Chronic Homelessness Research Articles

PHYSICAL AND MENTAL HEALTH NEEDS OF OLDER ADULTS EXPERIENCING HOMELESSNESS: CHALLENGES AND INNOVATIONS IN CARE

Abstract Adults over the age of 50 are the largest growing demographic of individuals experiencing homelessness. They enter a continuum of housing services with a myriad of chronic and acute health conditions that have often been unaddressed due to sporadic and episodic care utilization primarily within emergency services. The compounding health impacts of chronic homelessness accelerate aging within this demographic. Housing services offer an opportunity to address unmitigated health issues. Housing services are seeking research and programmatic interventions to meet this need. This symposium will explore the physical and mental health needs of older adults experiencing homelessness across the continuum of housing services from shelter entry to permanent supportive housing though a variety of research methodologies. The first presenter (Souza) will present results of a study applying latent class analysis to administrative shelter services data to identify unobservable subgroups within the population of older adults living in shelter. The second presenter (Berg) will discuss the implementation of shelter-based care services to older adults with complex medical needs in a low barrier, harm reduction focused hotel shelter. The third presenter (Robinson) will describe a qualitative investigation examining barriers to mental health care for older adults in permanent supportive housing. The discussant (Tsai) will lead symposium attendees in a discussion of future considerations for research, policy, and practice to meet the needs of this growing demographic of older adults.

Managing Health Without Stable Housing: Dimensions of Treatment Burden and Patient Capacity for People With Chronic Health Conditions Experiencing Homelessness.

Although chronic health conditions and homelessness are prevalent problems in the United States and globally, little research has used the lens of burden of treatment theory to examine the experiences of people facing these challenges simultaneously. This study aimed to illuminate dimensions of treatment burden, which refers to the work of being a patient with chronic conditions, and patient capacity to manage this burden in a sample of people experiencing homelessness and chronic health problems in Buffalo, New York, United States. We completed in-depth interviews with men and women recruited from a homelessness services organization (N = 27) and applied core concepts from burden of treatment theory to our analysis to probe how participants navigated tasks related to treatment and self-care. Using codebook thematic analysis involving three coders, results revealed four interconnected themes of complex coordination, self-monitoring, obtaining and using prescriptions and medical supplies, and communication and explaining health issues, which were confirmed through member checking (N = 6). These dimensions of treatment burden were dynamically impacted by patient capacity factors-which included trauma, medical mistrust, health literacy, and social support-as well as by social determinants of health such as housing and income. Findings support the need for more formal collaboration mechanisms between healthcare providers and social service agencies, active involvement of patients in their health plans, and policies such as Housing First to improve access to stable and affordable housing and social services for people with complex health issues.

The Annual Canadian Sociological Association Conference 2023. Research Cluster: Sociology of Housing

From May 29 to June 2, 2023, the Annual Conference of the Canadian Sociological Association was held at York University in Toronto, where various academic, research, educational, and administrative topics were discussed. The conference was part of the Congress of the Canadian Federation for the Humanities and Social Sciences and attracted speakers and attendees from Canada and other countries. Notably, for the first time since 2003, a research cluster focusing on the sociology of housing was presented, which had been initiated within the association at the end of 2021. Participants included scientific and pedagogical professionals, students, practitioners, and independent researchers, who engaged in two sections dedicated to sociological studies of housing and homelessness. Discussions covered a range of topics including chronic homelessness among women, mobile homelessness, the risk of homelessness among youth, attitudes towards the homeless, housing conditions of different social groups, and housing precarity. Special attention was given to state housing policy and the federal 'Housing First' strategy, the outcomes of which are subject to debate. The reports presented by the Sociology of Housing Research Cluster are of great interest to researchers focusing on housing issues in liberal democratic countries, including Canada, and to sociologists interested in developing housing sociology in Russia based on international experiences.

