Project Description

Drug Use, Housing Access, Stability and HIV Risk Among Low-Income Urban Residents

This 4-year study explored the relationship between structural factors of housing (access to housing subsidies and programs, status and stability) and HIV risk among low-income drug users compared to non-drug users. In particular, the project tested hypotheses that drug users have less access to federal, state and local housing subsidies and programs, and that housing instability increases drug users’ HIV risk. We conducted a survey with drug using and non-drug using low-income residents in the city of Hartford, Connecticut, and an adjacent peri-urban/suburban town, East Hartford to compare low-income drug users’ and low-income non-drug users’ access to housing and social services, and their housing stability over time in the two study towns controlling for personal characteristics. We specifically explored the relationship of housing access to drug use and housing status/stability, and the relationship between housing status and HIV risk for drug using and non-drug using low-income residents. The study also explored differences in program requirements and supportive services offered by different supportive housing programs and their impact on applicants’ access to supportive housing programs, maintenance of housing stability, and drug use and HIV risk behaviors.

Additional Information:

Medical College of Wisconsin

Julia Dickson-Gomez, Ph.D.
Principal Investigator

Jill Owczarzak, Ph.D.
Co-Investigator/ Ethnographer

Timothy McAuliffe, Ph.D.
Co-Investigator

Yvonne Stevenson M.S.
Research Scientist/Study Coordinator

Leah Przdwiecki
Data Specialist

Razia Azen
Statistician

ICR

Mark Convey, M.A.
Research Associate/Project Director

Margaret R. Weeks, Ph.D.
Co-Investigator

Ellen Cromley, Ph.D.
Medical Geographer

Eduardo Robles
Interviewer/Community Outreach

Gregory Palmer
Interviewer/Community Outreach

There is a growing recognition among HIV researchers that what are variously called
“structural,” “environmental,” or “fundamental social” causes of disease must be more effectively identified and addressed if we are to reduce the transmission of HIV substantially. Structural factors affecting the HIV risk of drug users examined in much research include laws restricting access to sterile injection equipment or laws banning funding for syringe exchange programs. One factor that has been hypothesized to increase HIV risk among drug users but that has received relatively little research attention to date is the effect of housing and drug policies on drug users’ housing status and subsequent HIV risk. While personal characteristics, such as drug use, may not in themselves cause homelessness, they make certain individuals more vulnerable to homelessness given an increasingly competitive housing market. Structural factors determine why pervasive homelessness exists in this historical time, while individual factors explain who is least able to compete for scarce affordable housing. This project tested hypotheses that drug users have less access to federal, state and local housing subsidies and programs than low-income non-drug users, and that housing instability increases drug users’ HIV risk using an instrument developed in an exploratory qualitative study, Housing Status/Stability and HIV Risk Among Drug Users (R21 DA 018607).
Longitudinal surveys were conducted with a cohort of 300 drug using and 150 non-drug using low-income residents of Hartford and East Hartford at baseline, 6 and 12 months. Low-income residents of the two communities were recruited through targeted sampling. We over-recruited 100 residents of supportive housing programs as part of this larger sample by directly recruiting at the agencies that provide supportive housing in order to ensure
sufficient sample size. The survey included detailed measures of housing status and stability, access to housing subsidies, supportive housing, welfare and health benefits, neighborhood characteristics, health and mental health status, drug use and HIV risk behaviors. In addition, we explored housing access at the neighborhood level (number of rental housing units, vacancy rates, number of supportive and low-income housing, number of shelters) by mapping secondary housing data and modeling housing availability using geospatial analysis. Risk were assessed at the neighborhood level by mapping and geospatial modeling of drug related and violent arrests, and locations of abandoned buildings in relation to participants’ residences or, if homeless, the location/s where they most frequently spend the night. In order to explore more fully the differences in philosophy and program requirements of different supportive housing programs as part of aim 4, we conducted in-depth interviews with service providers in each of the 5 supportive housing programs in the study towns. This exploratory aim allowed us to develop measures and relationships to more fully evaluate different supportive housing programs in a subsequent study.

To compare low-income drug users’ and low-income non-drug users’ access to housing and social services, and their housing stability over time in the two study towns controlling for personal characteristics.

To examine the mediating relationship of housing access between drug use and housing status/stability.

To examine the relationship between housing status and HIV risk for drug using and non-drug using low-income residents.

To explore differences in program requirements and supportive services offered by different supportive housing programs and their impact on applicants’ access to supportive housing programs, maintenance of housing stability, and drug use and HIV risk behaviors.