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Open Access Research article

Impact of housing on the survival of persons with AIDS

Sandra K Schwarcz12*, Ling C Hsu1, Eric Vittinghoff2, Annie Vu1, Joshua D Bamberger1 and Mitchell H Katz12

Author affiliations

1 San Francisco Department of Public Health, San Francisco, USA

2 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA

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Citation and License

BMC Public Health 2009, 9:220  doi:10.1186/1471-2458-9-220

Published: 7 July 2009

Abstract

Background

Homeless persons with HIV/AIDS have greater morbidity and mortality, more hospitalizations, less use of antiretroviral therapy, and worse medication adherence than HIV-infected persons who are stably housed. We examined the effect of homelessness on the mortality of persons with AIDS and measured the effect of supportive housing on AIDS survival.

Methods

The San Francisco AIDS registry was used to identify homeless and housed persons who were diagnosed with AIDS between 1996 and 2006. The registry was computer-matched with a housing database of homeless persons who received housing after their AIDS diagnosis. The Kaplan-Meier product limit method was used to compare survival between persons who were homeless at AIDS diagnosis and those who were housed. Proportional hazards models were used to estimate the independent effects of homelessness and supportive housing on survival after AIDS diagnosis.

Results

Of the 6,558 AIDS cases, 9.8% were homeless at diagnosis. Sixty-seven percent of the persons who were homeless survived five years compared with 81% of those who were housed (p < 0.0001). Homelessness increased the risk of death (adjusted relative hazard [RH] 1.20; 95% confidence limits [CL] 1.03, 1.41). Homeless persons with AIDS who obtained supportive housing had a lower risk of death than those who did not (adjusted RH 0.20; 95% CL 0.05, 0.81).

Conclusion

Supportive housing ameliorates the negative effect of homelessness on survival with AIDS.