Background
Reproductive-age women are uniquely affected by HIV across their life course. Housing instability has been identified as a modifiable risk factor for worse health outcomes among people living with HIV but is not well examined among reproductive-age women. We evaluated associations between housing status and HIV outcomes among reproductive-age women living with HIV (WLH).
Methods
The Study of Treatment and Reproductive Outcomes (STAR) examines cisgender women aged 18-45 years old with and without HIV in six Southern US sites. We analyzed baseline data for WLH enrolled in March 2021-August 2023. Participants were considered unstably housed if they self-reported living in a rooming/halfway house, shelter/welfare hotel, on the street/beach, jail/other correctional facility, residential drug/alcohol treatment facility, car, assisted living, or other unstable housing location. We evaluated associations between housing status and a) viral non-suppression, and b) missed HIV care visits using logistic regression models, adjusting for age, race, socioeconomic status, depressive symptoms, and illicit drug use.
Results
Among 473 WLH, median age was 37 (IQR 32-42) years. Participants were predominately non-Hispanic Black (80.1%), unmarried/unpartnered (68.7%), unemployed (52.2%), and high school educated (61.7%); 37.2% reported annual household income of $24,000 or less. Overall, 9.2% reported illicit drug use (excluding marijuana only) and 33.5% reported depressive symptoms. Among WLH, 7.0% reported unstable housing, 16.2% had a missed HIV visit in the last year, and 19.5% were virally non-suppressed. Unstably housed WLH were significantly more likely to be virally non-suppressed than stably housed WLH; this association persisted after adjusting for sociodemographic variables, depressive symptoms, and illicit drug use (OR: 2.92, Cl: 1.08-7.87). Unstably housed WLH were additionally more likely to miss at least one HIV visit in the past year, which also persisted after adjusting for these variables (OR: 2.35, Cl: 1.02-5.42; Table).
Conclusions
Housing instability was associated with over two times the odds of adverse HIV outcomes, even after adjusting for sociodemographic and psychosocial risk factors. This emphasizes its role as a key social determinant of health that must be addressed. Further research to assess the potential pathways for this association, such as access to care or comorbid conditions, will inform acceptable and scalable housing interventions to improve outcomes for WLH.