Physical and Sexual Abuse and Unstable Housing among Adolescents with HIV: Implications for Treatment Retention

Background: It is difficult to attract and retain adolescents with HIV in care. Stable housing is a vital component of treatment, without which continuity of care cannot occur. There is little data about adolescents distinct from adults regarding the circumstances around housing instability. Study objectives were to determine factors associated with unstable housing, ways adolescents are referred into care, and implications for treatment. Methods: A sample of 224 adolescents with HIV in New York City in one of the largest adolescent HIV programs in the United States. Data were collected in interviews at the time of intake, 1991-2004. Data collected were: demographics; HIV-related; sexual and reproductive; substance use; mental health; criminal justice; exposure to abuse; and emotional and economic resources. Outcomes variables were prior housing and current housing (unstable or stable). Results: 38.6% had a history of prior-to-treatment unstable housing, which was reduced to 12.9% at the time of program entry. Multivariate logistic regression models predicting prior unstable housing revealed physical abuse (OR=2.8, CI95=1.1-7.2) and referral from youth/social services entities. Continued unstable housing was associated with physical and sexual abuse (OR=5.4 CI95=1.1-25.3, OR=6.8, CI95=1.2-36.9) and adolescent history of arrest (OR=7.8, CI95=1.4-42.1). Of the 13% who could not transition into stable housing, most had been physically and sexually abused. Conclusions: When adolescents in abusive situations enter programs for youth, they have a positive impact on transitioning adolescents to safer households, and offer a route through which adolescents can be guided towards care, of which HIV is but one component.