Understanding Patterns of HIV Risk Behavior in an Under-Researched, Vulnerable Population: A Latent Class Analysis of Single Room Occupancy Building Residents

Background and Purpose: Recent research and policy, including the U.S. National HIV/AIDS Strategy, have drawn attention to homeless and precariously housed individuals as a population at elevated risk for contracting and transmitting HIV. Within the broader discourse on housing environments and HIV, certain residential milieus such as single room occupancy (SRO) buildings have been linked with drug and sex-related risk behaviors. SROs are buildings that rent small dormitory-style rooms to single adults, and SRO residents are often characterized in both research and popular media as uniformly transient, high-risk individuals. However, relatively little empirical research has directly examined variations and patterns of HIV risk behavior among SRO residents. This study aimed to address this gap by using latent class analysis to classify the behavior patterns of SRO residents and identify if high-risk subgroups existed.

Methods: A venue-based recruitment approach was used to select a sample of SRO residents from ten Chicago SRO buildings (n=163). Participants completed an interviewer-administered survey. Six categories of HIV risk behavior were assessed over a 30-day recall period: illicit drug use other than marijuana, problem drinking, multiple sex partners, sex without a condom, sex while drunk/high, and exchange of sex for money. Injection drug use was assessed but not included in the analysis due to low occurrence. Based on these behaviors, a latent class analysis classified participants into HIV risk groups. The number of latent classes was determined using Bayesian Information Criterion and model interpretability. A logistic regression was conducted to identify significant predictors of class membership. Predictors included age, gender, race, income, HIV status, and prior street homelessness.

Results: A two-class model was identified. Members of a low-risk group (76% of participants) had estimated probabilities (EP) of less than 0.1 of reporting four risk behaviors. Members were more likely to report sex without a condom (EP=0.17) and problem drinking (EP=0.25). In contrast, members of a high-risk group (24% of participants) were relatively more likely to report illicit drug use (EP=0.42), problem drinking (EP=0.56), and having sex with multiple partners (EP=0.24), while drunk/high (EP=0.63), or without a condom (EP=0.65). Introduction of covariates indicated that African Americans had 1.68 higher log odds of being classified in the high-risk group. Further, every $100 increase in income was associated with 0.21 decreased log odds of high-risk group membership.

Conclusions and Implications: The results suggest that high-risk behavior appears to be concentrated among a subgroup of SRO residents. As research continues to uncover links between housing environments and HIV, it is critical to identify patterns of risk among precariously housed populations such as SRO residents, and to recognize that the majority of members of these groups may have a relatively low risk profile.  Prevention interventions can then be targeted toward the subgroups that are most at risk. The strong link between income and risk group membership provides further evidence for economic disadvantage as a structural driver of HIV risk and suggests that financial interventions with SRO residents and other precariously housed groups could impact HIV risk behavior.