Longitudinal Determinants of Housing Stability Among People Living With HIV/AIDS Experiencing Homelessness.

Objectives. To examine patterns of and factors associated with housing stability over time among people living with HIV (PLWH) experiencing homelessness with co-occurring substance use and mental health disorders enrolled in a patient-centered medical home (PCMH) intervention.Methods. Between September 2013 and February 2017, we ascertained housing trajectories among PLWH in 9 sites in the United States by conducting interviews at baseline, 6, and 12 months after and dichotomized them as improved consistently versus did not improve consistently. We identified covariates affecting housing stability using the socioecological model.Results. Forty-three percent (n = 198) experienced consistent housing improvement. Participants with history of mental health diagnosis (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.02, 2.35; P = .04) or trauma (AOR = 1.72; 95% CI = 1.22, 2.41; P = .006) had improved housing status; those with recent injecting drug use (AOR = 0.41; 95% CI = 0.19, 0.90; P = .03) had less consistent housing improvement.Conclusions. Improved housing stability may possibly reflect the importance of PCMH interventions that integrate housing, health, and behavioral services with patient navigators to address complex needs of PLWH experiencing homelessness.

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.