Housing Is HIV Prevention
Housing assistance is a powerful way to prevent the spread of HIV.
People who have stable housing are less likely to acquire HIV infection or to transmit HIV infection to others -- regardless of other risks.
HIV prevention strategies will not succeed without attention to housing and other structural factors.1
Housing instability is a barrier to reducing HIV risk:
- People coping with homelessness and housing instability face enormous day-to-day challenges that affect their ability to reduce HIV risk.2
- Being unstably housed is associated with increased risk behavior and higher HIV infection rates -- after controlling for substance use, mental health issues, access to services, and other factors that contribute to risk.3
- Counseling, needle exchange, and other proven HIV prevention interventions are less effective at reducing HIV risk among people who are homeless or unstably housed.4
Housing status predicts HIV risk:
- People living with HIV/AIDS who are homeless or unstably housed are 2 to 6 times more likely to have recently used hard drugs, shared needles or engaged in high-risk sex.5
- Homeless women were as much as 5 times more likely to report drug use and sexual risk behaviors -- in part due to victimization by physical violence.6
- On the other hand, at-risk youth who had stable housing were significantly more likely to use condoms and less likely to have multiple sex partners.7
Housing assistance is HIV prevention:
- People with HIV/AIDS who are homeless or unstably housed who receive housing assistance are more likely to engage in medical care, reduce risk behaviors and enjoy better health.8
- When their housing situation improved, people living with HIV/AIDS reduced their drug related and sexual risk behaviors by as much as half, while those whose housing status worsened increased risky behaviors.9
- People with HIV who have access to stable housing are more likely to receive and adhere to antiretroviral medications, which lower viral load and reduce the risk of HIV transmission.10
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
- Include housing as a key component of HIV health care
- Continue to collect the data needed to inform HIV housing policy
- Purcell, D.W. & McCree, D.H. (2009). Recommendations from a research consultation to address intervention strategies for HIV/AIDS prevention focused on African Americans. American Journal of Public Health, 99(11): 1937-1940; Auerbach, J. (2009). Transforming social structures and environments to help in HIV prevention. Health Affairs, 28(6): 1655-1665; Gupta, G. R., Parkhurst, J. O., Ogden, J. A., et al. (2008). Structural approaches to HIV prevention. Lancet, 372(9640): 764-775.
- Aidala, A. & Sumartojo, E. (2007). Why housing? AIDS & Behavior, 11(6)/Supp 2: S1-S6; 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.
- See, e.g.: Kidder, D., Wolitski, R., Pals, S., et al. (2008). Housing status and HIV risk behaviors among homeless and housed persons with HIV. JAIDS, 49(4): 451-455; Aidala, A., Cross, J., Stall, R., et al. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS & Behavior, 9(3): 251-265.
- Des Jarlais, D., Braine, N. & Friedmann, P. (2007). Unstable housing as a factor for increased injection risk behavior at US syringe exchange programs. AIDS & Behavior, 11(6)/Supp 2: S78-S84; Elifson, K., Sterk, C., Theall, K. (2007). Safe living: The impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS & Behavior, 11(6)/Supp 2: S45-S55.
- 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; Sevelius, J.M., Reznick, O.G., Hart, S.L., & Schwarcz, S. (2009). Informing interventions: The importance of contextual factors in the prediction of sexual risk behaviors among transgender women. AIDS Education & Prevention, 21(2): 113-127; Kidder, et al. (2008); Kipke, M., Weiss, G., Wong, C. (2007). Residential status as risk factor for drug use and HIV risk among young men who have sex with men. AIDS & Behavior, 11(6)/Supp 2: S56-S69; Salazar, L., Crosby, R., Holtgrave, D., 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 & Behavior 11(6)/Supp 2: S70-S77; Coady, M.H., Latka, M.H., Thiede, H., et al. (2007). Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs). AIDS & Behavior, 11(6): 854-863; 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; Aidala, et al. (2005).
- Wenzel, S., Tucker, J., Elliot, M., Hambarsoomians, K. (2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS & Behavior, 11(6)/ Supp 2: S9-S20.
- 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.
- 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; Bamberger, J.D. (2010). Housing the Homeless with HIV in San Francisco. Presentation at the North American Housing and HIV/AIDS Research Summit, Toronto, Ontario, June 2010; Buchanan, D.R., Kee, R., Sadowski, L.S., & Garcia, D. (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; Aidala, et al., 2005.
- Aidala, et al., 2005.
- Lima, V.D. (2008). Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. Journal of Infectious Diseases, 198(1): 59-67; Wolitski, et al., 2007; Holtgrave, D. and Curran, J. (2006). What works, and what remains to be done, in HIV prevention in the United States. Annual Review of Public Health, 27: 261-275.
- 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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