The Relationship Between Housing Status and Substance Use and Sexual Risk Behaviors
People experiencing homelessness or unstable housing have higher rates of substance use, sexual risk behaviors, and HIV acquisition, as well as poorer health outcomes like mental illness, psychiatric disorders, tuberculosis, asthma, and bronchitis.
Although HIV risk behaviors like substance use and condomless sex are also prevalent among people currently seeking or receiving services at substance use disorder (SUD) treatment programs, associations with housing status in this population has not been well studied.
This study examined housing status, substance use, and HIV-related sexual risk behaviors among 1281 participants from 12 U.S. community-based SUD programs, using data from the NIDA Clinical Trials Network HIV Rapid Testing and Counseling study (CTN-0032). Substance use was also examined as a potential mediator of housing status and sexual risk behaviors.
Results of the analysis found mixed associations between housing status and substance use and sexual risk behaviors. Researchers found higher rates of problematic drug use, cocaine use, and sexual risk behaviors among unstably housed individuals compared to those who were stably housed. They also found that being unstably housed was indirectly related to an increased risk in engaging in several specific sexual risk behaviors, and that this relationship was mediated by drug use, especially cocaine, marijuana, or opioids.
However, no increased risk of drug use or sexual risk behaviors were found among people experiencing homelessness, possibly due to their relatively low numbers in the study sample. More research on this population is needed.
Conclusions: Unstably housed individuals have increased levels of substance use which, in turn, is associated with sexual behaviors that put them at greater risk for HIV infection. These relationships can help inform interventions aimed at assessing and reducing sexual risk behaviors for individuals seeking or receiving services in SUD treatment programs.