How to Reduce HIV Transmission in Homeless Individuals

Homeless people face a higher risk of HIV infection than other at-risk populations, and researchers believe that an improved definition of homelessness may help minimize this HIV risk.

Findings from a study published in the Journal of HIV/AIDS & Social Work suggest that gaining a better understanding of housing histories and the multiple levels of homelessness could help identify who may be at a higher risk for HIV.

“The homeless population can’t be painted with a broad brush because there will be people within that group who have more stability than others,” said study author Elizabeth Bowen. “This study came of wanting to break down what it means to be homeless and linking that with HIV risk behaviors.”

The primary focus of the study was on the single-room occupancy (SRO) housing residents in Chicago, which demonstrates the challenges of assigning a unified definition of homelessness. One subset of the SRO group contained individuals who considered themselves homeless, despite having a place to live.

This uncertainty derives from factors such as rent increase concerns and being unable to continue to afford even minimal housing like an SRO.

“That’s one end of the spectrum,” Bowen said. “It’s a transient population that’s bouncing into and out of SRO buildings and other locations, such as staying in overnight shelters or on the street. But on the other end is the long-term resident, who may have been stably housed for 20 years.”

To make an attempt to help minimize the risk of HIV, researchers noted the importance of targeting the right individuals.

“The long-term resident might need help in other areas, but the research suggests they’re not engaging in the same risky behaviors, such as drug use or having multiple sexual partners, as the residents who had been homeless more recently or who still considered themselves to be homeless,” Bowen said.

Bowen said the information is critical to social workers trying to identify which individuals are most in need of help.

“We talk a lot in social work about harm reduction,” Bowen said. “It is apparent to me that there is a sub-population of SRO residents who might need those harm-reduction services — and it wouldn’t have to be a major intervention. It might be a matter of brief screening and counseling.”

Since SROs are basic, low-rent units, developers can often convert these buildings into more profitable structures with ease and increasing frequency.

“Even while we were collecting data for this study, we saw some of these buildings closing,” Bowen said. “This limited option is getting increasingly scarce.”

The findings highlight the need for affordable housing in cities across the United States. Bowen noted that the association between health and housing is bigger than just HIV, and includes many chronic long-term health issues that are both mental and physical.

Although SROs are affordable, the rent still represents a large percentage of a resident’s income, which is often exclusively Supplemental Security Income, according to researchers.

“There’s very little money left over for food, health care, and other essentials,” Bowen said. “There needs to be not only high-quality affordable housing options, but more subsidized housing so people are not spending more than half of their fixed monthly income on a place to live.”