Abstract
ObjectivesBoth homelessness and incarceration are associated with housing instability, which in turn can disrupt continuity of HIV medical care. Yet, their impacts have not been systematically assessed among people living with HIV/AIDS (PLWHA).MethodsWe studied a retrospective cohort of 1,698 New York City PLWHA with both jail incarceration and homelessness during 2001–05 to evaluate whether frequent transitions between jail incarceration and homelessness were associated with a lower likelihood of continuity of HIV care during a subsequent one-year follow-up period. Using matched jail, single-adult homeless shelter, and HIV registry data, we performed sequence analysis to identify trajectories of these events and assessed their influence on engagement in HIV care and HIV viral suppression via marginal structural modeling.ResultsSequence analysis identified four trajectories; 72% of the cohort had sporadic experiences of both brief incarceration and homelessness, whereas others experienced more consistent incarceration or homelessness during early or late months. Trajectories were not associated with differential engagement in HIV care during follow-up. However, compared with PLWHA experiencing early bouts of homelessness and later minimal incarceration/homelessness events, we observed a lower prevalence of viral suppression among PLWHA with two other trajectories: those with sporadic, brief occurrences of incarceration/homelessness (0.67, 95% CI = 0.50,0.90) and those with extensive incarceration experiences (0.62, 95% CI = 0.43,0.88).ConclusionsHousing instability due to frequent jail incarceration and homelessness or extensive incarceration may exert negative influences on viral suppression. Policies and services that support housing stability should be strengthened among incarcerated and sheltered PLWHA to reduce risk of adverse health conditions.
Highlights
Maintaining continuous engagement in HIV medical care is critical for HIV disease management for people living with HIV/AIDS (PLWHA) [1, 2]
We studied a retrospective cohort of 1,698 New York City PLWHA with both jail incarceration and homelessness during 2001–05 to evaluate whether frequent transitions between jail incarceration and homelessness were associated with a lower likelihood of continuity of HIV care during a subsequent one-year follow-up period
Compared with PLWHA experiencing early bouts of homelessness and later minimal incarceration/homelessness events, we observed a lower prevalence of viral suppression among PLWHA with
Summary
Maintaining continuous engagement in HIV medical care is critical for HIV disease management for people living with HIV/AIDS (PLWHA) [1, 2]. The association between housing stability and HIV care has rarely been described among formerly incarcerated PLWHA; current evidence is mainly concentrated on disrupted HIV care post release [8,9,10]. Because both events affect housing stability and incarceration is strongly correlated with homelessness, it is important to take into account dynamic aspects of incarceration events along with homelessness to more accurately characterize the impact of housing instability on continuity of HIV care. The study tested the hypothesis that frequent transitions between jail incarceration and homelessness are associated with lower likelihood of subsequent engagement in HIV care and viral suppression, plausibly due to the greater housing instability of PLWHA with this pattern
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