LATEBREAKER
Health Disparities
Housing instability is associated with decreased viral suppression among people with HIV in the United States Birdget M Whitney* Bridget Whitney Lydia N Drumright Stephanie A Ruderman L Sarah Mixson Robin M Nance Amanda L Willig Sonia Napravnik Kenneth H Mayer Laura Bamford Edward Cachay Jeffrey M. Jacobson Joseph A Delaney Heidi M Crane
Background
People experiencing houselessness have ~5-10-fold higher prevalence of HIV compared to stably housed individuals. Among people with HIV (PWH), lack of stable housing contributes to impaired access to, and continuity of, care.
Methods
Analyses include adult PWH in clinical care at 6 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites who completed a self-reported assessment on housing between 2019-2023 and had a viral load measured within 18 months prior to their housing assessment. Housing stability was assessed using a single item: “In the past month, how would you describe your living situation?”; response options: ‘Homeless,’ ‘Unstable,’ ‘Stable,’ ‘Don’t know’. HIV viral suppression was defined as <50 copies/ml HIV1-RNA. Associations between housing stability and HIV viral suppression were estimated by relative risk regression adjusted for age, sex, race/ethnicity, and site.
Results
Among 6,406 PWH (median age: 52; 83% male; 44% White, 39% Black, 12% Hispanic), 9.1% reported housing instability: 4.6% ‘Unstable,’ 2.8% ‘Homeless,’ 1.7% ‘Don’t know’. Self-reported antiretroviral therapy use was high overall, 96.2%, but varied by housing status: 96.7% ‘Stable,’ 92.5% ‘Unstable,’ 85.5% ‘Homeless,’ 92.7% ‘Don’t know.’ Compared to their stably housed counterparts, PWH reporting an unstable living situation were 9% less likely to be virally suppressed (RR=0.91, 95%CI:0.86-0.96), PWH reporting houselessness were 24% less likely to be virally suppressed (RR=0.76, 95%CI:0.67-0.82), and PWH who reported ‘Don’t know’ in response to the stability of their living situation were 11% less likely to be virally suppressed (RR=0.89, 95%CI:0.81-0.98).
Conclusion
Housing instability was associated with a 9-24% lower likelihood of HIV viral suppression among PWH in care in the US. These results suggest that a growing lack of access to stable, affordable housing may be deleterious to successful management of HIV and a barrier to ending the HIV epidemic.
