Health and policy implications of housing conditions, neighborhood environments, housing choice, and mobility among women living in high poverty and HIV prevalence areas in the United States (US): HPTN 064

introduction. Inadequate housing and neighborhood conditions are associated with poor physical and mental health. We explore health and policy implications of housing conditions, neighborhood environments, housing choice, and mobility of women living in high poverty and HIV prevalence areas in the US.

methods. We conducted 120 one-on-one qualitative interviews and 35 focus groups (N=288) with women from the HPTN 064 Study in New York, the District of Columbia, North Carolina, and Georgia. We developed a conceptual framework in NVivo9 using constant comparative analysis and generated descriptive statistics using SAS 9.3.

results. Most participants were African-American women (87%), unmarried (61%), and had high school education or less (76%). Median age was 27 (IQR: 13), 47% reported annual incomes of ≤$10,000 and 63% reported government assistance as the main income source. Ten percent of participants were homeless. Participants felt trapped by chronic marginal living situations resulting from limited housing choice, financial constraints, and needing access to public transportation and resources. Participants believed their housing and neighborhood environments affected their physical and emotional well-being (e.g., illness from mold, concerns for own/child’s safety) and described making trade-offs that had immediate and long-term health implications (e.g., sex exchange for housing), but expressed low perceived control to improve these situations.

conclusions. Women living in poverty require assistance identifying and relocating to safe, affordable housing with access to transportation and resources. Efforts should be coupled with interventions designed to increase women’s financial assets and an evaluation of policies contributing to chronic poverty and unstable housing among women.