April 30, 2012
Consequences of homelessness -- such as not having access to sleeping quarters, regular meals, clean clothing and hygiene essentials -- had the greatest single effect on the physical and mental health of homeless HIV patients, according to a University of California-San Francisco (UCSF) survey.
The study's 288 homeless male participants were given physical and mental health scores between zero and 100. The median physical and mental health scores were 43 and 46, respectively. Unmet basic needs most greatly affected scores, lowering the physical health score 3.8 percent, and the mental score by 3.5 percent. Although regular use of antiretrovirals raised mental health scores 1.7 percent, the drugs only negligibly affected physical health scores.
Elise Riley, the study's lead author and an associate professor in the UCSF HIV/AIDS division at San Francisco General Hospital (SFGH), said keeping patients healthy and halting the spread of the virus requires a simultaneous focus on subsistence needs and HIV treatments. Spending on medication is "not going to be doing as much good if we don't have more opportunities for housing or other needs," said Riley.
SFGH HIV Clinic Medical Director Dr. Brad Hare agrees. He said the recession exacerbates the struggle to regulate treatment for patients who must prioritize basic necessities. "This study validates what we've seen," said Hare. "It recognizes just how important the structural barriers are to HIV care."
Dr. Edward Machtinger, UCSF's Women's HIV program director, found comparable associations between trauma and poor health outcomes for HIV-positive women in other studies. Machtinger said health providers must "ask the real questions" about patients' needs and prioritize linking them to existing services.
"Our focus in medicine needs to be broader than simply seeing patients in clinic and prescribing medications," Machtinger said.
The study, "Social, Structural and Behavioral Determinants of Overall Health Status in a Cohort of Homeless and Unstably Housed HIV-Infected Men," was published in PLoS One (2012;7(4):e35207).