To target HIV risk, define who’s ‘homeless’

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People who are homeless are at greater risk of HIV infection than those with stable housing. But fuzzy definitions of exactly what homelessness is can make it difficult to target services to reduce those risky behaviors.

Even from a research standpoint, definitions used in various studies lack consistency. A new study suggests how understanding housing histories and the multiple dimensions of homelessness can help better identify who might be at greater risk of transmitting or contracting 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,” says Elizabeth Bowen, assistant professor of social work at the University at Buffalo. “This study came of wanting to break down what it means to be homeless and linking that with HIV risk behaviors.”

The study, published in Journal of HIV/AIDS & Social Work, looked specifically at residents of single-room occupancy (SRO) housing in Chicago. Some SRO residents consider themselves homeless, even though they have a place to live, because of concerns about rent increases and an inability to continue to afford even minimal housing.

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“That’s one end of the spectrum,” says Bowen.  “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.”

When thinking about how to help minimize HIV risk, it’s important to target the right people, Bowen says.

“The long-term residents 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.”

This kind of information is critical to social workers trying to identify who might be most in need of help, Bowen adds.

“We talk a lot in social work about harm reduction. 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.”

This approach helps caseworkers predict homelessness

The findings also underscore the need for affordable housing in US cities. SROs are basic, low-rent units, often constituting buildings that developers can easily, and with increasing frequency, convert into more profitable structures.

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

The link between health and housing goes beyond HIV to include many chronic long-term health issues, both physical and mental. SROs might be affordable, but rent still represents a large percentage of a resident’s income, which is often exclusively Supplemental Security Income.

“There’s very little money left over for food, health care, and other essentials,” Bowen says. “There needs to be not only more 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.”

Source: University at Buffalo