Open AccessHIV Testing and ART Adherence Among Unstably Housed Black Men Who Have Sex with Men in the United States
Author(s) -
Stephanie L. Creasy,
Emmett R. Henderson,
Lee Bukowski,
Derrick D. Matthews,
Ronald D. Stall,
Mary Hawk
Publication year - 2019
Publication title -
aids and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.994
H-Index - 106
eISSN - 1573-3254
pISSN - 1090-7165
DOI - 10.1007/s10461-019-02647-w
Subject(s) - men who have sex with men , odds , logistic regression , demography , population , medicine , public health , odds ratio , health care , gerontology , psychology , human immunodeficiency virus (hiv) , family medicine , environmental health , political science , nursing , sociology , syphilis , pathology , law
Black men who have sex with men (BMSM) have the highest HIV incidence rate among all MSM in the United States (US), and are also disproportionately affected by homelessness and housing instability. However, little is known about the effects of homelessness on the HIV testing and care continuum for BMSM. Between 2014 and 2017, the Promoting Our Worth, Equality, and Resilience (POWER) study collected data and offered HIV testing to 4184 BMSM at Black Pride events in six US cities. Bivariate analyses were used to assess differences in sociodemographics and healthcare access between BMSM who self-reported homelessness and those who did not. Multivariable logistic regression models were used to assess differences in HIV testing by homelessness status. Finally, bivariate and multivariable models were used to assess differences in HIV care continuum and treatment adherence outcomes by homelessness status. 615 (12.1%) BMSM in our sample experienced homelessness in the last 12 months. BMSM who self-reported homelessness had higher odds of receiving an HIV test in the past 6 months compared to their stably housed counterparts. BMSM who self-reported homelessness had higher odds of reporting difficulty taking ART and of missing a dose in the past week compared to stably housed BMSM. Findings suggest that HIV testing outreach and treatment-related services targeting unstably housed BMSM may be effective. Future community-based research is needed to investigate how homelessness and housing instability affect ART adherence, and how this population may experience success in HIV testing and adherence despite economic and social marginalization.