Revisiting the threefold typology? An exploratory analysis of homelessness duration and recurrence in Belgium using administrative data

ABSTRACT This study explores administrative data from 2010 to 2018 to examine homelessness duration and recurrence in Belgium. We focus on people experiencing homelessness (PEH) with a reference address at a local welfare agency. By critically revisiting the classic threefold typology – transitional, episodic, and chronic, which is often derived from limited shelter-based data – the study adopts a four-group classification: first-timers, re-enterers, chronic and extremely chronic homelessness. Our findings align with prior research, confirming significant associations of shorter durations with families, women, and younger individuals. Interestingly, the majority of our dataset faces chronicity, including youth and families. Extremely chronic homelessness highlights administrative vulnerability, suggesting to reduce administrative barriers to enhance their access to rights. Providing a more nuanced understanding of duration and recurrence, based on administrative data over extended periods, is crucial for gaining deeper insights into the chronicity of homelessness, ultimately supporting more informed policy decisions.

Understanding the Population of People Experiencing Homelessness in Cape Town and their Service Use

Cape Town, South Africa, has an estimated 14,357 people living on the street or in temporary shelters. Current responses to homelessness are either punitive—focusing on law enforcement and displacement—or compassionate, offering basic relief like food or handouts. Neither approach is effectively addressing the root causes of homelessness, and the number of homeless individuals continues to rise. This paper advocates for a developmental approach that provides structured support to help people exit homelessness. There is limited knowledge about the causes of homelessness in South Africa, the services utilized by those affected, and the kind of support needed for sustainable solutions. To address this gap, a survey of 350 homeless individuals in Cape Town was conducted, gathering data on demographics, service use, income sources, health, substance use, and interactions with legal systems. The results reveal that the average duration of homelessness is 8.6 years, with over 70% of respondents experiencing homelessness for more than a year. The main causes of homelessness were identified as structural issues such as lack of income, housing access, and loss of family support. Only 11% of participants were in temporary shelters, and their average daily income was around R78 (about $4 USD). Substance use disorders were prevalent, affecting 63% of respondents, while 54% reported being arrested at least once during their experiencing homelessness. Most had not accessed developmental services, highlighting a critical gap in support. If the current approach persists, homelessness will worsen, with more individuals becoming entrenched in chronic homelessness. A shift towards a developmental approach is urgently needed, focusing on personalized support, affordable housing, rehabilitation, psychosocial services, and employment programs to facilitate a meaningful exit from homelessness.

Algorithm-Assisted Decision Making and Racial Disparities in Housing: A Study of the Allegheny Housing Assessment Tool

The demand for housing assistance across the United States far exceeds the supply, leaving housing providers the task of prioritizing clients for receipt of this limited resource. To be eligible for federal funding, local homelessness systems are required to implement assessment tools as part of their prioritization processes. The Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT) is the most commonly used assessment tool nationwide. Recent studies have criticized the VI-SPDAT as exhibiting racial bias, which may lead to unwarranted racial disparities in housing provision. In response to these criticisms, some jurisdictions have developed alternative tools, such as the Allegheny Housing Assessment (AHA), which uses algorithms to assess clients' risk levels. Drawing on data from its deployment, we conduct descriptive and quantitative analyses to evaluate whether replacing the VI-SPDAT with the AHA affects racial disparities in housing allocation. We find that the VI-SPDAT tended to assign higher risk scores to white clients and lower risk scores to Black clients, and that white clients were served at a higher rates pre-AHA deployment. While post-deployment service decisions became better aligned with the AHA score, and the distribution of AHA scores is similar across racial groups, we do not find evidence of a corresponding decrease in disparities in service rates. We attribute the persistent disparity to the use of Alt-AHA, a survey-based tool that is used in cases of low data quality, as well as group differences in eligibility-related factors, such as chronic homelessness and veteran status. We discuss the implications for housing service systems seeking to reduce racial disparities in their service delivery.

Isolation to stabilization: A Housing First approach to address homelessness in Kingston, Ontario.

