Abstract: HIV Risk and Prevention over Time Among Homeless Adults in Permanent Support Housing: The Impact of Social Networks (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Friday, January 12, 2018: 10:21 AM

Marquis BR Salon 14 (ML 2) (Marriott Marquis Washington DC)

* noted as presenting author

Suzanne Wenzel, PhD, Professor, University of Southern California, Los Angeles, CA

Harmony Rhoades, PhD, Research Assistant Professor, University of Southern California, Los Angeles, CA

Eric Rice, PhD, Associate Professor, University of Southern California, Los Angeles, CA

Lei Duan, PhD, Biostatistician, University of Southern California, los angeles, CA

Benjamin Henwood, PhD, Assistant Professor, University of Southern California, Los Angeles, CA

Hailey Winetrobe, MPH, CHES, Project Manager, University of Southern California, los angeles, CA

Taylor Harris, MA, Doctoral Student, University of Southern California, Los Angeles, CA

Wichada Hantanachaikul, MPH, CHES, Doctoral student, University of Southern California, los angeles, CA

Background and Purpose: Permanent supportive housing (PSH) for homeless persons provides a stable base from which to access health services. Homeless persons experience much higher rates of HIV/STIs, related risk behaviors, and social network composition-related risk and preventive behaviors than housed persons; yet little is known about HIV/STI risk and prevention behaviors among PSH residents. This study investigates HIV/STI risk and prevention over 12 months among formerly homeless persons in PSH, particularly with regard to how changes within social networks may influence risk and prevention behaviors.

Methods: Findings come from longitudinal research with 421 homeless adults moving into PSH in the Los Angeles area. Baseline interviews were conducted prior to or within 5 days of moving in, with follow-up interviews at 3, 6, and 12 months after move-in; 91% of respondents were retained at 12 months. These analyses examined change over time in past 3-month HIV risk and preventive behaviors using Generalized Linear Mixed Effects Models with decomposition of the between-subject and within-subject effects. Models controlled for demographics and size of the social network.

Results: Examination of sexual risk behavior outcomes (i.e., unprotected sex, multiple partners, exchange sex, concurrent sex, and sex under the influence of drugs/alcohol) in models which control for social network risk behavior reveal little change in behaviors over time, with the exception of exchange sex, which decreased significantly between prior-to-housing (4.6%) and 6 months after housing (2.0%). For all sexual risk outcomes, respondents who reported more social network members who engage in risky sex activity were more likely to report sexual risk behavior themselves. For multiple partners, exchange sex, concurrent sex, and sex under the influence of drugs/alcohol, over-time increases in the number of risk-taking network members were associated with increases in the respondents’ own risk-taking. For HIV prevention behaviors (i.e., attending an HIV prevention class, having a healthcare provider talk to you about HIV in the past 3 months), there were statistically significant declines over time (28% reported HIV prevention education at baseline, compared to 18% at 12 months). Having more social network members with whom respondents discussed HIV testing or condom use was associated with increased odds of recent HIV prevention education.

Conclusions and Implications: Longitudinal analyses of the possible influence of social networks on HIV risk and prevention demonstrate that social networks may be an important mechanism in understanding both sexual risk and HIV prevention behaviors among formerly homeless adults living in PSH. Of particular note is the relationship between perceived changes in sexual risk behaviors within respondents’ social networks and the respondent’s own sexual risk behavior over time. These findings suggest the importance of integrating HIV/STI prevention programming within PSH. Further, the association of residents’ social network characteristics with risk and prevention over time suggests that network-based intervention approaches deserve attention in reducing risk and improving sexual health among adults in PSH.