HIV and Public Policy: Predictors for Chronic Homelessness in Persons Living with HIV/AIDS

Abstract

HIV/AIDS is markedly more prevalent in the homeless population than in the population of individuals in stable dwellings. Challenges such as inadequate access to care, HIV-risk behaviors and the costs of healthcare make it difficult for homeless persons living with HIV/AIDS (PLWHA) to improve their health. Conversely, PLWHA are more susceptible to homelessness due to diminished financial agency and emotional support. Recent policies enacted by the U.S. Department of Housing and Urban Development have increased the amount of funding available to supportive housing programs, yet 25% of all homeless PLWHA fall into chronic homelessness and worse health outcomes over time. This paper tests the association between HIV-related risk factors and the likelihood of chronic homelessness in PLWHA. Our results highlighted that incarceration was a significant contributor, Odds Ratio 1.83, after adjusting for illicit substance use.

Considering that the U.S. federal and state governments spend more than $587 million dollars annually on housing and health support for the homeless, it may prove beneficial to the health of homeless PLWHA and more cost effective to the government over time to combine tailored housing prevention activities with programs known to reduce the transmission of HIV for homeless PLWHA who are more likely to recede into chronic homelessness.