Chronic homelessness, HIV, and other sexually transmitted infections in a cohort of homeless women

Background: Although multiple studies have examined the prevalence rates of sexually transmitted diseases among individuals who are homeless, surprisingly little is known about the prevalence of HIV and sexually transmitted infections (STI) among homeless women.

Objective: We examined the relationship between chronicity of homelessness, and HIV and STI seroprevalence rates among a sample of New York City homeless women.

Methods: Study participants were randomly selected from 28 family and single adult shelters using a two-level random sampling procedure. Shelters were first selected based on size and type; participants were then were then randomly identified from selected shelters. Eligibility criteria included demonstrated fluency in English or Spanish, age (participants had to be at least 18 years old), and the provision of informed consent. 329 women participated and were asked to provide detailed homeless histories and discuss past sexual risk experiences. Participants were also asked to provide biological samples which were used to determine prevalence of HIV, Chlamydia and Gonorrhea.

Results: While the prevalence of HIV and STIs was 1.8% and 4.6% respectively for all study participants, the combined prevalence rate of HIV, Chlamydia and Gonorrhea infections for participants who were chronically homeless was notably higher than the rate for women who did not fall into this category (12% versus 7%). In addition, women who were chronically homeless were more likely to engage in unprotected sex and other high risk sexual activity.

Conclusion: To be optimally effective, it is critical that HIV prevention efforts targeting homeless women factor in chronicity of homelessness.