The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness.

Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017.Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervention. HIV outcomes included linkage and retention in care, antiretroviral therapy prescription, and viral suppression collected via chart review.Results. In the 12 months after the intervention, 59.6% transitioned to more stable housing. Compared with those who became or remained unstably housed, participants with greater stability achieved significantly higher rates of retention (adjusted odds ratio [AOR] = 2.12; 95% confidence interval [CI] = 1.11, 4.05), were more likely to be prescribed antiretroviral therapy (AOR = 2.06; 95% CI = 1.62, 2.63), and had higher rates of viral suppression (AOR = 1.62; 95% CI = 1.03, 2.55).Conclusions. The use of patient navigators to create a network of services for PLWH who are unstably housed can improve housing stability and lead to improvements in HIV-related outcomes.

Risk factors associated with multi-dimensional stigma among people living with HIV/AIDS who are homeless/unstably housed.

BACKGROUND: Stigma may serve as a barrier to HIV care among homeless living with HIV/AIDS (PLWHA). The role of layered stigma related to the syndemic of homelessness, mental health, and substance use among PLWHA has not been examined. We explored the syndemic of HIV, homelessness, mental health, and substance use, as well as perceived and experienced provider stigma. We also examined factors contributing to high levels of stigma. METHODS: We identified PLWHA who were homeless with co-existing mental health and/or substance abuse. Surveys were conducted at study enrollment. External HIV stigma, external stigma related to homelessness, mental health, and substance abuse, HIV provider stigma, and provider stigma related to homelessness, mental health, and substance abuse were measured. Multivariable regression and psychometric assessments were conducted. RESULTS: Over 2/3 of participants (n = 528) reported HIV stigma. About 30% responded affirmatively to perceiving stigma related to their homelessness, 26% to substance use, and 19% to having a mental health condition in the past 12 months. Less than 20% reported perceiving stigma related to both homelessness and substance use, and 16% reported perceiving stigma related to both homelessness and mental health. Only15% reported HIV-related provider stigma. Those with lower mental functioning, greater unmet need, and less social support reported greater levels of stigma. CONCLUSIONS: Almost 70% of participants reported HIV stigma, with 1/4 experiencing stigma related to homelessness, substance use and mental health. Our current study highlights the complexity of stigma in vulnerable PLWHA and the importance of allocating resources to help improve outcomes.

"Choose the People Who Know": How Patient-Centered Medical Homes Reduce Disclosure Anxiety for People Living with HIV and Experiencing Homelessness.

While public and medical perceptions of HIV and those living with HIV have shifted to be more accepting, many individuals still report stigmatizing experiences in clinical and non-clinical settings. Interviews with 40 people living with HIV, homelessness, substance use, and mental illness participating in a patient-centered medical home (PCMH) were conducted in seven sites across the U.S. to assess experiences with stigma in social and clinical spheres. The most salient themes of the study were: 1) how current and past experiences of stigma-in interactions with friends, family, and providers-informed clients' relationships with disclosure, and 2) how, through coordinated and confidential systems of care, the PCMH minimized the necessity to disclose HIV status, thereby reducing the anxiety associated with it.