Homelessness is a significant and growing public health concern across Canada. In Kingston, Ontario, the number of people experiencing chronic homelessness has more than doubled from 136 people in 2020 to 296 in 2023. An emergency shelter-in-place hotel program was established in April 2020 to provide non-congregate shelter to people experiencing homelessness and vulnerable to SARS-CoV-2 infections. Beyond preventing COVID transmission, the unintentional consequence was that a population that experienced chronic homelessness reduced drug consumption and became stable. In 2022, with increased funding from the Ministry of Health and the City of Kingston, a new Housing First program was implemented to transition individuals from homelessness to long-term stable housing. Between November 2022 and June 2023, a total of 34 clients initiated the program. Of these clients, 10 completed the program and were successfully housed, 10 remained active participants, and 14 were discharged before completion. Strengths and challenges were identified. Diverse services provided to meet the population's needs and strong collaborations with various community partners were facilitating factors. Inadequate external resources, a lack of evening and prosocial activities, and outside peers (not part of the program) who influenced recovery plans were identified as challenges. This program illustrates that simultaneously integrating housing, community building, mental health, and addiction services is possible and provides an innovative way to stabilize this vulnerable population of people experiencing homelessness. Results from this program and the knowledge generated through implementation are being used to further scale up the program.

A Case Study Analysis of Library Services for Adults Experiencing Chronic Homelessness in Harrison County, Mississippi

ABSTRACT The author partnered with the Harrison County Library System (HCLS) to create a multilevel program plan for expanding library services to the growing number of homeless people who seek refuge in the library’s facilities. The research for this program plan involved evaluating existing library resources such as collections, programming, and available staff resources; identifying the best practices for providing services to people experiencing homelessness; identifying staff perceptions of working with the homeless; and identifying potential partners for expanded service offerings. The author used document analysis to research data on the library system (IMLS 2021 and reviewed library policy to identify barriers to providing service for the homeless. The author applied qualitative and humanistic research methods involving personal narratives (scenarios) provided through two separate one-on-one interviews with the library director to discuss the library system in general, and one one-on-one interview with six library staff working in the three libraries with the highest use by people experiencing homelessness. This paper discusses the findings from this mixed methods research project and their application to expanding services for chronically homeless patrons who use the HCLS.

Delaware Ranks 45th Nationally in Education Outcomes: Measuring Academic Success and Improving Educational Outcomes for Delaware's Youth.

Delaware's ranking as 45th in the nation for education outcomes highlights the multifaceted challenges and influences affecting children's development and education in the state. This paper explores how student success is measured in Delaware and the impact social determinants of health have on youth outcomes, including chronic absence, homelessness, nutrition, poverty, and adverse childhood experiences. By addressing these interconnected issues, Delaware can work towards closing achievement gaps and improving educational experiences for all students. Findings underscore the necessity for comprehensive support systems within schools informed by empirical evidence to foster a conducive learning environment and improve student outcomes. By addressing the social determinants of health driving educational challenges, policymakers can take a comprehensive approach to enhance the well-being and academic success of all children in Delaware.

Housing-related disparities in receipt of breast cancer screening among Medicaid beneficiaries.

