Risk and the residential environment: Prior homelessness as a predictor of HIV risk among adults living in single room occupancy housing

Background: Epidemiological research indicates that homeless and unstably housed individuals are at a higher risk for contracting HIV than their stably housed counterparts. However, little is known about how specific housing conditions including street homelessness and single room occupancy (SRO) hotel housing may be differentially associated with HIV risk. This study applies a risk environment theoretical framework to examine the relationship between past homelessness and HIV risk for SRO residents.

Methods: The study employed a cross-sectional survey design. A venue-based recruitment approach was used to select a sample of SRO residents (n=163) from nine privately owned Chicago SRO buildings.  Participants completed an interviewer-administered survey containing questions about their housing experiences, HIV risk behaviors, and demographics.

Results: Though 83% of participants reported lifetime homelessness, only 18% had been homeless in the past 12 months. In multivariate logistic regression analyses, past-year homelessness predicted recent risk behaviors including illicit drug use (OR=3.23), having sex while drunk or high (OR=2.74), and intravenous drug use (OR=4.91) when controlling for demographic factors, HIV status, and prior incarceration.

Conclusions: SRO residents who had been homeless in the past year were more likely to report certain drug and sex-related HIV risk behaviors. This finding suggests that homelessness and SRO housing may be linked with different environmental influences on HIV risk, a distinction rarely acknowledged in the literature on housing and HIV risk. In light of their elevated risk profile, individuals who have recently transitioned from homelessness to SRO housing may benefit from tailored HIV risk reduction interventions.