Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada.
BMC Public Health. 2022 Sep 22;22(1):1804. doi: 10.1186/s12889-022-14113-9.
Women living with HIV (WLWH) experience numerous social and structural barriers to stable housing, with substantial implications for access to health care services. This study is the first to apply the Canadian Definition of Homelessness (CDOH), an inclusive national guideline, to investigate the prevalence and correlates of housing status among WLWH in Metro Vancouver, Canada.
Our study utilized data from a longitudinal open cohort of cisgender and trans WLWH aged 14 years and older, in 2010-2019. Cross-sectional descriptive statistics of the prevalence of housing status and other social and structural variables were summarized for the baseline visits. Bivariate and multivariable logistic regression analyses were conducted using generalized linear mixed models (GLMM) for repeated measures to investigate the relationship between social and structural correlates and housing status among WLWH.
The study included 336 participants with 1930 observations over 9 years. Housing status derived from CDOH included four categories: unsheltered, unstable, supportive housing, and stable housing (reference). Evidence suggested high levels of precarious housing, with 24% of participants reporting being unsheltered, 47% reporting unstable housing, 11.9% reporting supportive housing, and 16.4% reporting stable housing in the last six months at baseline. According to the multivariable models, living in the Downtown Eastside (DTES) neighbourhood of Metro Vancouver, hospitalization, physical/sexual violence, and stimulant use were associated with being unsheltered, compared to stable housing; DTES residence, hospitalization, and physical/sexual violence were associated with unstable housing; DTES residence and stimulant use were associated with living in supportive housing.
Complex social-structural inequities are associated with housing instability among WLWH. In addition to meeting basic needs for living, to facilitate access to housing among WLWH, housing options that are gender-responsive and gender-inclusive and include trauma- and violence-informed principles, low-barrier requirements, and strong connections with supportive harm reduction services are critical.
感染艾滋病毒的女性（WLWH）在获得稳定住房方面面临着众多社会和结构性障碍，这对获得医疗保健服务产生了重大影响。本研究首次应用加拿大无家可归定义（CDOH），这是一项包容性的国家准则，来调查加拿大温哥华地铁区 WLWH 的住房状况的流行率及其相关因素。
我们的研究利用了 2010-2019 年期间，一个针对年龄在 14 岁及以上的顺性别和跨性别 WLWH 的纵向开放队列的数据。对基线访问的住房状况和其他社会及结构性变量的流行率进行了横截面描述性统计。使用广义线性混合模型（GLMM）进行重复测量，对社会和结构性相关因素与 WLWH 住房状况之间的关系进行了双变量和多变量逻辑回归分析。
研究共纳入了 336 名参与者，9 年间共进行了 1930 次观察。根据 CDOH 得出的住房状况包括四个类别：无遮蔽、不稳定、保障性住房和稳定住房（参照）。研究结果表明，住房状况极不稳定，24%的参与者报告无遮蔽，47%报告不稳定，11.9%报告保障性住房，16.4%报告在基线的最后六个月稳定住房。根据多变量模型，与稳定住房相比，居住在温哥华市中心东区（DTES）、住院、身体/性暴力和兴奋剂使用与无遮蔽有关；DTES 居住、住院和身体/性暴力与不稳定住房有关；DTES 居住和兴奋剂使用与保障性住房有关。
复杂的社会结构不平等与 WLWH 的住房不稳定有关。除了满足基本的生活需求外，为了促进 WLWH 获得住房，还需要提供性别敏感和包容的住房选择，并包括创伤和暴力知情原则、低门槛要求以及与支持性减少伤害服务的紧密联系。
