Changes in Social Networks and HIV Risk Behaviors Among Homeless Adults Transitioning Into Permanent Supportive Housing

Abstract

Permanent supportive housing (PSH) has been recognized by the U.S. federal government as the “clear solution” to chronic homelessness. Whether and how access to PSH affects HIV risk is unclear. This mixed methods pilot study uses a convergent parallel design in order to better understand social relationships and HIV risk during the transition from homelessness to PSH. Findings suggest that (a) Sexual activity and HIV risk behaviors increase with housing, (b) Social network size and composition appear to change as individuals transition into PSH, and (c) There is tension between moving forward and leaving behind the past once a person has housing. This study demonstrates that PSH constitutes a specific risk environment that has not been previously investigated.

Keywords

chronic homelessness housing first social network analysis qualitative methods

Get full access to this article

View all access options for this article.

References

Aidala

Cross

J. E.

Stall

Harre

Sumartojo

(2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251-265. doi:10.1007/s10461-005-9000-7

Bourgois

(1998). The moral economies of homeless heroin addicts: Confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Substance Use & Misuse, 33, 2323-2351. doi:10.3109/10826089809056260

Boyatzis

R. E.

(1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks, CA: Sage.

Brown

R. A.

Kennedy

D. P.

Tucker

J. S.

Golinelli

Wenzel

S. L.

(2013). Monogamy on the street: A mixed methods study of homeless men. Journal of Mixed Methods Research, 7(4), 328-346. doi:10.1177/1558689813480000

Brown

R. A.

Kennedy

D. P.

Tucker

J. S.

Wenzel

S. L.

Golinelli

Wertheimer

S. R.

Ryan

G. W.

(2012). Sex and relationships on the street: How homeless men judge partner risk on Skid Row. AIDS and Behavior, 16, 774-784. doi:10.1007/s10461-011-9965-3

Byrne

Bettger

J. P.

Brusilovskiy

Wong

Y.-L.

Metraux

Salzer

M. S.

(2013). Comparing neighborhoods of adults with serious mental illness and of the general population: Research implications. Psychiatric Services, 64, 782-788. doi:10.1176/appi.ps.201200365

Collins

S. E.

Malone

D. K.

Clifasefi

S. L.

Ginzler

J. A.

Garner

M. D.

Burlingham

. . . Larimer

M. E.

(2012). Project-based housing first for chronically homeless individuals with alcohol problems: Within-subjects analyses of 2-year alcohol trajectories. American Journal of Public Health, 102, 511-519. doi:10.2105/AJPH.2011.300403

Creswell

J. W.

Plano Clark

V. L.

(2011). Designing and conducting mixed methods research (2nd ed.). Thousand Oaks, CA: Sage.

Culhane

D. P.

(2008). The costs of homelessness: A perspective from the United States. European Journal of Homelessness, 2, 97-114.

10.

Culhane

D. P.

Gollub

E. L.

(2001). Connections between AIDS and homelessness (LDI Issue Brief, Vol. 6, No. 9). Philadelphia: University of Pennsylvania, Leonard Davis Institute of Health Economics.

11.

Culhane

D. P.

Metraux

Hadley

(2002). Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing. Housing Policy Debate, 13, 107-163. doi:10.1080/10511482.2002.9521437

12.

Drake

R. E.

Osher

F. C.

Wallach

M. A.

(1991). Homelessness and dual diagnosis. American Psychologist, 46, 1149-1158. doi:10.1037/0003-066X.46.11.1149

13.

Dunn

J. R.

Hayes

M. V.

(1999). Identifying social pathways for health inequalities: The role of housing. Annals of the New York Academy of Sciences, 896, 399-402. doi:10.1111/j.1749-6632.1999.tb08153.x

14.

Hawkins

R. L.

Abrams

(2007). Disappearing acts: The social networks of formerly homeless individuals with co-occurring disorders. Social Science & Medicine, 65, 2031-2042. doi:10.1016/j.socscimed.2007.06.019

15.

Henwood

B. F.

Hsu

H.-T.

Dent

Winetrobe

Carranza

Wenzel

(2013). Transitioning from homelessness: A “fresh-start” event. Journal of the Society for Social Work and Research, 4, 47-57. doi:10.5243/jsswr.2013.4

16.

