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Socioeconomic, Behavioral, and Clinical Characteristics of Persons Living with HIV Who Experience Homelessness in the United States, 2015–2016

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Abstract

Homelessness is a substantial barrier to consistent, recommended HIV care, access and adherence to antiretroviral therapy (ART), and sustained viral suppression, thus increasing the risk for morbidity and transmission. We used data from the Medical Monitoring Project for June 1, 2015–May 31, 2017 to estimate the weighted prevalence of homelessness among persons with diagnosed HIV (PWH) (N = 7665) overall and by selected sociodemographic, behavioral, and clinical characteristics. Prevalence of homelessness was 8.5%. PWH experiencing homelessness were > 3 times as likely to have needed and not received shelter or housing services (32% vs. 10%), > 4 times as likely to inject drugs (9% vs. 2%), and > 7 times as likely to engage in exchange sex (10% vs. 1%), respectively, compared with PWH who did not experience homelessness. Homelessness was associated with lower HIV care retention, ART dose adherence, and sustained viral suppression. This analysis demonstrates substantial need for enhanced treatment, care, and service delivery for PWH experiencing homelessness. Research has demonstrated that housing assistance programs improve HIV-related outcomes and diminish HIV risk behaviors; therefore, housing assistance for PWH should be prioritized in public health policies and practice.

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Acknowledgements

We thank the Medical Monitoring Project participants, project area staff, and Provider and Advisor Board members. We also acknowledge the contributions of the Clinical Outcomes Team and Behavioral and Clinical Surveillance Branch at the Centers for Disease Control and Prevention and Ms. Cheryll Kay Smith for critical review and copy-editing of the manuscript.

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Authors and Affiliations

  1. College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA

    Jacob J. Wainwright

  2. Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Jacob J. Wainwright & Hazel D. Dean

  3. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA

    Linda Beer, Yunfeng Tie & Jennifer L. Fagan

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Correspondence to Linda Beer.

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Wainwright, J.J., Beer, L., Tie, Y. et al. Socioeconomic, Behavioral, and Clinical Characteristics of Persons Living with HIV Who Experience Homelessness in the United States, 2015–2016. AIDS Behav 24, 1701–1708 (2020). https://doi.org/10.1007/s10461-019-02704-4

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  • DOI: https://doi.org/10.1007/s10461-019-02704-4

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