Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA, USA.
Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
AIDS Behav. 2019 Nov;23(11):3044-3051. doi: 10.1007/s10461-019-02647-w.
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.
美国（US）男男性行为者（MSM）中，与男性发生性关系的黑人（BMSM）HIV 发病率最高，同时也不成比例地受到无家可归和住房不稳定的影响。然而，对于无家可归对 BMSM 的 HIV 检测和护理连续性的影响知之甚少。在 2014 年至 2017 年间，“促进我们的价值、平等和韧性（POWER）”研究在六个美国城市的黑人骄傲活动中收集了 4184 名 BMSM 的数据并提供了 HIV 检测。使用双变量分析评估了自我报告无家可归和没有无家可归的 BMSM 在社会人口统计学和医疗保健获取方面的差异。使用多变量逻辑回归模型评估了无家可归状况对 HIV 检测的差异。最后，使用双变量和多变量模型评估了无家可归状况对 HIV 护理连续性和治疗依从性结果的差异。在我们的样本中，有 615 名（12.1%）BMSM 在过去 12 个月经历过无家可归。与稳定住房的 BMSM 相比，自我报告无家可归的 BMSM 在过去 6 个月接受 HIV 检测的可能性更高。与稳定住房的 BMSM 相比，自我报告无家可归的 BMSM 报告在过去一周内服用抗逆转录病毒药物（ART）有困难和漏服的可能性更高。研究结果表明，针对不稳定住房的 BMSM 的 HIV 检测外展和治疗相关服务可能是有效的。需要进行未来的基于社区的研究，以调查无家可归和住房不稳定如何影响 ART 依从性，以及这一人群如何在经济和社会边缘化的情况下在 HIV 检测和依从性方面取得成功。
