HIV risk among homeless adults transitioning to permanent supportive housing

Background: Homeless persons face increased risk of HIV. Policy has shifted toward providing integrated health services and permanent supportive housing (PSH) for homeless persons versus relying on shelters, yet there is limited information on HIV risk among persons transitioning into PSH and limited understanding of prevention needs. This feasibility study used qualitative and quantitative data to examine changes in HIV risk, social networks, and service use among adults transitioning into PSH.

Methods: We used criterion sampling to identify homeless individuals in Skid Row Los Angeles who had been accepted into PSH and who had near-term move-in dates. Semi-structured and structured interviews were conducted with 23 persons prior to moving into PSH and 3 months later.

Results: The majority of participants were African American. Prior to housing, most participants anticipated improved social relationships including intimate partnerships. Whereas 43% reported being sexually active prior to housing and 50% reported condom use, 52% were sexually active after housing and only 8% reported condom use. Sexual partners and drug users in participants' networks increased after being housed, and numbers of persons from whom they received social support decreased. The past 3 month HIV testing rate was 52% before housing and 57% after housing.

Discussion: The transition from homelessness to permanent supportive housing may be associated with unanticipated risks to health through changes in social networks and increased exposure to HIV. Greater attention should be focused on understanding and addressing HIV prevention as part of integrated health services and permanent supportive housing for homeless adults.