri P, Weinberg G. Community Health Advisory and Information Network: The introduction of combination therapies. Update report #1. New York: Joseph Mailman School of Public Health, Columbia University; 1997.Google Scholar
  26. 26.
    Community HIV Prevention and Primary Care Initative. The AIDS Institute, New York State Department of Health. 1996;57–91.Google Scholar
  27. 27.
    Cunningham WE, Rana HM, Shapiro MF, Hays RD. Reliability and validity of self-report CD4 counts in persons hospitalized with HIV disease. J Clin Epidemiol. 1997;50:829–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Fleishman JA, Sia DC, Hellinger FJ. Correlates of medical service utilization among people with HIV infection. Health Serv Res. 1994;29:527–48.PubMedGoogle Scholar
  29. 29.
    Markson LE, Houchens R, Fanning TR, Turner BJ. Repeated emergency department use by HIV infected persons: Effect of clinic accessibility and expertise in HIV care. J Acq Immune Defic Syndr Hum Retrovirol. 1998;17:35–41.Google Scholar
  30. 30.
    New Medicaid reimbursement rates for HIV primary care visits. Albany, NY: New York State Department of Health; 1991. Health Facility Series: H-86, D & TC - 45, HMO-39 89-99.Google Scholar

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Meredith Y. Smith
    • 1
  • Bruce D. Rapkin
    • 2
  • Gary Winkel
    • 1
  • Carolyn Springer
    • 2
  • Rosy Chhabra
    • 2
  • Ira S. Feldman
    • 3
  1. 1.Derald H. Ruttenberg Cancer CenterMount Sinai School of MedicineNew York
  2. 2.Department of PsychiatryMemorial Sloan-Kettering Cancer CenterNew York
  3. 3.AIDS InstituteNew York State Department of HealthAlbany

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