Examining the prevalence of chronic homelessness among single adults according to national definitions in Canada

This article examines the prevalence of chronic homelessness when applying definitions used in Canada to a sample of homeless and vulnerably housed single adults enrolled in a multi-city longitudinal study. The federal government’s current definition, Reaching Home, identified the highest proportion of homeless single adults (31 percent; 95% CI = 27.2 – 34.1) as “chronically homeless.” Our findings suggest that the federal definitions of chronic homelessness, which are based on both shelter stays and periods of homelessness outside the shelter system, are double the size of this sub-population when compared to definitions based on shelter stays alone. Participants who were male, identified as Indigenous, and reported problematic drug use, were more likely to be chronically homeless for definitions based on any-kind of homelessness. The findings highlight the importance of counting unsheltered and hidden homelessness to estimate the number of single adults who are chronically homeless.Cet article examine la prévalence de l’itinérance chronique lors de l’application de définitions utilisées au Canada à un échantillon d’adultes célibataires sans abri et logés de façon vulnérable, inscrits dans une étude longitudinale multi-villes. La définition actuelle du gouvernement fédéral, Reaching Home, a identifié la plus grande proportion d’adultes célibataires sans abri (31 pour cent ; 95 % CI = 27,2 - 34,1) comme «sans abri chronique». Nos résultats suggèrent que les définitions de l’itinérance chronique, qui sont basées à la fois sur les séjours en refuge et les périodes d’itinérance en dehors du système de refuge, représentent le double de la taille de cette sous-population par rapport aux définitions basées uniquement sur les séjours en refuge. Les participants qui étaient de sexe masculin, s’identifiaient comme indigènes et déclaraient avoir fait un usage problématique de drogues, étaient plus susceptibles d’être associés à l’itinérance chronique pour les définitions basées sur tout type d’itinérance. Les résultats soulignent l’importance de compter l’itinérance non abritée et cachée pour estimer le nombre d’adultes célibataires qui sont chroniquement sans abri

Aboriginal Status is a Prognostic Factor for Mortality among Antiretroviral Naive HIV-Positive Individuals First Initiating HAART

Background: Although the impact of Aboriginal status on HIV incidence, HIV disease progression, and accessto treatment has been investigated previously, little is known about the relationship between Aboriginal ethnicityand outcomes associated with highly active antiretroviral therapy (HAART). We undertook the present analysisto determine if Aboriginal and non-Aboriginal persons respond differently to HAART by measuring HIV plasmaviral load response, CD4 cell response and time to all-cause mortality.Methods: A population-based analysis of a cohort of antiretroviral therapy naïve HIV-positive Aboriginal menand women 18 years or older in British Columbia, Canada. Participants were antiretroviral therapy naïve, initiatedtriple combination therapy between August 1, 1996 and September 30, 1999. Participants had to complete abaseline questionnaire as well as have at least two follow-up CD4 and HIV plasma viral load measures. Theprimary endpoints were CD4 and HIV plasma viral load response and all cause mortality. Cox proportionalhazards models were used to determine the association between Aboriginal status and CD4 cell response, HIVplasma viral load response and all-cause mortality while controlling for several confounder variables.Results: A total of 622 participants met the study criteria. Aboriginal status was significantly associated with noAIDS diagnosis at baseline (p = 0.0296), having protease inhibitor in the first therapy (p = 0.0209), lower baselineHIV plasma viral load (p < 0.001), less experienced HIV physicians (P = 0.0133), history of IDU (p < 0.001), notcompleting high school (p = 0.0046), and an income of less than $10,000 per year (p = 0.0115). Cox proportionalhazards models controlling for clinical characteristics found that Aboriginal status had an increased hazard ofmortality (HR = 3.12, 95% CI: 1.77–5.48) but did not with HIV plasma viral load response (HR = 1.15, 95% CI:0.89–1.48) or CD4 cell response (HR = 0.95, 95% CI: 0.73–1.23).Conclusion: Our study demonstrates that HIV-infected Aboriginal persons accessing HAART had similar HIVtreatment response as non-Aboriginal persons but have a shorter survival. This study highlights the need forcontinued research on medical interventions and behavioural changes among HIV-infected Aboriginal and othermarginalized populations

A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats

Objective No previous experimental trials have investigated Housing First (HF) in both scattered site (SHF) and congregate (CHF) formats. We hypothesized that CHF and SHF would be associated with a greater percentage of time stably housed as well as superior health and psychosocial outcomes over 24 months compared to treatment as usual (TAU). Methods Inclusion criteria were homelessness, mental illness, and high need for support. Participants were randomised to SHF, CHF, or TAU. SHF consisted of market rental apartments with support provided by Assertive Community Treatment (ACT). CHF consisted of a single building with supports equivalent to ACT. TAU included existing services and supports. Results Of 800 people screened, 297 were randomly assigned to CHF (107), SHF (90), or TAU (100). The percentage of time in stable housing over 24 months was 26.3% in TAU (reference; 95% confidence interval (CI) = 20.5, 32.0), compared to 74.3% in CHF (95% CI = 69.3, 79.3, p<0.001) and 74.5% in SHF (95% CI = 69.2, 79.7, p<0.001). Secondary outcomes favoured CHF but not SHF compared to TAU. Conclusion HF in scattered and congregate formats is capable of achieving housing stability among people experiencing major mental illness and chronic homelessness. Only CHF was associated with improvement on select secondary outcomes

Addiction Treatment and Stable Housing among a Cohort of Injection Drug Users

Background: Unstable housing and homelessness is prevalent among injection drug users (IDU). We sought to examine whether accessing addiction treatment was associated with attaining stable housing in a prospective cohort of IDU in Vancouver, Canada. Methods: We used data collected via the Vancouver Injection Drug User Study (VIDUS) between December 2005 and April 2010. Attaining stable housing was defined as two consecutive ‘‘stable housing’ ’ designations (i.e., living in an apartment or house) during the follow-up period. We assessed exposure to addiction treatment in the interview prior to the attainment of stable housing among participants who were homeless or living in single room occupancy (SRO) hotels at baseline. Bivariate and multivariate associations between the baseline and time-updated characteristics and attaining stable housing were examined using Cox proportional hazard regression models. Principal Findings: Of the 992 IDU eligible for this analysis, 495 (49.9%) reported being homeless, 497 (50.1%) resided in SRO hotels, and 380 (38.3%) were enrolled in addiction treatment at the baseline interview. Only 211 (21.3%) attained stable housing during the follow-up period and of this group, 69 (32.7%) had addiction treatment exposure prior to achieving stable housing. Addiction treatment was inversely associated with attaining stable housing in a multivariate model (adjusted hazard ratio [AHR] = 0.71; 95 % CI: 0.52–0.96). Being in a partnered relationship was positively associated with the primary outcom