risk and the residential environment: prior homelessness as a predictor of hiv risk among adults...
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Risk and the Residential Environment:Prior Homelessness as a Predictor of HIV Risk
among Adults Living in Single Room Occupancy Housing
Elizabeth Bowen, PhDAssistant Professor
University at Buffalo School of Social Work
Presenter DisclosuresElizabeth Bowen
• The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose
Background• Homeless and unstably housed individuals are at a
higher risk for contracting or transmitting HIV1 • Potential pathways include increased substance
use, trading sex for money, and having multiple sexual partners2-5
• People in different housing conditions (e.g. shelters, street, SROs) often combined for analysiso Risk environment framework6 – how might these spaces
differentially affect risk?
What Are SROs?• “Housing of last resort”• Rooms usually < 200
square feet• Shared bathrooms and
no cooking facilities• Rent approximately
$300-$500/month• Private vs. public or
nonprofit• Transitory vs. stable
Research Questions
How do SRO residents’ histories of street homelessness vary?
Is this variation associated with HIV risk behavior?
Method• Cross-sectional survey design with SRO residents in
Chicago• Venue-based recruitment at 10 privately owned for-
profit SROs in the Uptown neighborhood• Recruitment card approach• $20 cash compensation
• Interviewer-administered survey• Final n = 163
Resultsn = 163
%
Male 78
Race
African American 63
White 28
Other Race or More Than One Race
10
Hispanic or Latino Ethnicity 7
Age Range = 21-76, M = 50
Resultsn = 163
%HIV Positive 6
Serious Mental Illness 68
Ever Incarcerated 74
Ever Convicted of a Felony 48
Homeless in Lifetime 83
Homeless in Past 12 Months 18
Mean Monthly Income $722
Mean Monthly Rent $316
Results%
Illicit Drug Use Other Than Marijuana in Past 30 Days
17
Alcohol Misuse (FAST Score of Three or More)
33
More Than One Sexual Partner – Past 30 Days
17
Sex Without Condom – Past 30 Days 30
Sex While Drunk/High – Past 30 Days 17
Lifetime Intravenous Drug Use 11
Lifetime Sex Exchange 21
Total Number of Recent Risk Behaviors
No Risk Behaviors 42
One Risk Behavior 26
Two or More Risk Behaviors 32
Results: Multivariate Analysis (ORs)
Illicit Drug Use
Problem Drinking
Multiple Partners
Sex No Condom
Sex Drunk/
High
Sex Exchange
IV Drug Use
Female 1.07 0.91 0.38 3.11 0.46 4.30 0.15
White 0.37 0.92 0.07 0.19 0.15 0.07 2.36
Other Race
1.95 1.11 0.38 0.68 0.36 0.83 1.80
Age 0.98 1.00 0.96 0.96 0.97 0.99 1.14
HIV+ 2.34 1.53 0.42 0.20 0.41 2.55 5.51
Prior Felony
3.18 5.13 1.49 1.66 0.71 6.32 2.80
Homeless in Past Year
3.23 1.16 2.28 1.04 2.74 1.70 4.91
Limitations• Cross-sectional study• Reliance on self-report data from interviewer-
administered survey• Non-probability sample from one geographical area• Small sample size and most participants had one or
no recent risk behaviors
Conclusions• Findings suggest that SRO living and homelessness
are not synonymous• SRO residents who had been homeless in the past
12 months were more likely to report some risk behaviors including illicit drug use, sex while drunk or high, and lifetime history of IV drug use• Individuals who have recently transitioned from
homelessness to SRO housing may benefit from tailored HIV risk reduction interventions
Conclusions• SRO housing being rapidly
demolished in many cities – need to consider policies to preserve SROs as both a short and long-term alternative to homelessness• Policies needed to improve
affordability and access to care and services for SRO residents
References1 Beijer, U., Wolf, A., & Fazel, S. (2012). Prevalence of tuberculosis, hepatitis C virus,
and HIV in homeless people: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(11), 859-870.
2Dickson-Gomez, J., McAuliffe, T., Convey, M., Weeks, M., & Owczarzak, J. (2011). Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents. Substance Abuse Treatment Prevention and Policy, 6(31), 1-12.
3 Elifson, K. W., Sterk, C. E., & Theall, K. P. (2007). Safe living: The impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS and Behavior, 11(6), 45-55.
4 Neblett, R. C., Davey-Rothwell, M., Chander, G., & Latkin, C. A. (2011). Social network characteristics and HIV sexual risk behavior among urban African American women. Journal of Urban Health, 88(1), 54-65.
5 Weir, B. W., Bard, R. S., O'Brien, K., Casciato, C. J., & Stark, M. J. (2007). Uncovering patterns of HIV risk through multiple housing measures. AIDS and Behavior, 11(6), 31-44.
6 Rhodes, T. (2002). The ‘risk environment’: A framework for understanding and reducing drug-related harm. International Journal of Drug Policy, 13(2), 85-94.