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Access to Housing as a Structural Intervention for Homeless and Unstably Housed People Living with HIV: Rationale, Methods, and Implementation of the Housing and Health Study

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Abstract

Homelessness and unstable housing have been associated with HIV risk behavior and poorer health among persons living with HIV/AIDS (PLWHA), yet prior research has not tested causal associations. This paper describes the challenges, methods, and baseline sample of the Housing and Health Study, a longitudinal, multi-site, randomized controlled trial investigating the effects of providing immediate rental housing assistance to PLWHA who were homeless or at severe risk of homelessness. Primary outcomes included HIV disease progression, medical care access and utilization, treatment adherence, mental and physical health, and risks of transmitting HIV. Across three study sites, 630 participants completed baseline sessions and were randomized to receive either immediate rental housing assistance (treatment group) or assistance finding housing according to local standard practice (comparison group). Baseline sessions included a questionnaire, a two-session HIV risk-reduction counseling intervention, and blood sample collection to measure CD4 counts and viral load levels. Three follow-up visits occurred at 6, 12, and 18 months after baseline. Participants were mostly male, Black, unmarried, low-income, and nearly half were between 40 and 49 years old. At 18 months, 84% of the baseline sample was retained. The retention rates demonstrate the feasibility of conducting scientifically rigorous housing research, and the baseline results provide important information regarding characteristics of this understudied population that can inform future HIV prevention and treatment efforts.

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Notes

  1. Income for HOPWA eligibility is 80% of the area median income, but was lower for the purposes of this study.

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Acknowledgments

We would like to thank the many people who made this study a success. In addition to the authors of this paper, the Housing and Health Study members (in alphabetical order) include Arturo Bendixen (AIDS Foundation of Chicago), Kate Briddell (City of Baltimore, Department of Housing and Community Development), Shahry Deyhimy (City of Los Angeles Housing Department), Paul Dornan (HUD), Myrna Hooper (Housing Authority of the City of Los Angeles), Jennafer Kwait (RTI), Fred Licari (RTI), Shirley Nash (City of Chicago Department of Public Health), Sherri L. Pals (CDC), William Rudy (HUD), and David Vos (HUD). We would also like to acknowledge the contributions of Rusty Bennett, Maria Caban, Sylvia Cohn, Lynne Cooper, Jay Cross, Maria DiGregorio, Clyde Hart, Kirk Henny, Kelly Kent, Lee Lam, Eugene Little, Ellen McCarty and Jerusalem House, Joyce Moon Howard, Noelle Richa, Danny Ringer, Randy Russell, Ruth Schwartz, and Tom Spira. We would like to thank the collaborating HUD grantee agencies in each city as follows: City of Baltimore Department of Housing and Community Development, City of Chicago Department of Public Health, AIDS Foundation of Chicago, City of Los Angeles Housing Department, Housing Authority of the City of Los Angeles, Shelter Partnership, Housing Authority of the County of Los Angeles, County of Los Angeles Office of AIDS Programs and Policies, Los Angeles Homeless Services Authority. Funding for the research study was provided by the Centers for Disease Control and Prevention to RTI under contract 200-2001-0123, Task 9 and funding for tenant-based rental housing assistance was provided by the Department of Housing and Urban Development.

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-37, Atlanta, GA, 30333, USA

    Daniel P. Kidder, Richard J. Wolitski & Cari Courtenay-Quirk

  2. Abt Associates, Bethesda, MD, USA

    Scott Royal

  3. Mailman School of Public Health, Columbia University, New York, NY, USA

    Angela Aidala

  4. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    David R. Holtgrave

  5. Department of Housing and Urban Development, Washington, DC, USA

    David Harre

  6. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Esther Sumartojo

  7. School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Ron Stall

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for the Housing and Health Study Team

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Correspondence to Daniel P. Kidder.

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The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Department of Housing and Urban Development.

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Kidder, D.P., Wolitski, R.J., Royal, S. et al. Access to Housing as a Structural Intervention for Homeless and Unstably Housed People Living with HIV: Rationale, Methods, and Implementation of the Housing and Health Study. AIDS Behav 11 (Suppl 2), 149–161 (2007). https://doi.org/10.1007/s10461-007-9249-0

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