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The Effects of Housing Status on Health-Related Outcomes in People living with HIV: A Systematic Review of the Literature

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Abstract

Introduction

HIV infection is increasingly characterized as a chronic condition that can be managed through adherence to a healthy lifestyle, complex drug regimens, and regular treatment and monitoring. The location, quality, and/or affordability of a person’s housing can be a significant determinant of his or her ability to meet these requirements. The objective of this systematic review is to inform program and policy development and future research by examining the available empirical evidence on the effects of housing status on health-related outcomes in people living with HIV/AIDS.

Methods

Electronic databases were searched from dates of inception through November 2005. A total of 29 studies met inclusion criteria for this review. Seventeen studies received a “good” or “fair” quality rating based on defined criteria.

Results

A significant positive association between increased housing stability and better health-related outcomes was noted in all studies examining housing status with outcomes of medication adherence (n = 9), utilization of health and social services (n = 5), and studies examining health status (n = 2) and HIV risk behaviours (n = 1).

Conclusions

Healthcare, support workers and public health policy should recognize the important impact of affordable and sustainable housing on the health of persons living with HIV.

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Acknowledgements

The authors gratefully acknowledge the support of the Ontario Ministry of Health and Long-Term Care and the Ontario HIV Treatment Network (OHTN). The views expressed in this manuscript are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-Term Care or the Ontario HIV Treatment Network.

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Authors and Affiliations

  1. Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 70 Richmond St. W. 4th Fl., Toronto, ON, Canada, M5B 1W8

    Chad A. Leaver, James R. Dunn & Stephen W. Hwang

  2. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Gordon Bargh

  3. Faculty of Medicine, Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada

    James R. Dunn & Stephen W. Hwang

  4. Faculty of Arts and Science, Department of Geography and Planning, University of Toronto, Toronto, ON, Canada

    James R. Dunn

  5. Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Stephen W. Hwang

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  1. Chad A. Leaver
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  2. Gordon Bargh
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  3. James R. Dunn
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Corresponding author

Correspondence to Chad A. Leaver.

Appendix 1

Appendix 1

Quality rating criteria for grading the internal validity of individual studies (28).

Rating “Good” if Meets all Criteria

 

  • Clear definition* of housing status classification;

  • Clear definition and adequate measurement of outcome;

  • Adequate adjustment for confounders.

* A clear definition of housing stability includes reference to at least one or more of the following components of housing status classification: (i) aspects of dwelling context, (ii) personal asset; and/or (iii) housing quality. For instance, a clear definition of stable housing would specify respondents housing circumstance as: living in a house or apartment—rented or owned by the participant (asset); and unstable housing would specify the participant as living in a short-term occupancy hotel, residence, or motel, or having moved more than once in the last year (context). A clear definition of unstable housing or homelessness may also be defined in studies as living in a hospice, shelter, on the street, or a car (context). Further, classification may also include actual quality of housing or structural dimensions of the dwelling relevant to the care and mobility of people living with HIV/AIDS, such as living in a walk-up apartment building (excessive stairs) or adequate amenities of the dwelling for privacy, rest or medication storage (crowding, ventilation or refrigeration).

Rating “Fair” if any or all of the Following Problems Occur, Without the Fatal Flaws Noted in the “Poor” Category

 

  • Clear* definition of housing status classification, but not ideal (undefined parameters of stable versus unstable housing);

  • Clear definition and measurement of outcome considered;

  • Partial adjustment for confounders.

Rating “Poor” if any of the Following Fatal Flaws Exist

 

  • Vague or unclear criteria for classification of housing status;

  • Vague or unclear definition of outcome considered;

  • Inadequate measurement of outcome considered;

  • Lack of adjustment for confounders.

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Leaver, C.A., Bargh, G., Dunn, J.R. et al. The Effects of Housing Status on Health-Related Outcomes in People living with HIV: A Systematic Review of the Literature. AIDS Behav 11 (Suppl 2), 85–100 (2007). https://doi.org/10.1007/s10461-007-9246-3

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  • DOI: https://doi.org/10.1007/s10461-007-9246-3

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