Abstract
Black men who have sex with men (BMSM) have the highest HIV incidence rate among all MSM in the United States (US), and are also disproportionately affected by homelessness and housing instability. However, little is known about the effects of homelessness on the HIV testing and care continuum for BMSM. Between 2014 and 2017, the Promoting Our Worth, Equality, and Resilience (POWER) study collected data and offered HIV testing to 4184 BMSM at Black Pride events in six US cities. Bivariate analyses were used to assess differences in sociodemographics and healthcare access between BMSM who self-reported homelessness and those who did not. Multivariable logistic regression models were used to assess differences in HIV testing by homelessness status. Finally, bivariate and multivariable models were used to assess differences in HIV care continuum and treatment adherence outcomes by homelessness status. 615 (12.1%) BMSM in our sample experienced homelessness in the last 12 months. BMSM who self-reported homelessness had higher odds of receiving an HIV test in the past 6 months compared to their stably housed counterparts. BMSM who self-reported homelessness had higher odds of reporting difficulty taking ART and of missing a dose in the past week compared to stably housed BMSM. Findings suggest that HIV testing outreach and treatment-related services targeting unstably housed BMSM may be effective. Future community-based research is needed to investigate how homelessness and housing instability affect ART adherence, and how this population may experience success in HIV testing and adherence despite economic and social marginalization.
Similar content being viewed by others
References
Centers for Disease Control and Prevention (CDC). Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report 2019; 24 (No.1). https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-24-1.pdf.
Centers for Disease Control and Prevention (CDC). HIV Among Gay and Bisexual Men. https://www.cdc.gov/hiv/group/msm/index.html. Accessed 23 Sept 2018.
Oster AM, Wiegand RE, Sionean C, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS. 2011;25(8):1103–12.
Buchér JB, Thomas KM, Guzman D. Community-based rapid HIV testing in homeless and marginally housing adults in San Francisco. HIV Med. 2007;8(1):28–31. https://doi.org/10.1111/j.1468-1293.2007.00423.x.
Liddicoat RV, Horton NJ, Urban R. Assessing missed opportunities for HIV testing in medical settings. J Gen Intern Med. 2004;19(4):349–56. https://doi.org/10.1111/j.1525-1497.2004.21251.x.
Fuqua V, Scott H, Scheer S, et al. Trends in the HIV epidemic among African American men who have sex with men, San Francisco, 2004–2011. AIDS Behav. 2015;19(12):2311–6. https://doi.org/10.1007/s10461-015-1020-3.
Matthews DD, Herrick AL, Coulter RWS, et al. Running backwards: consequences of current HIV incidence rates for the next generation of black MSM in the United States. AIDS Behav. 2016;20(1):7–26. https://doi.org/10.1007/s10461-015-1158-z.
U.S. Department of Housing and Urban Development. The 2017 Annual Homeless Assessment Report to Congress. http://www.hudexchange.info/resources/documents/2017-AHAR-Part-1.pdf. Accessed 23 Sept 2018.
Morton MH, Dworsky A, Matjasko JL, et al. Prevalence and correlates of youth homelessness in the United States. J Adolesc Health. 2017;62(1):14–21.
Aidala AA, Lee G, Abramson DM, et al. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11(6 Suppl):101–15. https://doi.org/10.1007/s10461-007-9276-x.
Desai MM, Rosenheck RA. HIV testing and receipt of test results among homeless persons with serious mental illness. Am J Psychiatry. 2004;161(12):2287–94. https://doi.org/10.1176/appi.ajp.161.12.2287.
Wenzel SL, Rhoades H, Harris T, et al. Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing. AIDS Care. 2007;29(5):570–4. https://doi.org/10.1080/09540121.2016.1234690.
Noska AJ, Belperio PS, Loomis TP. Prevalence of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus among homeless and nonhomeless United States Veterans. Clin Infect Dis. 2017;65(2):252–8. https://doi.org/10.1093/cid/cix295.
