Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents

<p>Abstract</p> <p>Background</p> <p>Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents.</p> <p>Methods</p> <p>Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior.</p> <p>Results</p> <p>Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations.</p> <p>Conclusions</p> <p>Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.</p

Sexual and Injection Risk among Women who Inject Methamphetamine in San Francisco

Methamphetamine (MA) use is on the rise in the United States, with many cities reporting increases of 100% or more in MA-related Emergency Department (ED) mentions. Women are keeping pace with this trend: in 2003, 40% of ED mentions and 45% of MA-related treatment admissions were female. Although there have been extensive examinations of MA use and HIV/STI risk among gay men in recent years, literature regarding female MA users is scarce. This paper examines female methamphetamine injectors in San Francisco, CA, from 2003–2005. We assessed sexual and injection related risk behaviors, comparing female MA injectors to female injectors of other drugs. We also examined whether MA use was independently associated with specific sexual and injection risk behaviors. We found that female MA injectors were significantly more likely than non-MA injectors to report unprotected anal intercourse, multiple sexual partners, receptive syringe sharing and sharing of syringes with more than one person in the past six months. In multivariate analysis, MA use among female injectors was significantly associated with anal sex, more than five sexual partners, receptive syringe sharing, and more than one syringe-sharing partner in the past six months. Deeper exploration of the relationship between MA use and sexual risk among women would benefit HIV/STI prevention efforts. In addition, existing interventions for drug-injecting women may need to be adapted to better meet the risks of female MA injectors