Abstract
Homelessness and housing instability are significant public health issues that increase the risks of HIV acquisition and transmission and adversely affect the health of people living with HIV. This article highlights the contributions of selected papers in this special issue of AIDS and Behavior and considers them within the broader context of prior research on the associations between housing status and HIV risk, use of HIV medical care, adherence to HIV treatment, and the physical health of HIV-seropositive persons. Special recognition is given to the roles of interrelated health problems, such as substance abuse, poor mental health, and physical and sexual abuse, that often co-occur and exacerbate the challenges faced by those who are homeless or unstably housed. Taken as a whole, the findings indicate a critical need for public health programs to develop strategies that address the fundamental causes of HIV risk among homeless and unstably housed persons and, for those living with HIV, contribute to their risk of disease progression. Such strategies should include “mid-stream” and “upstream” approaches that address the underlying causes of these risks. The successful implementation of these strategies will require leadership and the formation of new partnerships on the part of public health agencies. Such efforts, however, may have significant effects on the individuals and communities most affected by HIV/AIDS.
Similar content being viewed by others
References
Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251–265.
Aidala, A. A., Lee, G., Abramson, D., Messeri, P., & Siegler, A. (2007). Housing need, housing assistance and engagement with HIV medical care. AIDS and Behavior (this issue).
Aidala, A., & Sumartojo, E. (2007). Why housing? AIDS and Behavior (this issue).
Allen, D. M., Lehman, S., Green, T. A., Lindegren, M. L., Onorato, I. M., Forrester, W., et al. (1994). HIV infection among homeless adults and runaway youth, United States, 1989–1992. AIDS, 8, 1593–1598.
Bangsberg, D. R. (2006). Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clinical Infectious Diseases, 43, 939–941.
Bangsberg, D. R., Hecht, F., Charlesbois, E., Zolopa, A., Holodniy, M., Sheiner, L., Bamberger, J. C. M., & Moss, A. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS, 14, 357–366.
Bangsberg, D. R., & Moss, A. (1999). When should we delay highly active antiretroviral therapy? Journal of General Internal Medicine, 14, 446–448.
Breakey, W. R. (1997). Editorial: It’s time for the public health community to declare war on homelessness. American Journal of Public Health, 87, 153–155.
Burt, M., Aron, L. Y., & Lee, E. (2001). Helping America’s homeless: Emergency shelter or affordable housing? Washington, DC: Urban Institute Press.
Centers for Disease Control, Prevention. (2002). Guidelines for using antiretroviral agents among HIV-infected adults and adolescents: Recommendations of the Panel on Clinical Practices for Treatment of HIV. MMWR, 51(RR-7), 1–64.
Coady, M. H., Latka, M. H., Thiede, H., Golub, E. T., Ouellet, L., Hudson, S. M., et al. (2007). Housing status and associated differences in HIV risk behaviors among young injection drug users. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9248-1.
Culhane, D. P., Gollub, E., Kuhn, R., & Shpaner, M. (2001). The co-occurrence of AIDS and homelessness: Results from the integration of administrative databases for AIDS surveillance and public shelter utilization in Philadelphia. Journal of Epidemiology and Community Health, 55, 515–520.
Dasinger, L., & Speiglman, R. (2007). Homelessness prevention: The effects of a shallow rent subsidy program on housing outcomes among people with HIV or AIDS. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9250-7.
DesJarlais, D. C., Braine, N., & Friedmann, P. (2007). Unstable housing as a factor for increased injection risk behavior at US syringe exchange programs. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9227-6.
Douaihy, A. B., Stowell, K. R., Bui, T., Daley, D., & Salloum, I. (2005). HIV/AIDS and homelessness, Part 1: Background and barriers to care. AIDS Reader, 15, 516–520, 527.
Eastwood, E. A., & Birnbaum, J. M. (2007). Physical and sexual abuse and unstable housing among adolescents with HIV. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9236-5.
