Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States – Medical Monitoring Project, 2009–2015

ABSTRACT

Homelessness is a challenge to retention in HIV care and adherence to antiretroviral therapy. We describe the sociodemographic and behavioral characteristics of HIV-positive adults who reported recent homelessness. The Medical Monitoring Project is a complex sample survey of HIV-positive adults receiving medical care in the United States. We used weighted interview and medical record data collected from June 2009 to May 2015 to estimate the prevalence of depression, substance use, and HIV risk behaviors among adults experiencing recent homelessness. From 2009 to 2015, 8.3% of HIV-positive adults experienced recent homelessness. Homeless adults were more likely than housed adults to have major depression, to binge drink, use non-injection drugs, use injection drugs, and smoke. Over 60% of homeless adults were sexually active during the past year, with homeless adults reporting more condomless sex with an HIV-negative or unknown status sex partner than housed adults. Programs attempting to improve the health outcomes of HIV-positive homeless persons and reduce ongoing HIV transmission can focus on providing basic needs, such as housing, and ancillary services, such as mental health counseling or substance abuse treatment and counseling.

KEYWORDS:

• Homeless
• HIV
• HIV risk behaviors
• substance use
• depression

Acknowledgements

We thank participating Medical Monitoring Project patients, facilities, project areas, and Provider and Community Advisory Board members. We also acknowledge the contributions of the Clinical Outcomes Team and Behavioral and Clinical Surveillance Branch at CDC and the MMP 2009–2014 project areas (http://www.cdc.gov/hiv/statistics/systems/mmp/resources.html).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding for the Medical Monitoring Project is provided by a cooperative agreement (grant number PS09-937) from the Centers for Disease Control and Prevention.