Gamarel KE, Nelson KM, Stephenson R, et al. Anticipated HIV stigma and delays in regular HIV testing behaviors among sexually-active young gay, bisexual, and other men who have sex with men and transgender women. AIDS Behav. 2018;22(2):522–30. https://doi.org/10.1007/s10461-017-2005-1.
Levy ME. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18(5):972–96. https://doi.org/10.1007/s10461-014-0719-x.
Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32:513–31. https://doi.org/10.1037/0003-066X.32.7.513.
Bronfenbrenner U. Interacting systems in human development. Research paradigms: present and future. In: Bronfenbrenner U, editor. Making human beings human: bioecological perspectives on human development. Thousand Oaks: Sage; 2005. p. 67–93.
Bowen EA. A multilevel ecological model of HIV risk for people who are homeless or unstably housed and who use drugs in the urban United States. Soc Work Publ Health. 2016;31(4):264–75. https://doi.org/10.1080/19371918.2015.1137511.
Bukowski LA, Chandler CJ, Creasy SL, Matthews DD, Friedman MR, Stall RD. Characterizing the HIV care continuum and identifying barriers and facilitators to HIV diagnosis and viral suppression among black transgender women in the United States. JAIDS. 2018;79(4):413–20.
Eaton LA, Matthews DD, Bukowski LA, Friedman MR, Chandler CJ, Whitfield DL, Sang JM, Stall RD. The POWER Study Team Elevated HIV prevalence and correlates of PrEP use among a community sample of black men who have sex with men. JAIDS. 2018;79(3):339–46.
Khandor E, Mason K, Cowan L, Hwang S. The Street Health Report. www.streethealth.ca. Accessed 23 Sept 2018.
Logie CH, Wang Y, Marcus N, et al. Factors associated with the separate and concurrent experiences of food and housing insecurity among women living with HIV in Canada. AIDS Behav. 2018;22(9):3100–10. https://doi.org/10.1007/s10461-018-2119-0.
Sanchez TH, Kelley CF, Rosenberg E, et al. Lack of awareness of human immunodeficiency virus (HIV) infection: problems and solutions with self-reported HIV serostatus of men who have sex with men. Open Forum Infect Dis. 2014;1(2):ofu084. https://doi.org/10.1093/ofid/ofu084.
Acknowledgements
The authors thank the Center for Black Equity and local Black Pride organizations for partnering with us to implement POWER, the community-based organizations who performed onsite HIV testing on the study’s behalf, the thousands of study participants who volunteered their time to contribute to this research, and members of the POWER Study Team who made data collection possible. The local Black Pride organizations are as follows: D.C. Black Pride, Detroit’s Hotter than July, Houston Splash, In the Life Atlanta, Memphis Black Pride, and Philadelphia Black Pride. The community-based organizations that performed onsite HIV testing are as follows: Atlanta: AID Atlanta, AIDS Health Care Foundation, NAESM; Detroit: Community Health Awareness Group, Horizons Project, Unified; Houston: Avenue 360, Houston AIDS Foundation, Positive Efforts; Memphis: Friends for Life; Philadelphia: Access Matters, Philadelphia FIGHT; Washington, D.C.: Us Helping Us. The members of POWER study team are as follows: Center for Black Equity: Earl D. Fowlkes, Jr., Michael S. Hinson, Jr.; Columbia University: Patrick A. Wilson; University of Connecticut: Lisa A. Eaton; Rutgers University: Henry Fisher-Raymond; University of Pittsburgh: Leigh A. Bukowski, Cristian J. Chandler, Derrick D. Matthews, Steven P. Meanley, Jordan M. Sang, and Ronald D. Stall.
Funding
Supported in part by the National Institute for Nursing Research (Grant No. R01NR013865). The authors have no other financial disclosures. ERH is supported by the National Institute of Mental Health (Grant No. T32MH094174).
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Creasy, S.L., Henderson, E.R., Bukowski, L.A. et al. HIV Testing and ART Adherence Among Unstably Housed Black Men Who Have Sex with Men in the United States. AIDS Behav 23, 3044–3051 (2019). https://doi.org/10.1007/s10461-019-02647-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-019-02647-w