Clinical Review

Homelessness, HIV, and HCV

The homeless and people without stable housing are shown to have higher rates of HIV and hepatitis C infection and low medication adherence rates.


According to researchers from Columbia University in New York City, McMaster University in Hamilton, Ontario, Canada, and Ontario HIV Treatment Network, in Canada, homelessness and unstable housing situations are associated with higher rates of HIV and hepatitis C infection (HCV). They reviewed 152 studies involving 139,757 participants who had HIV or were co-infected with HCV. The researchers found “strong evidence” that the lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate medical care, adherence to treatment, sustained viral suppression, and reduction of risk behaviors.

Research data showed that the worse the housing status, the less the engagement and utilization of HIV medical care. Homeless patients had more emergency department (ED) admissions; homeless males had longer hospital stays; and homeless injection-drug users were more often hospitalized than were people with HIV in high socioeconomic neighborhoods.

In another study, homelessness was significantly associated with baseline HCV-positive status. Twenty-five studies reported that homelessness or unstable housing was associated with significantly poorer outcomes on 1 or more indications of physical or mental health functioning and quality of life, mental health symptoms or diagnosis, or diagnosed physical health comorbidities, such as HCV and tuberculosis. The studies also showed the impact of having a home on both treatment and adherence to treatment. One study of co-infected patients who were on antiretroviral therapy (ART) or beginning HCV treatment found that good housing conditions reduced the risk of nonadherence to ART, regardless of the treatment of HCV. Stable housing also doubled the odds of ART use.


Data from another study also found participants with a fixed address were more likely to stop abusing drugs. Obtaining stable housing was also associated with using an outpatient setting rather than the ED as the usual source of care.

“Housing first” interventions are receiving growing attention, the researchers note, as a potential health care cost-containment strategy. As interventions for people with complex health conditions, changing housing status is “both possible and promising.”

Aidala AA, Wilson MG, Shubert V, et al. Am J Public Health. 2016;106(1):e1-e23
doi: 10.2105/AJPH.2015.302905.

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