Wenzel Suzanne L, Rhoades Harmony, Harris Taylor, Winetrobe Hailey, Rice Eric, Henwood Ben
a USC School of Social Work , Los Angeles , CA , USA.
AIDS Care. 2017 May;29(5):570-574. doi: 10.1080/09540121.2016.1234690. Epub 2016 Sep 21.
Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the health and wellbeing of PSH residents.
无家可归者感染艾滋病毒的比例极高，搬进永久性支持性住房（PSH）可以提供一个稳定的基础，以便获得所需的预防服务。然而，在这一关键的过渡时期，人们对艾滋病毒风险或预防行为知之甚少。当前的研究调查了准备搬进PSH的无家可归者中的性传播感染和艾滋病毒风险及预防行为，以及近期预防和治疗服务（即教育、检测、药物治疗）的使用情况。数据来自对421名无家可归成年人在搬进PSH之前的访谈。37%的受访者有性行为；其中，75.7%报告有未采取保护措施的性行为。近三分之二（64%）报告在过去一年进行过艾滋病毒检测，40%报告检测过其他性传播感染。不到三分之一（31%）的受访者报告在最近一次艾滋病毒检测时接受了检测后咨询。10%的人自我报告艾滋病毒血清阳性。在艾滋病毒呈阳性的人中，57.1%报告抗逆转录病毒（ARV）依从性低于100%。在艾滋病毒阴性的受访者中，不到1%的人被开了暴露前预防（PrEP）药物。不到一半（46.4%）的样本报告在过去一年接受过任何艾滋病毒预防教育。这群即将搬进PSH的无家可归成年人报告艾滋病毒风险行为发生率高，但艾滋病毒预防教育率低，PrEP使用率极低。此外，艾滋病毒呈阳性的受访者中抗逆转录病毒药物依从性低表明存在艾滋病毒传播和感染的重大风险。对于无家可归者来说，进入PSH是一个过渡时期，此时综合护理对于确保良好的健康结果至关重要，但这些数据表明，这一人群中PrEP和其他艾滋病毒预防服务的获取情况很差。因此，需要整合PrEP和其他艾滋病毒预防服务的多方面服务，以防止在这一高风险、易受伤害的人群中传播和感染艾滋病毒，并确保PSH居民的健康和福祉。
