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Single Room Occupancy Residence: Processes Linking Housing to Not Engaging in HIV Outpatient Care

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Abstract

Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents’ health and wellbeing.

Resumen

La indigencia y la inestabilidad de vivienda reducen la participación en la atención médica, la adherencia al tratamiento y la salud de las personas viviendo con VIH/SIDA. Sin embargo, los procesos mediante los cuales la vivienda inestable e insegura conllevan a resultados adversos de salud permanecen poco estudiados y son el enfoque de este manuscrito. En el 2012–2014, llevamos a cabo entrevistas cualitativas con pacientes hospitalizados con VIH desconectados de servicios de atención ambulatoria (n = 120). Analizamos el contenido de las entrevistas (n = 44) con participantes que residían en un programa de ocupación de habitación individual (SRO, por sus siglas en inglés), guiados por la Teoría del Estilo de Vida Saludable. Aunque el programa de ocupación de habitación individual surgió en las entrevistas como residencias antihigiénicas y propicias para el uso de drogas y la violencia, los participantes se mantuvieron en el programa de ocupación de habitación individual por largo tiempo. Esto generó experiencias de inestabilidad en la vivienda, inseguridad y falta de control que reforzó tendencias (habitus) y comportamientos antitéticos a adherirse a la atención médica. Pedimos investigaciones e intervenciones para transformar los programas de ocupación de habitación individual en viviendas que protejan la salud y el bienestar de sus residentes.

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Data Availability

Based on the IRB, only persons on the IRB protocol and affiliated with the study have access to the data.

Code Availability

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Funding

This manuscript is based on a grant funded by NIH R01 MH095849 (PI: Helen-Maria Lekas and Lisa Rosen-Metsch).

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Authors and Affiliations

  1. Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, Orangeburg, NY, USA

    Helen-Maria Lekas & Crystal Lewis

  2. Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA

    Helen-Maria Lekas & Crystal Lewis

  3. Benjamin N. Cardoso School of Law, Yeshiva University, New York, NY, USA

    Sara Lunden

  4. Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Susan Aileen Olender

  5. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Lisa Rosen-Metsch

Authors
  1. Helen-Maria Lekas
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  2. Crystal Lewis
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  3. Sara Lunden
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  4. Susan Aileen Olender
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  5. Lisa Rosen-Metsch
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Contributions

Drs. Lekas, Lewis, Olender, and Rosen-Metsch and Ms. Lunden all participated in the processes of data analysis and manuscript preparation. Dr. Lekas and Ms. Lunden also conducted the coding process and Drs. Lekas also participated in the collection of interview data.

Corresponding author

Correspondence to Helen-Maria Lekas.

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Conflict of Interest

None of the Authors have any conflict of interest.

Ethical Approval

As indicated on page 8 of the Blind copy of the manuscript: “The Institutional Review Board of the university and the hospital affiliated with the study and the authors approved the study.”

Consent to Participate

The consenting process was described in pages 7 and 8 of the Blind copy of the manuscript and was approved by the IRB of the university and hospital affiliated with the study and the authors: “Potentially eligible participants admitted to the hospital’s Adult Infectious Disease unit were initially identified through medical records. These individuals were then approached and asked to participate in the study. Those interested were screened for remaining eligibility criteria at bedside, and screening typically lasted 20–25 min. If eligible, informed consent was obtained and, in most cases, the interview took place immediately after the screening.”

Consent for Publication

The manuscript is based on verbatim excerpts from in-depth interviews and survey data. These data were elicited through patient interviews for which we obtained IRB permission. We have IRB permission to publish out findings, provided we de-identify the data which we did. We had also obtained a federal certificate of confidentiality to further protect the study participants’ confidentiality.

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Lekas, HM., Lewis, C., Lunden, S. et al. Single Room Occupancy Residence: Processes Linking Housing to Not Engaging in HIV Outpatient Care. AIDS Behav 25, 2644–2656 (2021). https://doi.org/10.1007/s10461-021-03225-9

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