The interconnections between substance use, HIV risk, and lack of adherence to HIV medications are particularly strong among homeless individuals, as has been noted in earlier research.

In the current study, the authors described patterns of alcohol and drug use, associations between substance use and taking part in high-risk sex, and the associations between substance use and adherence to HIV treatment regimens in a sample of 602 HIV-positive individuals who were homeless or housed unstably. The study subjects were participants in a housing-based intervention, the Housing and Health Study.

"Participants experienced high levels of substance use," the authors wrote, noting significant associations between substance use and treatment adherence, as well as between substance use and high-risk sexual practices within the entire group. In group analyses by sexual orientation/gender, the association between substance use and treatment adherence was found chiefly among heterosexual males; the relationship between several drugs and high-risk sexual practices was strongest among men who have sex with men.

"Health professionals working with HIV-seropositive individuals should routinely ascertain housing status and screen for substance use and risky sex," the authors concluded.

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