title: A review of the HIV-infected homeless sub-population at the Centre for HIV/AIDS Research, Education and Services, Department of Medicine, University Hospital of the West Indies.
abstract: OBJECTIVE
  The twin epidemics of HIV and homelessness present several challenging aspects to the development of programmes for the provision of treatment and care. This paper describes the characteristics of this population being managed by a collaborative effort between the Centre for HIV/AIDS Research, Education and Services, Department of Medicine, University Hospital of the West Indies and the National Council on Drug Abuse.
  
  
  METHODS
  A retrospective descriptive study was conducted via review of patients'medical files. Demographic and clinical data of the HIV-infected homeless population were summarized, highlighting issues related to the provision of care, rates of antiretroviral therapy (ART) uptake and subsequent adherence to treatment and known factors associated with HIV transmission.
  
  
  RESULTS
  A total of 12 cases were included in the analysis. There was an average age of 38.0 years (IQR 32.5-49.25) with the majority being female, nine (75.0%). Late stage diagnosis was a common feature. The majority of cases were eligible for ART on first contact, with CD4 counts on average being 284.4 (95% CI 10.9.0, 459.8). Significant risk factors for HIV transmission were also identified as all cases reported being sexual active with limited condom use reported and high reported numbers of lifetime partners, 30 (IQR 25.0-100.0). Other factors identified include eight (66.6%) cases reporting sexually transmitted infection (STI) symptoms, 10 (83.3%) reporting substance abuse and nine (75.0%) reporting sex work.
  
  
  CONCLUSIONS
  The implementation of combination interventions providing a comprehensive package of services that address the multitude of issues facing the HIV-infected homeless population is required in order to appropriately manage this population.
authors.affiliation: Centre for HIV/AIDS Research, Education and Services, University Hospital of the West Indies, Kingston 7, Jamaica. Geoffrey.barrow@uwimona.edu.jm.
authors.forename: G
authors.initials: G
authors.lastname: Barrow
authors.affiliation: Department of Medicine, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: N
authors.initials: N
authors.lastname: Clare-Pascoe
authors.affiliation: Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
authors.forename: A
authors.initials: A
authors.lastname: Bahadur
authors.affiliation: National Council on Drug Abuse, Jamaica.
authors.forename: U
authors.initials: U
authors.lastname: Atkinson
authors.forename: C
authors.initials: C
authors.lastname: Browne
authors.affiliation: Department of Medicine, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: T R
authors.initials: TR
authors.lastname: Clarke
authors.affiliation: Department of Medicine, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: E N
authors.initials: EN
authors.lastname: Barton
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006526:Hepatitis C / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology; D016903:Drug Monitoring