76 Background: People experiencing or at risk of homelessness (PEH) are often diagnosed with advanced breast cancer, suggesting barriers to preventive care and screening. However, there is limited data that examine screening among PEH, undermining efforts to characterize and address potential disparities in screening. To address this gap, we investigated housing-related disparities in receipt of breast cancer screening in Medicaid, which disproportionately serves low-income PEH. Methods: We used a novel linkage of Pennsylvania Medicaid data with encounter-level data on housing-related services (Housing Management Information System; HMIS) from 2011 to 2017. We compared rates of biennial mammography between a cohort of Medicaid women receiving housing-related services in HMIS (i.e., a proxy for experience/risk of homelessness) and randomly sampled comparison beneficiaries without any housing services use. We estimated both unadjusted and adjusted disparities in receipt of biennial mammography (controlled for county and year fixed effects, demographic and Medicaid eligibility characteristics, and baseline healthcare utilization and comorbidities). We also examined heterogeneity in disparities by beneficiaries in the following HMIS subgroups: 1) receiving supportive housing, 2) experiencing chronic homelessness (i.e., 12+ months of homelessness), and 3) unstably housed (housed but receiving homelessness prevention services). Results: We identified 1,792 Medicaid beneficiaries with an HMIS encounter and 71,664 comparison beneficiaries. Those in the HMIS cohort were more likely to be younger, non-Hispanic Black, eligible for Medicaid due to disability, and have a higher number of inpatient visits and comorbidities. The unadjusted proportion receiving mammogram was 44.8% and 50.1% in the HMIS vs. comparison cohort, with an overall disparity of 5.3 percentage-points (pp, P <.001). This disparity estimate remained was robust to adjusting for covariates (-4.3 pp; P < .001). We found the largest adjusted disparity when comparing beneficiaries experiencing chronic homelessness (-8.5 pp; P = .038) relative to the comparison cohort. In contrast, the disparity was smaller among women receiving supportive housing (-3.7 pp; P = .098) and unstably housed women (-3.3 pp; P = .071). Conclusions: There was a significant disparity in the utilization of mammography among women PEH, especially those who experience chronic homelessness, in Pennsylvania Medicaid. Our finding illuminates the health consequences of housing insecurity and underscore a need for programs providing adequate housing, such as supportive housing, to address disparities in screening. In the meantime, greater efforts should be dedicated to improving the uptake of screening among at-risk populations at the point of contact with the healthcare system (e.g. when PEH engage with care).

Unravelling the Complexity of Homelessness: Investigating Reasons and Risk Factors for Chronic Homelessness

ObjectivesHomelessness is a complex and pressing issue affecting individuals and communities worldwide, including Northern Ireland. Understanding its root causes and associated risk factors is crucial for effective interventions. This study aims to identify primary contributors to homelessness and explore risk factors linked to chronic homelessness in Northern Ireland. MethodsUtilizing an anonymized, linked dataset incorporating Northern Ireland Housing Executive (NIHE) and health and social care data, we will conduct a pioneering record linkage study. This analysis will focus on unravelling homelessness dynamics, particularly chronic homelessness, spanning from 2012 to 2022. ResultsThrough our comprehensive analysis of using linked administrative datasets, we anticipate unveiling significant insights into the prevalence and persistence of chronic homelessness in Northern Ireland. By employing descriptive analyses, we will uncover nuanced patterns and trends, shedding light on the multifaceted dynamics of homelessness within the region. Moreover, our examination aims to identify key factors contributing to the persistence of chronic homelessness, providing crucial insights for developing targeted interventions and support systems. The outcomes of this analysis will not only contribute to a deeper understanding of the complexities surrounding homelessness but also serve as a foundation for evidence-based policymaking and community initiatives aimed at alleviating homelessness in Northern Ireland. ConclusionThis study has the potential to increase our understanding about the characteristics, needs and outcomes of the homeless population in Northern Ireland. It is possible that the results may contribute to facilitating further cross-departmental integration and commitment to addressing vulnerable homeless households with complex needs.

Beyond the margins: antenatal health and healthcare behaviours among homeless women in Kolkata Municipal Corporation, India.

