Effects of Housing On Health and Wellbeing in HIV Positive Women
The social context of poverty often changes the priorities of impoverished persons, frequently reassigning important issues such as health and wellbeing as less important than meeting basic subsistence needs, such as housing. An HIV+ woman’s housing needs may either promote or impede her from getting HIV medical care. The current study sought to find if there were differences between stably housed and unstably housed HIV+ women in adherence to treatment, emotional wellness, environmental safety, physical health status, and risk behaviors.
This cross-sectional study investigated the relationship between housing and physical health and emotional wellbeing among 832 extremely low income HIV+ women receiving services from a non-profit AIDS service organization (ASO) in the mid-south region. The survey questionnaire assesses the client’s status in the following domains, with varying possible maximum scores: Adherence to Treatment (0-6), Emotional Wellness (0-24), Environmental Safety (0-22), Physical Health (0-27) and Risk Reduction (0-27). In each domain, a lower score indicates a better outcome. Regression analysis compared stably housed and unstably housed HIV+ women on the survey variables.
Significant differences were found between stably housed and unstably housed HIV+ women on all outcome variables except Adherence to Treatment. All subjects had excellent outcomes in Adherence to Treatment, and no differences were found between stably housed and unstably housed clients on this domain. Significant univariate main effects for housing status were obtained for Emotional Wellness, F (1, 268) =6.836, p =0.009; Environmental Safety, F (1, 268) =21.155, p=0.000; Physical Health, F (1, 268) =5.356, p=0.021; and Risk Reduction, F (1, 268) =6.857, p =0.009.
Given that depression and stressful events are important predictors of premature ART discontinuation and non-adherence, factors associated with poor health outcomes, the finding that women who are unstably housed are doing worse in Emotional Wellness than stably housed women is concerning. Stably housed women reported much lower number of Environmental Safety concerns than their unstably housed HIV+ peers. Housing security may offer environmentally safe conditions unavailable for women coping with homelessness or unstable housing.
In addition to dealing with housing issues, unstably housed women have more Physical Health limitations and less stamina. As physical health, energy, and vitality are needed to manage one’s day-to-day living, poorer health can increase women’s barriers in finding stable housing. A significant difference was found between stably and unstably housed women in Risk Reduction, suggesting that stable housing results in lower rates of engagement in risky behaviors, thus protecting the population at large.
Taken together with studies done elsewhere, these results suggest that housing services for HIV+ women may be an effective way to increase their health and wellbeing as well as prevent transmission to others, therefore managing the epidemic while having salutary effects on the community. To develop effective prevention, treatment and support strategies for women with HIV, it is critical to address and improve their social-economic and housing conditions.