Breaking the Link Between Homelessness and HIV
Homelessness is both a cause and an effect of HIV infection.
People coping with homelessness are at greater risk of becoming infected with HIV and people living with HIV/AIDS experience high rates of housing loss and instability.
Homelessness increases the risk of HIV infection:
- The pressure of daily survival needs, exposure to violence, substance use as a way to cope with stress or mental health issues, and other conditions of homelessness make homeless and unstably housed persons extremely vulnerable to HIV infection.1
- The people most at risk of HIV -- men who have sex with men, persons of color, homeless youth, IV drug users, and impoverished women -- are significantly more likely to become HIV infected over time if they lack stable housing.2
- People who are homeless or unstably housed have HIV infection rates as much as 16 times higher than people who have a stable place to live.3
HIV infection increases the risk of homelessness:
- At least half of all people living with HIV/AIDS experience homelessness or housing instability.4
- Housing is the greatest unmet need of people living with HIV.5
- For many people with HIV, problems finding and keeping stable housing are exacerbated by discrimination related to HIV, sexual orientation, race, culture, mental health issues, substance use and/or involvement with the criminal justice system.6
For people with HIV/AIDS, housing is a matter of life or death:
- People with HIV/AIDS who are homeless or unstably housed have worse overall physical and mental health. Their CD4 counts are lower and their viral loads are higher. They are less likely to receive and adhere to antiretroviral therapy, and they are more likely to die prematurely.7
- Low-income people with HIV/AIDS who receive housing assistance have better access to health care services, their physical and mental health improves, and they live longer.8
- Over time, stable housing can significantly reduce avoidable emergency and hospital care. The savings in health care costs can offset the cost of housing interventions.9
What's Needed: Evidence-Based HIV/AIDS Housing Policy
- Make safe, affordable housing available to all people living with HIV
- Make housing assistance a top HIV prevention priority
- Continue to collect the data needed to inform HIV housing policy
- Aidala, A. & Sumartojo, E. (2007). Why housing? AIDS & Behavior, 11(6)/Supp 2: S1-S6.
- See, e.g.: Marshall, B., Kerr, T., Shoveller, J., et al. (2009). Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health and Place, 15(3): 753-760; Stein, J.A., Nyamathi, A.M., Zane, J.I. (2009). Situational, psychosocial and physical health related correlates of HIV/AIDS risk behaviors in homeless men. American Journal of Men's Health, 3(1): 25-35; Wenzel, S., Tucker, J., Elliot, M., et al. (2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS & Behavior, 11(6)/ Supp 2: S9-S20; Kipke, M.D., Weiss, G., & Wong, C.F. (2007). Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS & Behavior, 11(6)/Supp 2: S56-S69; Marshall, B., Wood, E., Li, K., et al. (2007). Elevated syringe borrowing among men who have sex with men: A prospective study. JAIDS, 46(2): 248-252.
- Kerker, B., Bainbridge, J., Li, W., et al. (2005). The health of homeless adults in New York City: A report from the New York City Departments of Health and Mental Hygiene and Homeless Services; Robertson, M., Clark, R., Charlebois, E., et al. (2004). HIV seroprevalence among homeless adults in San Francisco. American Journal of Public Health, 94(7): 1207-1217; Culhane, D., Gollub, E., Kuhn, R., et al. (2001). The co-occurrence of AIDS and homelessness: Results from the integration of administrative data for AIDS surveillance and public shelter utilization in Philadelphia. Journal of Epidemiology & Community Health, 55(7): 515-520.
- Rourke, S.B., Tucker, R., Monette, L., et al. (2010). Positive spaces healthy places: Identifying those in greatest need three years later. Presented at the North American Housing and HIV/AIDS Research Summit V, Toronto, Ontario, June 2010; Aidala, A., Lee, G., Abramson, D., et al. (2007). Housing need, housing assistance, and connection to medical care, AIDS & Behavior, 11(6)/Supp 2: S101-S115.
- Bekele, T., Rourke, S.B., Tucker, R., et al. (in press). Direct and indirect effects of social support on heath-related quality of life among persons living with HIV/AIDS: Results from the Positive Spaces Health Places Study. AIDS Care; Shubert, V. & Bernstine, N. (2007). Moving from fact to policy: Housing is HIV prevention and health care. AIDS & Behavior, 11(6)/Supp 2: 167-S171.
- Greene, S., Tucker, R., Rourke, S.B., et al. (2010). "Under My Umbrella": The housing experiences of HIV positive parents who live with and care for their children in Ontario. Archives of Women's Mental Health, 13(3): 223-232; Purcell, D.W. and McCree, D.H. (2009). Recommendations from a research consultation to address intervention strategies for HIV/AIDS prevention focused on African American, American Journal of Public Health, 99(11): 1937-1940; Monette, L., Rourke, S.B., Tucker, R., et al. (2009). Housing status and health outcomes in Aboriginal people living with HIV/AIDS in Ontario: The Positive Spaces, Healthy Places Study. Canadian Journal of Aboriginal Community-Based HIV/AIDS Research, 2: 41-60; Wolitski, R.J., Pals, S.L., Kidder, D.P., Courtenay-Quirk, C., & Holtgrave, D.R. (2009). The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS & Behavior, 13(6): 1222-1232.
- Rourke, S.B., et al., 2010; Kidder, D., Wolitski, R., Campsmith, M., & Nakamura, G. (2007). Health status, health care use, medication use, and medication adherence in homeless and housed people living with HIV/AIDS. American Journal of Public Health, 97(12): 2238-2245; Leaver, C.A., Bargh, G., Dunn, J.R., et al. (2007). The effects of housing status on health-related outcomes in people living with HIV: A systematic review of the literature. AIDS & Behavior, 11(6)/Supp 2: S85-S100; Aidala, A.A., Lee, G., Abramson, D.M., Messeri, P., & Siegler, A. (2007). Housing need, housing assistance, and connection to HIV medical care. AIDS & Behavior, 11(6)/Supp 2: 101-115.
- Wolitski, R.J., Kidder, D.P., Pals, S.L., et al. (2010). Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS & Behavior, 14(3): 493-503; Buchanan, D.R., Kee, R., Sadowski, L.S., et al. (2009). The Health Impact of Supportive Housing for HIV-Positive Homeless Patients: A Randomized Controlled Trial. American Journal of Public Health, 99/Supp 3: S675-S680.; Schwarcz, S.K., Hsu, L.C., Vittinghoff, E., et al. (2009). Impact of housing in the survival of people with AIDS. BMC Public Health, 9: 220.
- Wolitski, et al., 2010; Bauer, J., Battista, A., & Bamberger, J.D. (2010). Housing the homeless with HIV in San Francisco. Presented at the North American Housing and HIV/AIDS Research Summit V, Toronto, Ontario, June 2010.
- Wolitski, R., Kidder, D. & Fenton, F. (2007). HIV, homelessness, and public health: Critical Issues and a call for increased action. AIDS & Behavior, 11(6)/Supp 2: S167-S171.
- U.S. Centers for Disease Control and Prevention (2010). HIV/AIDS in the United States.
- Findings and recommendations from the Office of National AIDS Policy consultation on housing and HIV prevention and care, December 17, 2009. Available from the National AIDS Housing Coalition, Washington, D.C.
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