Despite high childbearing rates among homeless women in India, the antenatal health and healthcare behaviours among such population remain poorly understood. To address this research gap, a mixed-methods approach was employed in the present study, involving interviews with a sample of 400 women aged 15-49 years, utilising time and location sampling techniques. Additionally, a purposeful sample of 52 women from the same age group participated in in-depth interviews. The respondents exhibited rampant socio-economic backwardness, including chronic homelessness (36%), no formal education (54%), engagement in rag picking (31%), and low income levels. About 56% of the women reported poor self-rated health (SRH), notably higher among those aged 35 and above and those living alone (68%). Poor SRH was also prevalent among the ever married (61%), ragpickers (61%), beggars (62%), chronic homeless individuals (62%), tobacco (60%) and alcohol consumers (61%), and those with chronic diseases (61%). Common health issues included depression or anxiety (56%) and iron deficiency anaemia (35%). The level of unmet healthcare needs was 41%, with significant variation across diseases. Lack of reproductive health rights and awareness, socio-cultural beliefs, stigma, socio-economic poverty, poor quality of public healthcare services, irregularity in charity-run healthcare, and time constraints hindered antenatal care visits. The study underscores the urgent need for population-centric programmes and policies aimed at promoting reproductive health to achieve Sustainable Development Goal 3 of 'Good health and wellbeing' by 2030.

Factors associated with homeless experiences amid the COVID-19 pandemic in the Nipissing District, Ontario, Canada.

Canadian homelessness is an ongoing issue, especially in the Nipissing District, Ontario, where agencies work to support those in need. However, these efforts were challenged with the sudden onset of the COVID-19 pandemic. Drawing on the Cycle of Homelessness model, this study examines sociodemographic factors associated with homeless experiences during the pandemic. Using data from the 2021 (n = 207) Nipissing District homeless enumeration survey and employing bivariate and multivariate binary logistic analyses, this study examined sociodemographic factors associated with reasons of homelessness, barriers to housing loss and experiences of chronic and episodic homelessness during the pandemic. The results showed a significant sociodemographic variation in the experiences of the homeless population during the COVID-19 pandemic. Those over the age of 35 versus their younger counterparts were more likely (43.7%) found in emergency shelters. Multivariate findings indicated that females experienced housing/financial loss and interpersonal/family issues, directly causing homelessness, 2.2 and 2.5 times more than males, respectively. Welfare recipients were more likely to experience health-related reasons for housing loss (Odds Ratio (OR): 2.8), chronic homelessness (OR: 3.3), addiction (OR: 2.9), and mental health-related barriers to housing (OR: 4.1). Those aged 25-34, 25-44, and 45+ were 7.9, 4.9, and 5.1 times more likely to face chronic homelessness. Conclusions: Welfare recipients are more at-risk of health-related housing loss, addiction, and mental health barriers to housing, and chronic homelessness. This could be attributed to poor public planning and policies that put people in marginal economic and housing circumstances, especially during the pandemic. Therefore, policy reform is required to address the main barriers in eliminating homelessness.

The Aspire Social Impact Bond: How social impact bond financing can promote positive social and economic outcomes

AbstractFinancing human service delivery through social impact bonds (SIBs) is the subject of some critical commentary in the academic literature, but this tends to be largely theoretical rather than empirically based. This paper presents empirical evidence of how SIB financing can promote positive social and economic outcomes for governments, not‐for‐profit providers, individual service beneficiaries and society more broadly. The paper presents some of the results of an evaluation of the Aspire SIB, which financed an innovative intensive case management program providing housing and wraparound supports over a 3‐year period for people experiencing chronic homelessness. Aspire participants experienced significantly improved outcomes and decreased service needs, delivering downstream cost savings across several areas of government service delivery. This paper describes how the SIB financing mechanism underpinned the success of Aspire by promoting flexible, collaborative, outcome‐focussed and data‐informed responses to a challenging, multi‐faceted social problem.

Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness.

Individuals experiencing chronic homelessness have high rates of persistent co-occurring mental health and substance use disorders (COD), and they often have difficulty with service engagement and retention, resulting in symptom exacerbation and housing loss. This study pilot tested Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking (MISSION), a multicomponent wraparound treatment approach to improve COD symptoms and housing stability among individuals experiencing chronic homelessness and persistent COD. This open pilot study enrolled and assessed 109 individuals with a COD experiencing chronic homelessness and offered one year of MISSION. Statistically significant improvements were observed in behavioral health symptoms and functioning, days of illicit drug use, and housing stability. By treatment completion, 85% of participants were referred to social and behavioral supports. This pilot study demonstrates that MISSION helped to successfully engage participants in treatment, reduce substance use and mental health symptoms, and improve housing outcomes.

