Integrating mental health and substance use treatment with HIV care for people experiencing homelessness

Abstract

Homelessness is common in high-income and middle-income countries, with an estimated 580 000 people in the USA experiencing homelessness on any given night. 1 Henry M de Sousa T Roddey C Gayen S Bednar TJ The 2020 annual homeless assessment report (AHAR) to congress: part 1. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdfDate: January, 2021 Date accessed: May 24, 2022 Google Scholar People living with HIV have an increased risk of experiencing homelessness: from 2009 to 2015, 8·3% of people living with HIV in the USA reported an episode of homelessness in the previous year, compared with 0·2% of the general population annually. 2 Padilla M Frazier EL Carree T Shouse RL Fagan J Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States—Medical Monitoring Project, 2009–2015. AIDS Care. 2020; 32: 594-599 Crossref PubMed Scopus (12) Google Scholar This overrepresentation is due to many factors; for example, people living with HIV—particularly those with multiple marginalised identities—face discrimination in housing and employment markets, and both HIV infection and homelessness share common risk factors. People who use drugs, those living with mental health problems, and members of ethnic, racial, gender, and sexual minority communities have an increased risk of both HIV and homelessness. 3 Folsom DP Hawthorne W Lindamer L et al. Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am J Psychiatry. 2005; 162: 370-376 Crossref PubMed Scopus (388) Google Scholar , 4 US Centers for Disease Control and PreventionHIV in the United States and dependent areas. https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate: 2021 Date accessed: May 24, 2022 Google Scholar The underlying drivers of homelessness are structural, including the scarcity of affordable housing, income inequality, and racism. However, individual factors such as mental health and substance use problems are common precipitants, because people with these conditions face barriers to income and housing. Moreover, homelessness increases the severity of these conditions and decreases access to treatments. 5 Gutwinski S Schreiter S Deutscher K Fazel S The prevalence of mental disorders among homeless people in high-income countries: an updated systematic review and meta-regression analysis. PLoS Med. 2021; 18e1003750 Crossref PubMed Scopus (22) Google Scholar Integrating HIV and substance misuse services: a person-centred approach grounded in human rightsIntegrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. Full-Text PDF