Women, housing, and HIV: The effects of a housing continuum

Globally, women are disproportionately affected by HIV. Access to housing, healthcare, education, income, and employment are confirmed social determinants of health (SDH) that increase HIV incidence and risk.  Across 4 US cities (Atlanta, Los Angeles, New York, Philadelphia), we review the interaction between a housing continuum and gender and their relationship with HIV, STIs, unprotected sex and partner concurrency.

African-Americans (N=1,063; n_men=533, n_women=532) were grouped according to whether they lived in their own home (“stably-housed”); with family (“live-with-family”); sexual partner (“live-with-partner”); or other group living arrangement, such as an SRO or homeless shelter (“other-living”).

Of 1,063 respondents, 605 (57%) were stably-housed (65% women, χ2(3)=49.15, p<0.05).  Women were more likely to be unemployed than men (χ2(1)=16.5059, p=<0.05), though there were no significant differences between income, education, or healthcare. 531 were HIV-positive (69% stably-housed; p<0.05), 148 STI-positive (49% stably-housed, p=0.061), and 195 maintained concurrent partnerships (53% stably-housed, p=0.455).  Women were more likely to be HIV-positive (AOR=1.95, p<0.05), STI-positive (AOR=8.29, p<0.05), and have higher unprotected sex risk than men (IRR=1.72, p=0.024). After controlling for SDH and HIV-risk covariates, models show women in other-living were more likely to be HIV+ (OR=2.23, p=0.036) and have concurrent partnerships (OR=2.18, p=0.088)  than men. Also, the risk for unprotected sex for women who live-with-partner was 3.61 times the risk for males who live-with-partner (95%CI: 0.879, 14.86).  Interestingly, women in other-living had unprotected sex 64% less often than men in other-living (95%CI: 0.131, 0.996).  Additional research, viewing housing along a continuum, must be done to guide interventions and policy.