Identifying 2SLGBTQ+ individuals experiencing homelessness using Point-in-Time counts: Evidence from the 2021 Toronto Street Needs Assessment survey.

The objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada. Data was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey. Two hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness. Our study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations.

Implementation of the Community Homes for Opportunity Program Among Community Mental Health Staff in Southwestern Ontario

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline–spring 2018 and post-implementation – winter 2019). Data analysis guided by Leininger’s ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.

The effect of merging mandated collaborations on performance in homeless services

ABSTRACT Mandated collaboration forces a tension, where organizations must work together to create a strong collaboration while pursuing their organizational missions. Merging these mandated collaborations can increase collaboration, but at the cost of local responsiveness. We ask whether merging mandated collaborations improves performance at the community, collaboration, and organization levels in the case of homeless services. We find merging CoCs did not significantly decrease homelessness or increase service provision, although collaboration increased. Additionally, chronic homelessness increased by an average of 30%. Our findings suggest merging mandated collaborations differentially affects performance depending on the level examined.

Learning More From Homeless Point-in-Time Counts

Previous research has found that patterns of sheltered homelessness and characteristics of people who use shelters vary between point-prevalence and period-prevalence tallies, but there are no comparable data for unsheltered homelessness. We derive a three-year period-prevalence measure of unsheltered homelessness from data collected in a point-in-time count, by weighting individuals by the inverse number of months, out of the last 36, that they report being homeless. We illustrate using data from the 2022 Point-in-Time Count in Nashville/Davidson County Tennessee, which found 634 unsheltered people. We estimate that the three-year prevalence of unsheltered homelessness would be at least 3.5 times the one-night count, but that far fewer people would meet the US Department of Housing and Urban Development’s definition of chronic homelessness. Over half of people sampled outdoors, especially those living with household members and pets, report never using shelter. Point-in-time counts can yield far more information useful for planning than the simple count itself.

Transgender Women Experiencing Homelessness - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020.

Transgender women experience high prevalence of homelessness, which can affect their likelihood of acquiring HIV infection and can lead to poor medical outcomes. CDC analyzed data from the National HIV Behavioral Surveillance Among Transgender Women to identify whether personal characteristics and social factors affecting transgender women were associated with duration of homelessness during the past 12 months. Longer duration and chronic homelessness might indicate greater unmet needs, which increases their likelihood for acquiring HIV infection. Ordinal logistic regression was conducted to calculate adjusted prevalence odds ratios and 95% CIs for transgender women from seven urban areas in the United States experiencing homelessness 30-365 nights, 1-29 nights, and zero nights during the past 12 months. Among 1,566 transgender women, 9% reported 1-29 nights homeless and 31% reported 30-365 nights homeless during the past 12 months. Among participants who reported physical intimate partner violence or forced sex, 50% and 47%, respectively, reported experiencing 30-365 nights homeless. Furthermore, 55% who had been evicted or denied housing because of their gender identity and 58% who had been incarcerated during the past year experienced 30-365 nights homeless. The odds of transgender women experiencing longer duration of homelessness was associated with being younger and having a disability; higher psychological distress scores were associated with longer duration of homelessness. Analysis of social determinants of health found transgender women experiencing longer homelessness to be less educated, living below the Federal poverty level, and having lower social support. Therefore, focusing on HIV prevention and interventions addressing housing instability to reduce the duration of homelessness among transgender women is important. Further, integrating housing services with behavioral health services and clinical care, specifically designed for transgender women, could reduce HIV acquisition risk and improve HIV infection outcomes.