LATEBREAKER
HIV / STI
Housing instability is associated with higher prevalence of recent methamphetamine, cocaine, and opioid use among people with HIV in the US Joseph A Delaney* Bridget Whitney Heidi M Crane Dominique Heinke Stephanie A Ruderman L Sarah Mixson Robin M Nance Amanda L Willig Sonia Napravnik Kenneth H Mayer Laura Bamford Edward Cachay Jeffrey Jacobson Rob J Fredericksen Lydia N Drumright Joseph A Delaney
Background
There is growing evidence that lack of stable housing may make people with HIV (PWH) more vulnerable to substance use. In particular, MCO (Methamphetamine, Cocaine, and/or Opioid) use is associated with increased health concerns and social stigma.
Methods
We included PWH in clinical care in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort from 2019 or later who completed a patient reported outcome assessment in a cross-sectional analysis. We estimated associations between the most recent self-reported housing stability response and the closest preceding or concurrent MCO use assessment using relative risk regression adjusted for age, sex, race/ethnicity, and CNICS clinical site. 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’. Substance use was assessed via the ASSIST as any use in the past 3 months of any of the MCO substances.
Results
Our study included 5,580 PWH (average age: 52; 81% male; 41% White, 42% Black, 11% Hispanic; average time in care: 9.5 years), of which 5,075 (91.0%) reported stable housing. Overall, 10.9% of participants reported recent use of ≥1 MCO (7.2% Methamphetamine, 4.3% Cocaine, 2% Opioids). PWH who reported a housing status other than stable were 2.94 (95%CI: 2.51-3.43) times more likely to report MCO use compared to those stably housed (Figure). PWH who were unhoused were the most likely to report MCO use (RR=3.91, 95%CI: 3.20-4.77).
Conclusion
Lack of stable housing, particularly being unhoused, was associated with an increased burden of substance use among PWH. This finding highlights that housing instability is associated with increased negative health consequences and should be prioritized an important social determinant of health among this vulnerable population. Increased access to substance treatment programs remains vital to improving outcomes of PWH.