Elifson, K. W., Sterk, C. E., & Theall, K. P. (2007). Safe living: The impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS and Behavior (this issue).
Estebanez, P. E., Russell, N. K., Aguilar, M. D., Beland, F., & Zunzunegui, M. V. (2000). Women, drugs and HIV/AIDS: Results of a multicentre European study. International Journal of Epidemiology, 29, 734–743.
Fenton, K. A., & Imrie, J. (2005). Increasing rates of sexually transmitted diseases in homosexual men in western Europe and the United States: Why? Infectious Disease Clinics of North America, 19, 311–331.
Gardner, L. I., Metsch, L. R., Anderson-Mahoney, P., Loughlin, A. M., del Rio, C., Strathdee, S., Sansom, S. L., Siegal, H. A., Greenberg, A. E., Holmberg, S. D., & the Antiretroviral Treatment, Access Study Group (2005). Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS, 19, 423–431.
German, D., Davey, M., & Latkin, C. A. (2007). Residential transience and HIV risk behaviors among injection drug users. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9238-3.
Gordon, A. J., Montlack, M. L., Freyder, P., Johnson, D., Bui, T., & Williams J. for the AIM-HIGH Team. (2007). The Allegheny Initiative for Mental Health Integration for the Homeless: Integrating heterogeneous health services for homeless persons. American Journal of Public Health, 97, 401–405.
Henny, K. D., Kidder, D. P., Stall, R., & Wolitski, R. J. (2007). Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9251-6.
Holtgrave, D. R., Briddell, K., Little, E., Bendixen, A. V., Hooper, M., Kidder, D. P., et al. (2007). Cost and threshold analysis of housing as an HIV prevention intervention. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9274-z.
Institute of Medicine. (1988). Homelessness, health and human needs. Washington, DC: National Academy Press, Institute of Medicine.
Kidder, D. P., Pals, S. L., Wolitski, R. J., Royal, S., & Stall, R. for the Housing and Health Study. (2006). HIV medication use, adherence, and disclosure to family members are associated with viral load in homeless or unstably housed HIV positive persons. Poster presented at the XVI International Conference on AIDS, Toronto, Ontario, Canada.
Kidder, D. P., Wolitski, R. J., Campsmith, M. L., & Nakamura, G. V. (in press). Health status, health care use, and medication adherence in homeless and housed people living with HIV. American Journal of Public Health.
Kidder, D. P., Wolitski, R. J., Royal, S., Aidala, A., Courtenay-Quirk, C., Holtgrave, D. R., et al. (2007). 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 and Behavior (this issue), doi: 10.1007/s10461-007-9249-0.
Knowlton, A., Arnsten, J., Eldred, L., Wilkinson, J., Gourevitch, M., Shade, S., et al. (2006) Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. Journal of Acquired Immune Deficiency Syndromes, 41, 486–492.
Krieger, J., & Higgins, D. L. (2002). Housing and health: Time again for public health action. American Journal of Public Health, 92, 758–768.
Kushel, M. B., Colfax, G., Ragland, K., Heineman, A., Palacio, H., & Bangsberg, D. R. (2006). Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clinical Infectious Diseases, 43, 234–242.
Leaver, C. A., Bargh, G., Dunn, J. R., & Hwang, S. W. (2007). The effects of housing status on health-related outcomes in people living with HIV: A systematic review of the literature. AIDS and Behavior (this issue).
Loughlin, A., Metsch, L., Gardner, L., Anderson-Mathoney, P., Barrigan, M., & Strathdee, S. (2004). Provider barriers to prescribing HAART to medically-eligible HIV-infected drug users. AIDS Care, 16, 485–500.
Lyles, C. M., Kay, L. S., Crepaz, N., Herbst, J. H., Passin, W. F., Kim, A. S., et al. (2007) Best-evidence interventions: Findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. American Journal of Public Health, 97, 133–143.
