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Among persons with HIV (PWH), homelessness is associated with poorer health. From 2009 to 2014, national HIV prevention goals included a reduction in homelessness among PWH. We sought to examine social ecological factors associated with homelessness among PWH at a sub-national level during that period. National data identified Delaware as the only jurisdiction where homelessness among PWH declined from 2009 to 2014. We analyzed population-level indicators and conducted telephone interviews with 6 key stakeholders to further examine this trend. Overall homelessness, household poverty, and median housing price were associated with homelessness among PWH in Delaware. Key stakeholders highlighted centralized services as program strengths, and pointed to common challenges, e.g., long wait lists, limited availability of units, and complex procedures. In addition to broader social and economic factors, coordinated program strategies may improve housing outcomes for PWH. Monitoring trends at sub-national levels can help identify successful approaches as well as ongoing challenges.

Reducing homelessness among persons with HIV: An ecological case study in Delaware