Risk and the Residential Environment: Prior Homelessness as a Predictor of HIV Risk among Adults Living in Single Room Occupancy Housing Elizabeth Bowen, PhD Assistant Professor University at Buffalo School of Social Work

Presenter Disclosures Elizabeth Bowen The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

Background Homeless and unstably housed individuals are at a higher risk for contracting or transmitting HIV 1 Potential pathways include increased substance use, trading sex for money, and having multiple sexual partners 2-5 People in different housing conditions (e.g. shelters, street, SROs) often combined for analysis o Risk environment framework 6 – how might these spaces differentially affect risk?

What Are SROs? “Housing of last resort” Rooms usually < 200 square feet Shared bathrooms and no cooking facilities Rent approximately $300-$500/month Private vs. public or nonprofit Transitory vs. stable

Research Questions How do SRO residents’ histories of street homelessness vary? Is this variation associated with HIV risk behavior?

Method Cross-sectional survey design with SRO residents in Chicago Venue-based recruitment at 10 privately owned for-profit SROs in the Uptown neighborhood Recruitment card approach $20 cash compensation Interviewer-administered survey Final n = 163

Results n = 163 % Male78 Race African American63 White28 Other Race or More Than One Race 10 Hispanic or Latino Ethnicity 7 AgeRange = 21-76, M = 50

Results n = 163 % HIV Positive6 Serious Mental Illness68 Ever Incarcerated74 Ever Convicted of a Felony48 Homeless in Lifetime83 Homeless in Past 12 Months18 Mean Monthly Income$722 Mean Monthly Rent$316

Results % Illicit Drug Use Other Than Marijuana in Past 30 Days 17 Alcohol Misuse (FAST Score of Three or More) 33 More Than One Sexual Partner – Past 30 Days 17 Sex Without Condom – Past 30 Days30 Sex While Drunk/High – Past 30 Days17 Lifetime Intravenous Drug Use11 Lifetime Sex Exchange21 Total Number of Recent Risk Behaviors No Risk Behaviors42 One Risk Behavior26 Two or More Risk Behaviors32

Results: Multivariate Analysis (ORs) Illicit Drug Use Problem Drinking Multiple Partners Sex No Condom Sex Drunk/ High Sex Exchange IV Drug Use Female White Other Race Age HIV Prior Felony Homeless in Past Year

Limitations Cross-sectional study Reliance on self-report data from interviewer- administered survey Non-probability sample from one geographical area Small sample size and most participants had one or no recent risk behaviors

Conclusions Findings suggest that SRO living and homelessness are not synonymous SRO residents who had been homeless in the past 12 months were more likely to report some risk behaviors including illicit drug use, sex while drunk or high, and lifetime history of IV drug use Individuals who have recently transitioned from homelessness to SRO housing may benefit from tailored HIV risk reduction interventions

Conclusions SRO housing being rapidly demolished in many cities – need to consider policies to preserve SROs as both a short and long-term alternative to homelessness Policies needed to improve affordability and access to care and services for SRO residents

Thank you! Elizabeth Bowen

References 1 Beijer, U., Wolf, A., & Fazel, S. (2012). Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(11), Dickson-Gomez, J., McAuliffe, T., Convey, M., Weeks, M., & Owczarzak, J. (2011). Access to housing subsidies, housing status, drug use and HIV risk among low- income U.S. urban residents. Substance Abuse Treatment Prevention and Policy, 6(31), Elifson, K. W., Sterk, C. E., & Theall, K. P. (2007). Safe living: The impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS and Behavior, 11(6), Neblett, R. C., Davey-Rothwell, M., Chander, G., & Latkin, C. A. (2011). Social network characteristics and HIV sexual risk behavior among urban African American women. Journal of Urban Health, 88(1), Weir, B. W., Bard, R. S., O'Brien, K., Casciato, C. J., & Stark, M. J. (2007). Uncovering patterns of HIV risk through multiple housing measures. AIDS and Behavior, 11(6), Rhodes, T. (2002). The ‘risk environment’: A framework for understanding and reducing drug-related harm. International Journal of Drug Policy, 13(2),