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Best Evidence Yet

Large-scale CDC study shows homeless people with HIV/AIDS more likely to engage in behavior that leads to HIV transmission

October 30, 2008

In the largest and most comprehensive study we've seen yet, researchers from the Centers for Disease Control and Prevention (CDC) have concluded that homeless people living with HIV and AIDS are more likely to engage in behaviors that increase risk for transmitting HIV. "Findings underscore the need to provide HIV prevention services to homeless persons and address their housing needs," the study reads.

The study, which will be published later this year in The Journal of Acquired Immune Deficiency Syndromes, was conducted by CDC researchers Daniel Kidder, Richard Wolitski, Sherri Pals and Michael Campsmith. Housing Status and HIV Risk Behaviors Among Homeless and Housed Persons with HIV concluded that homeless individuals who were sexually active had more sex partners, were more likely to exchange sex for money or drugs, and more likely to use drugs or alcohol than their non-homeless counterparts. These variables have been proven to increase the risk of transmitting HIV. The study controlled for "confounding variables," such as drug and alcohol use, to show that lack of housing was the defining factor that predicted risky behaviors among homeless people.

The study looked at 8,075 individuals from 2000 to 2003 diagnosed with HIV or AIDS within two years. Four percent of participants were homeless at the time they were interviewed.

"The results are conclusive and compelling. The way the study was designed, you can really say that housing status is a predictor of behavior that leads to HIV transmission," said Virginia Shubert, cofounder of Shubert Botein Policy Associates and a leading expert on housing as a tool for HIV prevention.

No Surprises

The Housing Status study is the second in a two-part paper by Kidder and Wolitski. The first part published in the American Journal of Public Health in December 2007, looked at health care outcomes and concluded that homeless people with HIV and AIDS were more likely to have a higher viral load and less likely to take antiretrovirals -- further increasing their risk of transmitting HIV. Other studies have shown those with low viral loads are less likely to transmit HIV.

"A lot of what we find is not going to come as a surprise to those who know this population and know intuitively that this is true, but having such a large sample is new and makes the evidence that more compelling," Kidder said.

Study participants were reported as homeless if they were living in a shelter or on the streets at the time they were interviewed. "What's most devastating is that this study is actually a conservative estimate, since they couldn't reach most homeless people who aren't connected to care," Shubert said. "Often there's the argument that people with HIV and AIDS shouldn't be singled out. But this is a group where the consequences of leaving them homeless leads to more infections."

Growing Body of Research

In recent years, evidence showing that stable housing for people with HIV/AIDS is a key tool for prevention and health care outcomes has been growing. In 2007 the National AIDS Housing Coalition released a special issue of The Journal of AIDS and Behavior, which published 18 peer-reviewed articles on the relationship of housing status and HIV risk and health outcomes.

"This [most recent CDC] study is another source of evidence for the relationship between housing status and risk behaviors," said Angela Aidala, a professor at Columbia University's Mailman School of Public Health, an expert on AIDS and housing and the author of the ongoing CHAIN studies, which have shown that people are less likely to engage in behavior that leads to HIV transmissoin when they are stably housed.

"The work of advocacy groups and researchers have brought attention to this, and it has had an impact for funders and jurisdictions," Aidala said.

This article was provided by Housing Works. It is a part of the publication Housing Works AIDS Issues Update. Visit Housing Works' website to find out more about their activities, publications and services.
See Also
Housing and HIV Prevention/Treatment


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