The Relationship between Homelessness, HIV and Health in the Deep South

Background: Previous literature has shown that HIV prevalence is higher among people experiencing homelessness (PEH) than people who are stably housed, underscoring the need to increase HIV testing among this vulnerable population. PEH who are living with HIV also experience lower rates of adherence to antiretroviral therapy (ART), retention in HIV care, and viral suppression. Moreover, PEH often face multi-level barriers which prevent them from tending to their overall physical and mental health. Thus, there is an urgent need to develop sustainable community responses that promote HIV testing and treatment as well as healthcare strategies for individuals experiencing homelessness to facilitate personal and public health, especially among groups that carry a disproportionate burden of HIV.

Methods: We conducted 30 face-to-face interviews with adults who utilized homeless shelter services (20 males; 10 females, including one transgender woman). Eligible participants were (1) 18 years and older; (2) a guest/resident at a homeless shelter; and (3) recently tested for HIV at the shelter. Two coders read the transcripts and analyzed the qualitative data to identify trends and themes. Demographic data, including age, gender, race, and ethnicity, were also collected to describe study participants.

Results: About 47% of participants were older than 50 years of age, and most were Black (76.7%). Three participants tested positive for HIV. Qualitative data analysis revealed several key themes including: Circumstances leading to homelessness, how homelessness affects their health, support system, knowledge about HIV, acceptability to HIV testing, and barriers to healthcare. Substance use was the most commonly mentioned cause for homelessness, while interpersonal violence was more commonly cited by female participants. Participants reported low social support and low and/or outdated knowledge about HIV. Participants were open to HIV testing; however, some of them were not willing to continue regular HIV testing. Some participants lacked transportation, health insurance, and proper documents/identifications, which were identified as prominent healthcare barriers. Additionally, many participants disclosed comorbid conditions such as chronic obstructive pulmonary disease (COPD), mental health issues (e.g., post-traumatic stress disorder, bipolar disorder, schizophrenia), heart problems, stroke, high blood pressure, and high cholesterol. Some participants also revealed that they were victims of violent crimes (e.g., gun violence).

Conclusions/Implications: Homeless shelters are well positioned to provide integrated, shelter-based care to marginalized populations to address HIV, substance use, and other comorbid conditions. These organizations can also provide a valuable source of up-to-date and targeted HIV information and support for HIV health behaviors. Further, the expertise and resources held by social workers suggests that they could play an integral role in the health and welfare of this traditionally marginalized population.