Connection between social determinants and HIV prevention
Abstract Format : Housing instability has been associated with poor health outcomes among people who inject drugs (PWID). This study investigates the associations of local-level housing and economic conditions with homelessness among a large sample of PWID, which is an underexplored topic to date.
Methods : PWID in this cross-sectional study were recruited from 19 large cities in the USA as part of National HIV Behavioral Surveillance. PWID provided self-reported information on demographics, behaviors and life events. Homelessness was defined as residing on the street, in a shelter, in a single room occupancy hotel, or in a car or temporarily residing with friends or relatives any time in the past year. Data on county-level rental housing unaffordability and demand for assisted housing units, and ZIP code-level gentrification (e.g., index of percent increases in non-Hispanic white residents, household income, gross rent from 1990 to 2009) and economic deprivation were collected from the US Census Bureau and Department of Housing and Urban Development. Multilevel models evaluated the associations of local economic and housing characteristics with homelessness.
Results : Sixty percent (5394/8992) of the participants reported homelessness in the past year. The multivariable model demonstrated that PWID living in ZIP codes with higher levels of gentrification had higher odds of homelessness in the past year (adjusted OR=1.11, 95% CI=1.04 to 1.17).
Conclusions : Additional research is needed to determine the mechanisms through which gentrification increases homelessness among PWID to develop appropriate community-level intervention.
Reference: Linton SL, Cooper HL, Kelley ME for the National HIV Behavioral Surveillance Study Group, et al Cross-sectional association between ZIP code-level gentrification and homelessness among a large community-based sample of people who inject drugs in 19 US cities BMJ Open 2017;7:e013823.
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Sabriya L Linton1, Hannah LF Cooper2, Mary E Kelley2, Conny C Karnes2, Zev Ross3, Mary E Wolfe2, Samuel R Friedman4, Don Des Jarlais5, Salaam Semaan6, Barbara Tempalski6, Catlainn Sionean6, Elizabeth DiNenno6, Cyprian Wejnert6, Gabriela Paz-Bailey6 for the National HIV Behavioral Surveillance Study Group
1 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
2 Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
3 ZevRoss Spatial Analysis, Ithaca, New York, USA
4 Institute for Infectious Disease Research, National Development and Research Institutes, New York, New York, USA
5 Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, USA
6 Centers for Disease Control and Prevention, Atlanta, Georgia, USA