Hopper

(2012). The counter-reformation that failed? A commentary on the mixed legacy of supported housing. Psychiatric Services, 63, 461-463. doi:10.1176/appi.ps.201100379

17.

Kennedy

D. P.

Wenzel

S. L.

Tucker

J. S.

Green

H. D.

Jr. Golinelli

Ryan

G. W.

. . .Zhou

(2010). Unprotected sex of homeless women living in Los Angeles County: An investigation of the multiple levels of risk. AIDS and Behavior, 14, 960-973. doi:10.1007/s10461-009-9621-3

18.

Kidder

D. P.

Wolitski

R. J.

Pals

S. L.

Campsmith

M. L.

(2008). Housing status and HIV risk behaviors among homeless and housed persons with HIV. Journal of Acquired Immune Deficiency Syndromes, 49, 451-455. doi:10.1097/QAI.0b013e31818a652c

19.

Latkin

C. A.

German

Vlahov

Galea

(2013). Neighborhoods and HIV: A social ecological approach to prevention and care. American Psychologist, 68, 210-224. doi:10.1037/a0032704

20.

Latkin

C. A.

Mandell

Vlahov

(1996). The relationship between risk networks’ patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: A prospective study. Drug and Alcohol Dependence, 42, 175-181. doi:10.1016/S0376-8716 (96)01279-3

21.

Office of the High Commissioner for Human Rights. (1976). International covenant on economic, social and cultural rights. Geneva, Switzerland: United Nations. Retrieved from http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx

22.

Padgett

D. K.

(2007). There’s no place like (a) home: Ontological security among persons with serious mental illness in the United States. Social Science & Medicine, 64, 1925-1936. doi:10.1016/j.socscimed.2007.02.011

23.

Padgett

D. K.

(2012). Qualitative and mixed methods in public health. Thousand Oaks, CA: Sage.

24.

Padgett

D. K.

Henwood

Abrams

Drake

R. E.

(2008). Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. American Journal of Orthopsychiatry, 78, 333-339. doi:10.1037/a0014155

25.

Palinkas

L. A.

Holloway

I. W.

Rice

Fuentes

Chamberlain

(2011). Social networks and implementation of evidence-based practices in public youth-serving systems: A mixed-methods study. Implementation Science, 6, 113. doi:10.1186/1748-5908-6-113

26.

Palinkas

L. A.

Horwitz

S. M.

Chamberlain

Hurlburt

M. S.

Landsverk

(2011). Mixed-methods designs in mental health services research: A review. Psychiatric Services, 62, 255-263. doi:10.1176/ps.62.3.pss6203_0255

27.

Pearson

Montgomery

A. E.

Locke

(2009). Housing stability among homeless individuals with serious mental illness participating in housing first programs. Journal of Community Psychology, 37, 404-417. doi:10.1002/jcop.20303

28.

Pickett-Schenk

S. A.

Cook

J. A.

Grey

D. D.

Butler

S. B.

(2007). Family contact and housing stability in a national multi-site cohort of homeless adults with severe mental illness. Journal of Primary Prevention, 28, 327-339. doi:10.1007/s10935-007-0098-4

29.

Rhoades

Wenzel

S. L.

Golinelli

Tucker

J. S.

Kennedy

D. P.

Green

H. D.

Zhou

(2011). The social context of homeless men’s substance use. Drug and Alcohol Dependence, 118, 320-325. doi:10.1016/j.drugalcdep.2011.04.011

30.

Rice

Holloway

I. W.

Barman-Adhikari

Fuentes

Brown

C. H.

Palinkas

L. A.

(2014). A mixed methods approach to network data collection. Field Methods, 26, 252-268. doi:10.1177/1525822X13518168

31.

Rice

Milburn

N. G.

Rotheram-Borus

M. J.

(2007). Pro-social and problematic social network influences on HIV/AIDS risk behaviours among newly homeless youth in Los Angeles. AIDS Care, 19, 697-704. doi:10.1080/09540120601087038

32.

Rice

Stein

J. A.

Milburn

(2008). Countervailing social network influences on problem behaviors among homeless youth. Journal of Adolescence, 31, 625-639. doi:10.1016/j.adolescence .2007.10.008

33.

