title: Housing status and the health of people living with HIV/AIDS.
abstract: Individuals who are homeless or living in marginal conditions have an elevated burden of infection with HIV. Existing research suggests the HIV/AIDS pandemic in resource-rich settings is increasingly concentrated among members of vulnerable and marginalized populations, including homeless/marginally-housed individuals, who have yet to benefit fully from recent advances in highly-active antiretroviral therapy (HAART). We reviewed the scientific evidence investigating the relationships between inferior housing and the health status, HAART access and adherence and HIV treatment outcomes of people living with HIV/AIDS (PLWHA.) Studies indicate being homeless/marginally-housed is common among PLWHA and associated with poorer levels of HAART access and sub-optimal treatment outcomes. Among homeless/marginally-housed PLWHA, determinants of poorer HAART access/adherence or treatment outcomes include depression, illicit drug use, and medication insurance status. Future research should consider possible social- and structural-level determinants of HAART access and HV treatment outcomes that have been shown to increase vulnerability to HIV infection among homeless/marginally-housed individuals. As evidence indicates homeless/marginally-housed PLWHA with adequate levels of adherence can benefit from HAART at similar rates to housed PLWHA, and given the individual and community benefits of expanding HAART use, interventions to identify HIV-seropositive homeless/marginally-housed individuals, and engage them in HIV care including comprehensive support for HAART adherence are urgently needed.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada. mjmilloy@cfenet.ubc.ca
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology*; D023241:Antiretroviral Therapy, Highly Active; D001294:Attitude to Health; D002170:Canada / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D019562:Viral Load; D016903:Drug Monitoring