Housing Need, Housing Services, and Receipt of HIV Medical Care

Background. Recent changes in federal support for HIV services affecting the availability of funds for housing assistance have raised concerns about possible negative effects on access and maintenance in HIV treatment. We investigated the relationship between housing and HIV medical care among persons living with HIV/AIDS in New York City.

Methods. We examined the relationship between housing and medical care indicators among 1660 HIV-positive adults participating in three randomly-sampled longitudinal cohorts. Data were collected between 1994 and 2004 using structured in-person interviews. Need for housing assistance was indicated by past six month experience with homelessness or unstable housing, or self-reported housing problems and need for housing services.

Findings. At the service system level, yearly rates of need for housing assistance have remained at between 35% and 50% of all PLWH interviewed. As some obtain housing assistance or resolve housing problems, others develop housing needs. Over-time analyses show a strong and consistent relationship between housing and medical care outcomes. Housing need is negatively associated with entry and retention in HIV medical care. Receipt of housing assistance is the strongest predictor of entry into care, and entry in care that meets good clinical practice standards, controlling for client demographics, substance use, health and mental health status, receipt of case management, mental health, and drug treatment services.

Conclusion. Findings suggest the condition of homelessness/ housing need, and not simply traits of homeless individuals as a "special population," influences access and maintenance in HIV medical care. Provision of housing improves medical care outcomes.