Basic Subsistence Needs and Overall Health Among Human Immunodeficiency Virus-infected Homeless and Unstably Housed Women

• Published in: American journal of epidemiology Vol. 174; no. 5; pp. 515 - 522
• Main Authors: RILEY, Elise D, MOORE, Kelly, SORENSEN, James L, TULSKY, Jacqueline P, BANGSBERG, David R, NEILANDS, Torsten B
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01.09.2011; Oxford Publishing Limited (England)
• Subjects: Adult; Biological and medical sciences; Crack Cocaine; Drug therapy; Drug use; Epidemiology; Female; General aspects; Genital Diseases, Female - complications; Health Status; HIV; HIV Infections - complications; HIV Infections - epidemiology; Homeless people; Homeless Persons; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Medical sciences; Mental Disorders - complications; Mental health; Miscellaneous; Original Contributions; Poverty; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; San Francisco - epidemiology; Social Support; Substance-Related Disorders - complications; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Womens health; San Francisco; San Francisco California; Human; Immunopathology; Retroviridae; AIDS; Immune deficiency; Lentivirus; Epidemiology; Infection; Virus; Need; Homeless; Health status; HIV; homeless persons; Viral disease; Female; Human immunodeficiency virus; Woman; Public health; women
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwr209

Some gender differences in the progression of human immunodeficiency virus (HIV) infection have been attributed to delayed treatment among women and the social context of poverty. Recent economic difficulties have led to multiple service cuts, highlighting the need to identify factors with the most influence on health in order to prioritize scarce resources. The aim of this study was to empirically rank factors that longitudinally impact the health status of HIV-infected homeless and unstably housed women. Study participants were recruited between 2002 and 2008 from community-based venues in San Francisco, California, and followed over time; marginal structural models and targeted variable importance were used to rank factors by their influence. In adjusted analysis, the factor with the strongest effect on overall mental health was unmet subsistence needs (i.e., food, hygiene, and shelter needs), followed by poor adherence to antiretroviral therapy, not having a close friend, and the use of crack cocaine. Factors with the strongest effects on physical health and gynecologic symptoms followed similar patterns. Within this population, an inability to meet basic subsistence needs has at least as much of an effect on overall health as adherence to antiretroviral therapy, suggesting that advances in HIV medicine will not fully benefit indigent women until their subsistence needs are met.