Effective age-related interventions, specifically for youth and those 50 and above
Policy, Program, Intervention or other types of research evaluation
Issues : Young age and housing instability independently predict virologic failure, driving heightened HIV risk and poor health outcomes among unstably housed lesbian, gay, bisexual, transgender and/or queer (LGBTQ) youth. Supportive housing has been shown to promote viral load suppression among marginalized groups. However, little is known about the impact of housing on health outcomes for LGBTQ youth, who are living at the intersection of social marginalization and late-adolescent development stage. The aim of this study is to examine a unique supportive housing program for young LGBTQ adults (age 18-24) who are living with HIV.
Description : The housing program, opened in Spring 2017, provides 10 furnished 2-bedroom units to house up to 20 residents in two adjacent apartment buildings in Brooklyn, NY. As of March 2018, there are 18 program residents. The housing site is staffed by program coordinators who assist residents to manage processes and appointments regarding health, educational, employment and housing goals, as well as provide support for physical and behavioral health care. A key objective of the housing program is to support residents to achieve and maintain HIV viral load suppression though medication and appointment adherence reminders and motivational interviewing. Individuals who have experienced housing instability, are living with HIV infection, personally identify as LGBTQ and are age 18-24 are eligible for the housing program.
A mixed-metods study initiated upon program opening is designed to assess the effect of the program on HIV management, mental health, substance use, sexual health, HIV stigma and self-esteem. Data collection includes descriptive statistics gathered through a resident questionnaire administered following program entry and at 3-month intervals thereafter, and in-depth semi-structured interviews conducted approximately three months following a resident's program enrollment.
Lessons learned : The majority of residents surveyed to date (n=13, average age 21.8 years) identify as male (85%), black (69% ), and unemployed seeking work (62%). Over 75% of these residents report moving more than three times in the past two years and 62% have experienced homelessness in their lifetime. Prior to entry into the housing program, most residents had been staying temporarily with a family member or friend (38%) or residing in emergency housing (23%). Most residents (62%) report histories of incarceration, 54% have experienced intimate partner violence in the past year, and 100% report perceived HIV stigma.
As of March 2018, all current residents (n=18) were actively monitoring their HIV viral load and 83% (15 residents) were virally suppressed (<200 copies/mL). Qualitative interviews (n=8) reveal that the housing program promotes medication adherence and viral load suppression among LGBTQ youth by 1) shielding residents from the risk environment; 2) connecting residents to culturally appropriate physical and behavioral health services; and 3) developing a sense of community which fosters mutual support and prosocial health norms and mitigates the negative effects of internalized stigma.
Recommendations : Affirming, safe housing for HIV-positive LGBTQ youth supports viral suppression and other positive health and psychosocial outcomes. Baseline quantitative findings reflect volatile residential instability, vulnerability to violence and incarceration, and high internalized stigma among homeless and unstably housed LGBTQ young adults. Qualitative data reveal how supportive, congregate housing can provide protective environmental predicability and foster positive peer relationships. These factors influence LGBTQ youths' development of a sense of self and health-promoting behaviors, pointing to the critical importance of housing as a structural intervention for this vulnerable group.