The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD

AbstractBackgroundFew studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior.MethodsAmong a cohort of 1405 current and former injection drug users in follow-up from 2005 to 2009, we used random intercept models to assess the temporal association between homelessness and subsequent injection drug use, and to determine whether the association between homelessness and sustained injection drug use among active injectors differed from the association between homelessness and relapse among those who stopped injecting. We also assessed the association between homelessness and subsequent injection-related risk behavior among participants who injected drugs consecutively across two visits. Homelessness was categorized by duration: none, <1 month, and ≥1 month.ResultsHomelessness was reported on at least one occasion by 532 (38%) participants. The relationship between homelessness and subsequent injection drug use was different for active injectors and those who stopped injecting. Among those who stopped injecting, homelessness was associated with relapse [<1 month: AOR=1.67, 95% CI (1.01, 2.74); ≥1 month: AOR=1.34 95% CI (0.77, 2.33)]. Among active injectors, homelessness was not associated with sustained injection drug use [<1 month: AOR=1.03, 95% CI (0.71, 1.49); ≥1 month: AOR=0.81 95% CI (0.56, 1.17)]. Among those injecting drugs across two consecutive visits, homelessness ≥1 month was associated with subsequent injection-related risk behavior [AOR=1.61, 95% CI (1.06, 2.45)].ConclusionHomelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care

Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and transportation access to unmet need for medical care

Public Housing Relocations and Partnership Dynamics in Areas With High Prevalences of Sexually Transmitted Infections

We investigated the implications of one structural intervention—public housing relocations—for partnership dynamics among individuals living areas with high sexually transmitted infection (STI) prevalence. High-prevalence areas fuel STI endemicity and are perpetuated by spatially assortative partnerships

Impact of Public Housing Relocations: Are Changes in Neighborhood Conditions Related to STIs Among Relocaters?

Cross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, male:female sex ratios) would have reduced odds of testing positive for an STI over time

Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing

Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every nine months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs

Building health equity through housing policies: critical reflections and future directions for research

Housing may be at once the most powerful and underused tool at our disposal to improve population health. Using examples from the USA, we argue that current levels of housing insecurity are the result of clear and inequitable policy choices, leading to the entrenchment of health inequities-particularly, across race and class. Solutions to housing insecurity must, therefore, be structural. The COVID-19 pandemic has opened a window of opportunity for these structural housing policy reforms. Through justice- and action-oriented research, health researchers can inform the development and implementation of housing policies that advance health equity. We offer a series of recommendations to better position our field to achieve this goal

Public Support for Policies to Increase Housing Stability During the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic has exacerbated longstanding housing precarity. This study measures the public support for policies designed to increase housing stability and gauges whether support levels are associated with views about the role of evictions in COVID-19 transmission and the existence of racial inequities in the housing market.MethodsA cross-sectional survey with a representative sample of U.S. adults in November 2020 assessed support for 4 housing policies. Logistic regression models estimated the adjusted levels of support for each policy, with separate models testing the association with whether or not a respondent recognized the role of evictions in increased COVID-19 transmission or acknowledged racial inequities in the housing market.ResultsMost U.S. adults supported policies aimed to increase housing stability during the COVID-19 pandemic, including extending moratoriums on evictions (63%) and foreclosures (67%) and increasing emergency rental assistance (63%). In total, 54% supported increased government spending on housing vouchers. Adults who agreed that averting eviction would slow COVID-19 transmission had higher support for housing stability policies, as did those who agreed that it was easier for White families to find affordable, high-quality housing than Black families.ConclusionsSupport for housing stability policies was strong among U.S. adults, particularly among those who agreed that preventing evictions slowed COVID-19 transmission and among those who acknowledged racial inequities in the housing market. Raising public awareness of the connections among unstable housing, infectious disease transmission, and racial inequity could broaden the support for policies to keep people in their homes through the pandemic

Estimation of place-based vulnerability scores for HIV viral non-suppression: an application leveraging data from a cohort of people with histories of using drugs

Abstract The relationships between place (e.g., neighborhood) and HIV are commonly investigated. As measurements of place are multivariate, most studies apply some dimension reduction, resulting in one variable (or a small number of variables), which is then used to characterize place. Typical dimension reduction methods seek to capture the most variance of the raw items, resulting in a type of summary variable we call “disadvantage score”. We propose to add a different type of summary variable, the “vulnerability score,” to the toolbox of the researchers doing place and HIV research. The vulnerability score measures how place, as known through the raw measurements, is predictive of an outcome. It captures variation in place characteristics that matters most for the particular outcome. We demonstrate the estimation and utility of place-based vulnerability scores for HIV viral non-suppression, using data with complicated clustering from a cohort of people with histories of injecting drugs

Housing insecurity among black women surviving intimate partner violence during the COVID-19 pandemic: an intersectional qualitative approach

Abstract Background Housing instability is highly prevalent among intimate partner violence (IPV) survivors, and the coupling consequences of structural racism, sexism, classism, and the COVID-19 pandemic, may create more barriers to safe and adequate housing, specifically for Black women IPV survivors. In particular, the consequences of the COVID-19 pandemic had the potential to amplify disadvantages for Black women IPV survivors, yet very little research has acknowledged it. Therefore, the current study sought to assess the experiences of housing insecurity among Black women experiencing intimate partner violence (IPV) while navigating racism, sexism, and classism during the COVID-19 pandemic. Methods From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity. Results Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors’ ability to obtain and sustain safe housing. We derived five themes to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; and strategies to maintain housing. Conclusions Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Interventions are needed to reduce the impact of these intersecting systems of oppression and power to facilitate the resources necessary for Black women IPV survivors to identify safe housing