|dc.description.abstract||Housing and health are inextricably linked. Extensive research has concluded that social determinants of health—such as wealth, education, and housing instability—impact health outcomes. HIV is an idyllic example of how structural drivers influence risk, and housing acts as an ideal intermediary through which to guide outcomes.
This dissertation aims to highlight important ideas in structural interventions and HIV-related outcomes: 1) to establish covariation of cause and effect by grouping housing participants based on severity of housing insecurity; 2) to compare sexual risk, substance use and abuse, and depression and trauma outcomes of each housing group; 3) to control for alternate explanations by comparing differentially housed groups in a randomized controlled trial; 4) to consider a housing instability continuum that asserts risk outcomes increase as housing instability increases; and 5) to determine the effects of cohabitants on sexual risk, depression, and substance use outcomes.
Results from this research confirm there is a relationship between housing instability and risk. Compared to housed respondents, unstably housed participants had greater odds of having: unprotected sex with a known-serostatus partner, STI-positive status, concurrent partners, recent incarceration history, alcohol and drug dependence, injecting and other illegal drug use, recent inpatient drug treatment history, depression, traumatic experiences, and poorer quality of life after controlling for possible confounding factors. Also, women were also at greater risk for unprotected sex, partner concurrency, and HIV-positive serostatus. Though the unstably housed were most at-risk across all outcomes, the hypothesized housing continuum did not follow the postulated order; further research must be conducted. The results support cohabitants also affect risk, but identifying persons who generate ‘most risk’ across all outcomes may not be feasible.
This research may provide insight about strengths or barriers to care for PLWH to service providers and equip future housing interventions to create better outcomes for PLWH and the unstably housed.||