Shaw

(2004). Housing and public health. Annual Review of Public Health, 25, 397-418. doi:10.1146/annurev.publhealth.25.101802.123036

34.

Singer

Clair

(2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17, 423-441. doi:10.1525/maq.2003.17.4.423

35.

Trumbetta

S. L.

Mueser

K. T.

Quimby

Bebout

Teague

G. B.

(1999). Social networks and clinical outcomes of dually diagnosed homeless persons. Behavior Therapy, 30, 407-430. doi:10.1016/S0005-7894(99)80018-5

36.

Tsai

Mares

A. S.

Rosenheck

R. A.

(2012). Does housing chronically homeless adults lead to social integration? Psychiatric Services, 63, 427-434. doi:10.1176/appi.ps.201100047

37.

Tsemberis

Gulcur

Nakae

(2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94, 651-656. doi:10.2105/AJPH.94.4.651

38.

Tucker

J. S.

Kennedy

Ryan

Wenzel

S. L.

Golinelli

Zazzali

(2009). Homeless women’s personal networks: Implications for understanding risk behaviors. Human Organization, 68, 129-140.

39.

Tucker

J. S.

Wenzel

S. L.

Golinelli

Kennedy

D. P.

Ewing

Wertheimer

(2013). Understanding heterosexual condom use among homeless men. AIDS and Behavior, 17, 1637-1644. doi:10.1007/s10461-012-0165-6

40.

Tucker

J. S.

Wenzel

S. L.

Golinelli

Zhou

Green

H. D.

Jr. (2011). Predictors of substance abuse treatment need and receipt among homeless women. Journal of Substance Abuse Treatment, 40, 287-294. doi:10.1016/j.jsat.2010.11.006

41.

U.S. Department of Housing and Urban Development. (2010). The 2010 annual homeless assessment report to Congress. Washington, DC: Author. Retrieved from https://www.onecpd.info/resources/documents/2010HomelessAssessmentReport.pdf

42.

U.S. Interagency Council on Homelessness. (2010). Opening doors: Federal strategic plan to prevent and end homelessness. Washington, DC: Author.

43.

Weir

B. W.

Bard

R. S.

O’Brien

Casciato

C. J.

Stark

M. J.

(2007). Uncovering patterns of HIV risk through multiple housing measures. AIDS and Behavior, 11(2 Suppl.), 31-44. doi:10.1007/s10461-007-9284-x

44.

Wenzel

S. L.

Green

H. D.

Jr. Tucker

J. S.

Golinelli

Kennedy

D. P.

Ryan

Zhou

(2009). The social context of homeless women’s alcohol and drug use. Drug and Alcohol Dependence, 105, 16-23. doi:10.1016/j.drugalcdep.2009.05.026

45.

Wenzel

S. L.

Rhoades

Hsu

H.-T.

Golinelli

Tucker

J. S.

Kennedy

D. P.

. . .Ewing

(2012). Behavioral health and social normative influence: Correlates of concurrent sexual partnering among heterosexually-active homeless men. AIDS and Behavior, 16, 2042-2050. doi:10.1007/s10461-011-0066-0

46.

Wenzel

S. L.

Tucker

J. S.

Elliott

M. N.

Hambarsoomians

(2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS and Behavior, 11(2 Suppl.), 9-20. doi:10.1007/s10461-006-9193-4

47.

Wong

Y.-L. I.

Stanhope

(2009). Conceptualizing community: A comparison of neighborhood characteristics of supportive housing for persons with psychiatric and developmental disabilities. Social Science & Medicine, 68, 1376-1387. doi:10.1016/j.socscimed.2009.01.046

48.

Yanos

P. T.

Barrow

S. M.

Tsemberis

(2004). Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness: Successes and challenges. Community Mental Health Journal, 40, 133-150. doi:10.1023/B:COMH.0000022733.12858.cb

49.

Yanos

P. T.

Stefancic

Tsemberis

(2012). Objective community integration of mental health consumers living in supported housing and of others in the community. Psychiatric Services, 63, 438-444. doi:10.1176/appi.ps.201100397