British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.
Curr HIV/AIDS Rep. 2012 Dec;9(4):364-74. doi: 10.1007/s11904-012-0137-5.
Individuals who are homeless or living in marginal conditions have an elevated burden of infection with HIV. Existing research suggests the HIV/AIDS pandemic in resource-rich settings is increasingly concentrated among members of vulnerable and marginalized populations, including homeless/marginally-housed individuals, who have yet to benefit fully from recent advances in highly-active antiretroviral therapy (HAART). We reviewed the scientific evidence investigating the relationships between inferior housing and the health status, HAART access and adherence and HIV treatment outcomes of people living with HIV/AIDS (PLWHA.) Studies indicate being homeless/marginally-housed is common among PLWHA and associated with poorer levels of HAART access and sub-optimal treatment outcomes. Among homeless/marginally-housed PLWHA, determinants of poorer HAART access/adherence or treatment outcomes include depression, illicit drug use, and medication insurance status. Future research should consider possible social- and structural-level determinants of HAART access and HV treatment outcomes that have been shown to increase vulnerability to HIV infection among homeless/marginally-housed individuals. As evidence indicates homeless/marginally-housed PLWHA with adequate levels of adherence can benefit from HAART at similar rates to housed PLWHA, and given the individual and community benefits of expanding HAART use, interventions to identify HIV-seropositive homeless/marginally-housed individuals, and engage them in HIV care including comprehensive support for HAART adherence are urgently needed.
无家可归者或生活在边缘环境中的个体感染艾滋病毒的负担加重。现有研究表明，在资源丰富的环境中，艾滋病毒/艾滋病疫情越来越集中在弱势和边缘化人群，包括无家可归/居住条件边缘的人，他们尚未从高效抗逆转录病毒疗法（HAART）的最新进展中充分受益。我们回顾了调查住房条件差与艾滋病毒/艾滋病感染者（PLWHA）的健康状况、HAART 可及性和依从性以及艾滋病毒治疗结果之间关系的科学证据。研究表明，无家可归/居住条件边缘是 PLWHA 中的常见现象，与较差的 HAART 可及性和不理想的治疗结果相关。在无家可归/居住条件边缘的 PLWHA 中，HAART 可及性/依从性或治疗结果较差的决定因素包括抑郁、非法药物使用和药物保险状况。未来的研究应考虑已证明会增加无家可归/居住条件边缘者感染艾滋病毒脆弱性的 HAART 可及性和 HV 治疗结果的社会和结构性决定因素。有证据表明，具有足够依从性的无家可归/居住条件边缘的 PLWHA 可以与有住房的 PLWHA 一样从 HAART 中受益，并且鉴于扩大 HAART 使用对个人和社区的益处，迫切需要采取干预措施来识别艾滋病毒血清阳性的无家可归/居住条件边缘者，并让他们参与艾滋病毒护理，包括全面支持 HAART 依从性。
