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Published in: AIDS and Behavior 9/2018

01-09-2018 | Original Paper

Long-Term Supportive Housing is Associated with Decreased Risk for New HIV Diagnoses Among a Large Cohort of Homeless Persons in New York City

Authors: Christopher T. Lee, Andrea Winquist, Ellen W. Wiewel, Sarah Braunstein, Hannah T. Jordan, L. Hannah Gould, R. Charon Gwynn, Sungwoo Lim

Published in: AIDS and Behavior | Issue 9/2018

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Abstract

It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing. We linked data from a cohort of 21,689 persons without a previous HIV diagnosis who applied to a supportive housing program in New York City (NYC) during 2007–2013 to the NYC HIV surveillance registry. We used time-dependent Cox modeling to compare new HIV diagnoses among recipients of supportive housing (defined a priori, for program evaluation purposes, as persons who spent > 7 days in supportive housing; n = 6447) and unplaced applicants (remainder of cohort), after balancing the groups on baseline characteristics with propensity score weights. Compared with unplaced applicants, persons who received ≥ 3 continuous years of supportive housing had decreased risk for new HIV diagnosis (HR 0.10; CI 0.01–0.99). Risk of new HIV diagnosis decreased with longer duration placement in supportive housing. Supportive housing might aid in primary HIV prevention.
Literature
1.
go back to reference Aidala AA, Wilson MG, Shubert V, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016;106:e1–23.CrossRefPubMedPubMedCentral Aidala AA, Wilson MG, Shubert V, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016;106:e1–23.CrossRefPubMedPubMedCentral
2.
go back to reference Beijer U, Wolf A, Fazel S. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:859–70.CrossRefPubMedPubMedCentral Beijer U, Wolf A, Fazel S. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:859–70.CrossRefPubMedPubMedCentral
3.
go back to reference Kerker BD, Bainbridge J, Kennedy J, et al. A population-based assessment of the health of homeless families in New York City, 2001–2003. Am J Public Health. 2011;101:546–53.CrossRefPubMedPubMedCentral Kerker BD, Bainbridge J, Kennedy J, et al. A population-based assessment of the health of homeless families in New York City, 2001–2003. Am J Public Health. 2011;101:546–53.CrossRefPubMedPubMedCentral
4.
go back to reference Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. J Acquir Immune Defic Syndr. 2008;49:451–5.CrossRefPubMed Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. J Acquir Immune Defic Syndr. 2008;49:451–5.CrossRefPubMed
5.
go back to reference Kipke MD, Weiss G, Wong CF. Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS Behav. 2007;11:56–69.CrossRefPubMedPubMedCentral Kipke MD, Weiss G, Wong CF. Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS Behav. 2007;11:56–69.CrossRefPubMedPubMedCentral
6.
go back to reference Logan JL, Frye A, Pursell HO, Anderson-Nathe M, Scholl JE, Korthuis PT. Correlates of HIV risk behaviors among homeless and unstably housed young adults. Public Health Rep. 2013;128:153–60.CrossRefPubMedPubMedCentral Logan JL, Frye A, Pursell HO, Anderson-Nathe M, Scholl JE, Korthuis PT. Correlates of HIV risk behaviors among homeless and unstably housed young adults. Public Health Rep. 2013;128:153–60.CrossRefPubMedPubMedCentral
7.
go back to reference Wenzel SL, Rhoades H, Harris T, Winetrobe H, Rice E, Henwood B. Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing. AIDS Care. 2017;29:570–4.CrossRefPubMed Wenzel SL, Rhoades H, Harris T, Winetrobe H, Rice E, Henwood B. Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing. AIDS Care. 2017;29:570–4.CrossRefPubMed
8.
go back to reference Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372:764–75.CrossRefPubMed Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372:764–75.CrossRefPubMed
9.
go back to reference Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9:251–65.CrossRefPubMed Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9:251–65.CrossRefPubMed
10.
go back to reference Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11:101–15.CrossRefPubMed Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11:101–15.CrossRefPubMed
12.
go back to reference Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99(Suppl 3):S675–80.CrossRefPubMedPubMedCentral Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99(Suppl 3):S675–80.CrossRefPubMedPubMedCentral
15.
go back to reference Lim S, Marcus SM, Singh TP, Harris TG, Levanon Seligson A. Bias due to sample selection in propensity score matching for a supportive housing program evaluation in New York City. PLoS ONE. 2014;9:e109112.CrossRefPubMedPubMedCentral Lim S, Marcus SM, Singh TP, Harris TG, Levanon Seligson A. Bias due to sample selection in propensity score matching for a supportive housing program evaluation in New York City. PLoS ONE. 2014;9:e109112.CrossRefPubMedPubMedCentral
16.
go back to reference CDC. Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep. 2014;63(3):1–10. CDC. Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep. 2014;63(3):1–10.
17.