Montaner, J. S. G., Hogg, R., Wood, E., Kerr, T., Tyndall, M., Levy, A. R., et al. (2006). The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet, 368, 531–536.
Moss, A. R., Hahn, J. A., Perry, S., Charlebois, E. D., Guzman, D., Clark, R. A., et al. (2004). Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: A prospective study. Clinical Infectious Disease, 39, 1190–1198.
Nyamathi, A. M., Christiani, A., Windokun, F., Jones, T., Strehlow, A., & Shoptow, S. (2005). Hepatitis C virus infection, substance use and mental illness among homeless youth: A review. AIDS, 19(Suppl. 3), S34–S40.
O’Connell, J. J., Mattison, S., Judge, C. M., Allen, J. S., & Koh, H. K. (2005). A public health approach to reducing morbidity and mortality among homeless people in Boston. Journal of Public Health Management Practice, 11, 311–316.
O’Toole, T. P., Gibbon, J. L., Hanusa, B. H., Freyder, P. J., Conde, A. M., & Fine, M. J. (2004). Self-reported changes in drug and alcohol use after becoming homeless. American Journal of Public Health, 94, 830–835.
Rotheram-Borus, M. J., Koopman, C., Haignere, C., & Davies, M. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association, 266, 1237–1241.
Royal, S., Cohn, S., Kwait, J., Kidder, D., Wolitski, R., Stall, R., et al. (2006). Factors associated with adherence to HIV medications in homeless or unstably housed persons living with HIV. Poster presented at the XVI International Conference on AIDS, Toronto, Ontario, Canada.
Salazar, L. F., Crosby, R. A., Holtgrave, D. R., Head, S., Hadsock, B., Todd, J., et al. (2007). Homelessness and HIV-associated risk behavior among African American men who inject drugs and reside in the urban south of the United States. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9239-2.
Satcher, D. (2006). Ethnic disparities in health: The public’s role in working for equality. PLOS Medicine, 3(10), e405, doi:10.1371/journal.pmed.0030405.
Scott, A., Ellen, J., Clum, G., & Leonard, L. (2007). HIV and housing assistance in four US cities: Variations in local experience. AIDS and Behavior (this issue), doi: 10.1007/s10461-007-9247-2.
Smith, M. Y., Rapkin, B. D., Winkel, G., Springer, C., Chahabra, R., & Feldman, I. S. (2000). Housing status and health care service utilization among low-income persons with HIV/AIDS. Journal of General Internal Medicine, 15, 731–738.
Sumartojo, E. (2000). Structural factors in HIV prevention: Concepts, examples, and implications for research. AIDS, 14(Suppl. 1), S3–S10.
Thiele, B. (2002). The human right to adequate housing: A tool for promoting and protecting individual and community health. American Journal of Public Health, 92, 712–715.
Weir, B. W., Bard, R. S., O’Brien, K., Casciato, C. J., & Stark, M. J. (2007). Uncovering patterns of HIV risk through multiple housing measures: Implications for assessment and intervention. AIDS and Behavior (this issue).
Wenzel, S. L., Tucker, J. S., Elliott, M. N., & Hambarsoomains, K. (2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS and Behavior (this issue), doi: 10.1007/s10461-006-9193-4.
Zolopa, A. R., Hahn, J. A., Gorter, R., Miranda, J., Wlodarczyk, D., Peterson, J., et al. (1994). HIV and tuberculosis infection in San Francisco’s homeless adults—prevalence and risk factors in a representative sample. Journal of the American Medical Association, 272, 455–461.
Author information
Authors and Affiliations
Corresponding author
Additional information
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention
Rights and permissions
About this article
Cite this article
Wolitski, R.J., Kidder, D.P. & Fenton, K.A. HIV, Homelessness, and Public Health: Critical Issues and a Call for Increased Action. AIDS Behav 11 (Suppl 2), 167–171 (2007). https://doi.org/10.1007/s10461-007-9277-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-007-9277-9