Results: 80% of subjects were active substance users, while 81% reported a history of incarceration. After controlling for possible correlates, subjects were almost three times more likely to have an undetectable viral load (less than 400 copies/ml) at the six month follow-up, compared to their viral load at the time of intake (OR=2.89, 95% CI=5.87, 1.42). Results of the qualitative interviews indicated that housing's effect on adherence is mediated by material and subjective improvements in the lives of previously homeless PLWHA. Housing's materiality effect is produced by: a) reducing exposure to risk environments, b) reducing chaos in living conditions, and c) increasing access to psychosocial and support services. Housing's subjective effect is realized by a) changing medication-related attitudes among housing residents, b) establishing health-seeking collective norms, and c) improving medication-related self-efficacy.
Implications: The results indicate that housing should be conceptualized as an effective treatment for homeless PLWHA. Moreover, the results suggest that when housed, mandatory abstinence may not be required for PLWHA to be adherent to their medication. The materiality effects of housing underline the manner in which housing operates as a structural intervention that changes the risk environment for homeless PLWHA. Elements of the subjective pathway are embedded in the theory of planned behavior (Fishbein & Azjen, 1975) and illustrate the manner in which congregate housing acts as a catalyst for these cognitive processes. The identification of a conceptual model for housing's influence builds on previous scholarship and needs to be tested in future research.