go back to reference Xu S, Ross C, Raebel MA, Shetterly S, Blanchette C, Smith D. Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals. Value Health. 2010;13:273–7.CrossRefPubMed Xu S, Ross C, Raebel MA, Shetterly S, Blanchette C, Smith D. Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals. Value Health. 2010;13:273–7.CrossRefPubMed
19.
go back to reference Begier EM, Bennani Y, Forgione L, et al. Undiagnosed HIV infection among New York City jail entrants, 2006: results of a blinded serosurvey. J Acquir Immune Defic Syndr. 2010;54:93–101.PubMed Begier EM, Bennani Y, Forgione L, et al. Undiagnosed HIV infection among New York City jail entrants, 2006: results of a blinded serosurvey. J Acquir Immune Defic Syndr. 2010;54:93–101.PubMed
20.
go back to reference Hernan MA, Brumback B, Robins JM. Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology. 2000;11:561–70.CrossRefPubMed Hernan MA, Brumback B, Robins JM. Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology. 2000;11:561–70.CrossRefPubMed
21.
go back to reference Fewell Z, Hernan MA, Wolfe F, Tilling K, Choi H, Sterne JAC. Controlling for time-dependent confounding using marginal structural models. Stata J. 2004;4:402–20. Fewell Z, Hernan MA, Wolfe F, Tilling K, Choi H, Sterne JAC. Controlling for time-dependent confounding using marginal structural models. Stata J. 2004;4:402–20.
22.
go back to reference Milby JB, Schumacher JE, Wallace D, Freedman MJ, Vuchinich RE. To house or not to house: the effects of providing housing to homeless substance abusers in treatment. Am J Public Health. 2005;95:1259–65.CrossRefPubMedPubMedCentral Milby JB, Schumacher JE, Wallace D, Freedman MJ, Vuchinich RE. To house or not to house: the effects of providing housing to homeless substance abusers in treatment. Am J Public Health. 2005;95:1259–65.CrossRefPubMedPubMedCentral
23.
go back to reference Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community Ment Health. 2011;47:227–32.CrossRef Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community Ment Health. 2011;47:227–32.CrossRef
24.
go back to reference Palepu A, Patterson ML, Moniruzzaman A, Frankish CJ, Somers J. Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders. Am J Public Health. 2013;103(Suppl 2):e30–6.CrossRefPubMedPubMedCentral Palepu A, Patterson ML, Moniruzzaman A, Frankish CJ, Somers J. Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders. Am J Public Health. 2013;103(Suppl 2):e30–6.CrossRefPubMedPubMedCentral
25.
go back to reference Larimer ME, Malone DK, Garner MD, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009;301:1349–57.CrossRefPubMed Larimer ME, Malone DK, Garner MD, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009;301:1349–57.CrossRefPubMed
26.
go back to reference Kidder DP, Wolitski RJ, Royal S, et al. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav. 2007;11:149–61.CrossRefPubMed Kidder DP, Wolitski RJ, Royal S, et al. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav. 2007;11:149–61.CrossRefPubMed
27.
go back to reference Wenzel SL, Tucker JS, Elliott MN, Hambarsoomians K. Sexual risk among impoverished women: understanding the role of housing status. AIDS Behav. 2007;11:9–20.CrossRefPubMed Wenzel SL, Tucker JS, Elliott MN, Hambarsoomians K. Sexual risk among impoverished women: understanding the role of housing status. AIDS Behav. 2007;11:9–20.CrossRefPubMed
28.
go back to reference Lim S, Singh TP, Gwynn RC. Impact of a supportive housing program on housing stability and sexually transmitted infections among New York City young adults aging out of foster care. Am J Epidemiol. 2017;186:297–304.CrossRefPubMed Lim S, Singh TP, Gwynn RC. Impact of a supportive housing program on housing stability and sexually transmitted infections among New York City young adults aging out of foster care. Am J Epidemiol. 2017;186:297–304.CrossRefPubMed
29.
go back to reference Xia Q, Teixeira-Pinto A, Forgione LA, Wiewel EW, Braunstein SL, Torian LV. Estimated HIV incidence in the United States, 2003–2010. J Acquir Immune Defic Syndr. 2017;74:10–4.CrossRefPubMed Xia Q, Teixeira-Pinto A, Forgione LA, Wiewel EW, Braunstein SL, Torian LV. Estimated HIV incidence in the United States, 2003–2010. J Acquir Immune Defic Syndr. 2017;74:10–4.CrossRefPubMed
30.
go back to reference Hall HI, An Q, Tang T, et al. Prevalence of diagnosed and undiagnosed HIV infection—United States, 2008–2012. MMWR Morb Mortality Wkly Rep. 2015;64:657–62. Hall HI, An Q, Tang T, et al. Prevalence of diagnosed and undiagnosed HIV infection—United States, 2008–2012. MMWR Morb Mortality Wkly Rep. 2015;64:657–62.
33.
go back to reference Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York City. AIDS Care. 2018;30:9–17.CrossRefPubMed Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York City. AIDS Care. 2018;30:9–17.CrossRefPubMed
Metadata
Title
Long-Term Supportive Housing is Associated with Decreased Risk for New HIV Diagnoses Among a Large Cohort of Homeless Persons in New York City
Authors
Christopher T. Lee
Andrea Winquist
Ellen W. Wiewel
Sarah Braunstein
Hannah T. Jordan
L. Hannah Gould
R. Charon Gwynn
Sungwoo Lim
Publication date
01-09-2018
Publisher
Springer US
Published in
AIDS and Behavior / Issue 9/2018
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-018-2138-x

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