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Social, Structural and Behavioral Determinants of Overall Health Status in a Cohort of Homeless and Unstably Housed HIV-Infected Men

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  • Elise D Riley
  • Torsten B Neilands
  • Kelly Moore
  • Jennifer Cohen
  • David R Bangsberg
  • Diane Havlir

Abstract

Background: Previous studies indicate multiple influences on the overall health of HIV-infected persons; however, few assess and rank longitudinal changes in social and structural barriers that are disproportionately found in impoverished populations. We empirically ranked factors that longitudinally impact the overall health status of HIV-infected homeless and unstably housed men. Methods and Findings: Between 2002 and 2008, a cohort of 288 HIV+ homeless and unstably housed men was recruited and followed over time. The population was 60% non-Caucasian and the median age was 41 years; 67% of study participants reported recent drug use and 20% reported recent homelessness. At baseline, the median CD4 cell count was 349 cells/µl and 18% of eligible persons (CD4 90% ranked 5th for its positive influence on mental health, and viral load ranked 4th for its negative influence on physical health. Conclusions: The inability to meet food, hygiene, and housing needs was the most powerful predictor of poor physical and mental health among homeless and unstably housed HIV-infected men in an urban setting. Impoverished persons will not fully benefit from progress in HIV medicine until these barriers are overcome, a situation that is likely to continue fueling the US HIV epidemic.

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  • Elise D Riley & Torsten B Neilands & Kelly Moore & Jennifer Cohen & David R Bangsberg & Diane Havlir, 2012. "Social, Structural and Behavioral Determinants of Overall Health Status in a Cohort of Homeless and Unstably Housed HIV-Infected Men," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-7, April.
    • Handle: RePEc:plo:pone00:0035207
    DOI: 10.1371/journal.pone.0035207
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    1. Kimberly A Koester & Shane P Collins & Shannon M Fuller & Gabriel R Galindo & Steven Gibson & Wayne T Steward, 2013. "Sexual Healthcare Preferences among Gay and Bisexual Men: A Qualitative Study in San Francisco, California," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-11, August.
    2. Jessica H. Leibler & Daniel D. Nguyen & Casey León & Jessie M. Gaeta & Debora Perez, 2017. "Personal Hygiene Practices among Urban Homeless Persons in Boston, MA," IJERPH, MDPI, vol. 14(8), pages 1-9, August.
    3. Shoshana Y Kahana & Richard A Jenkins & Douglas Bruce & Maria I Fernandez & Lisa B Hightow-Weidman & Jose A Bauermeister & Adolescent Medicine Trials Network for HIV/AIDS Interventions, 2016. "Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-19, April.
    4. Carmen H Logie & Jesse I R Jenkinson & Valerie Earnshaw & Wangari Tharao & Mona R Loutfy, 2016. "A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-20, September.

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