Single Room Occupancy Residence: Processes Linking Housing to Not Engaging in HIV Outpatient Care.

Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents' health and wellbeing.

RESUMEN: La indigencia y la inestabilidad de vivienda reducen la participación en la atención médica, la adherencia al tratamiento y la salud de las personas viviendo con VIH/SIDA. Sin embargo, los procesos mediante los cuales la vivienda inestable e insegura conllevan a resultados adversos de salud permanecen poco estudiados y son el enfoque de este manuscrito. En el 2012­2014, llevamos a cabo entrevistas cualitativas con pacientes hospitalizados con VIH desconectados de servicios de atención ambulatoria (n = 120). Analizamos el contenido de las entrevistas (n = 44) con participantes que residían en un programa de ocupación de habitación individual (SRO, por sus siglas en inglés), guiados por la Teoría del Estilo de Vida Saludable. Aunque el programa de ocupación de habitación individual surgió en las entrevistas como residencias antihigiénicas y propicias para el uso de drogas y la violencia, los participantes se mantuvieron en el programa de ocupación de habitación individual por largo tiempo. Esto generó experiencias de inestabilidad en la vivienda, inseguridad y falta de control que reforzó tendencias (habitus) y comportamientos antitéticos a adherirse a la atención médica. Pedimos investigaciones e intervenciones para transformar los programas de ocupación de habitación individual en viviendas que protejan la salud y el bienestar de sus residentes.

Missed Opportunities for HIV Testing Among STD Clinic Patients.

Current HIV testing guidelines recommend that all adolescents and adults aged 13-64 be routinely screened for HIV in healthcare settings. Sexually transmitted disease (STD) clinic patients represent a population at increased risk for HIV, justifying more frequent risk assessment and testing. This analysis describes missed opportunities for HIV testing among a sample of STD clinic patients to identify areas where HIV testing services may be improved. Secondary analysis was conducted using data from Project AWARE, a randomized trial of 5012 adult patients from 9 STD clinics in the United States, enrolled April-December 2010. HIV testing history, healthcare service utilization, and behavioral risks were obtained through audio computer-assisted self-interview. Missed opportunities for HIV testing, defined as having a healthcare visit but no HIV test in the last 12 months, were characterized by location and frequency. Of 2315 (46.2%) participants not tested for HIV in the last 12 months, 1715 (74.1%) had a missed opportunity for HIV testing. These missed opportunities occurred in both traditional (54.9% at family doctor, 20.3% at other medical doctor visits) and non-traditional (28.5% at dental, 19.0% at eye doctor, 13.9% at correctional facility, and 13.3% at psychology visits) testing settings. Of 53 participants positive for HIV at baseline, 16 (30.2%) had a missed testing opportunity. Missed opportunities for HIV testing were common in this population of STD clinic patients. There is a need to increase routinized HIV screening and expand testing services to a broader range of healthcare settings.