Skip to main content

Advertisement

Log in

Housing status and health care service utilization among low-income persons with HIV/AIDS

  • Populations At Risk
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults.

DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997.

MAIN RESULTS: Six percent of study participants were homeless, 24.5% were “doubled-up,” and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physician regularly (P=.0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P=.02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit (P=.007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After multivariate adjustment, doubled-up participants were found to make more emergency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeless were shown to use slightly more outpatient care than the stably housed.

CONCLUSION: Our study documents differences in health care utilization patterns across stably housed, doubled-up, and homeless HIV-infected persons after controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and hence may be more likely to experience adverse clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arno PS, Bonuck KA, Green J, et al. The impact of housing status on health care utilization among persons with HIV disease. J Health Care Poor Underserved. 1996;7:36–49.

    PubMed  CAS  Google Scholar 

  2. Allen DM, Lehman JS, Green TA, et al. HIV infection among homeless adults and runaway youth, United States, 1989–1992. AIDS. 1994;8:1593–8.

    Article  PubMed  CAS  Google Scholar 

  3. Green J, Arno PS. The “Medicaidization” of AIDS: trends in the financing of HIV-related medical care. JAMA. 1990;264:1261–6.

    Article  PubMed  CAS  Google Scholar 

  4. Torres RA, Mani S, Altholz J, Brickner PW. Human immunodeficiency virus infection among homeless men in a New York City shelter: association with Mycobacterium tuberculosis infection. Arch Intern Med. 1990;150:2030–6.

    Article  PubMed  CAS  Google Scholar 

  5. Wojtusik L, White MC. Health status, needs, and health care barriers among the Homeless. J Health Care Poor Underserved. 1998;9:140–52.

    PubMed  CAS  Google Scholar 

  6. Weinreb L, Goldberg R, Perloff J. Health characteristics and medical services patterns of sheltered homeless and low income housed mothers. J Gen Intern Med. 1998;13:3890–7.

    Article  Google Scholar 

  7. Cousineau MR. Health status of and access to health services by residents of urban encampments in Los Angeles. J Health Care Poor Underserved. 1997;8:70–82.

    PubMed  CAS  Google Scholar 

  8. Messeri P. Community Health Advisory and Information Network: Access to primary care and change in health status. Update report #6. New York: Joseph Mailman School of Public Health, Columbia University; 1996.

    Google Scholar 

  9. Shapiro M, Morton S, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. JAMA. 1999;281:2305–15.

    Article  PubMed  CAS  Google Scholar 

  10. Wright BRE, Caspi A, Moffitt TE, Silva PA. Factors associated with doubled-up housing—a common precursor to homelessness. Soc Serv Rev. 1998;92–111.

  11. O’Toole TP, Gibbon JL, Hanusa BH, Fine MJ. Utilization of health care services among subgroups of urban homeless and housed poor. J Health Polit Policy Law. 1999;24:91–114.

    PubMed  CAS  Google Scholar 

  12. Shinn M, Knickman JR, Weitzman BC. Social relationships and vulnerability to becoming homeless among poor families. Am Psych. 1991;46:1180–7.

    Article  CAS  Google Scholar 

  13. Clement M, Hollander H. Natural history and management of the seropositive patient. In: Sande MA, Volberding PA, eds. The Medical Management of AIDS. 3rd ed. Philadelphia: WB Saunders; 1992:91.

    Google Scholar 

  14. Mor V, Fleishman JA, Dresser M, Piette J. Variation in health service use among HIV-infected patients. Med Care. 1992;1:17–29.

    Article  Google Scholar 

  15. Crystal S, Sambamoorthi U, Merzel C. The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts. Health Serv Res. 1995;30:593–614.

    PubMed  CAS  Google Scholar 

  16. Piette JD, Mor V, Mayer K, Zierler S, Wachtel T. The effects of immune status and race on health service use among people with HIV disease. Am J Public Health. 1993;83:510–4.

    Article  PubMed  CAS  Google Scholar 

  17. Andersen RM, Newman J. Societal and individual determinants of medical care utilization in the United States. Mil Mem Fund Quart. 1973;51:95–124.

    Article  CAS  Google Scholar 

  18. Rossi P. Down and Out in America. Chicago: U Chicago Press; 1989.

    Google Scholar 

  19. Bozzette S, Hays R, Berry, Kanouse D, Wu A. Derivation and psychometric properties of a brief quality of life measure for HIV. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8:253–65.

    PubMed  CAS  Google Scholar 

  20. Draper NR, Smith H. Applied Regression Analysis. New York: John Wiley; 1998:340–2.

    Google Scholar 

  21. Bonuck KA, Arno PS, Social and medical factors affecting hospital discharge of persons with HIV/AIDS. J Community Health. 1997;22:225–32.

    Article  PubMed  CAS  Google Scholar 

  22. Zolopa AR, Hahn JA, Gorter RG, et al. HIV and tuberculosis infection in San Francisco’s homeless adults: prevalence and risk factors in a representative sample. JAMA. 1994;272:455–61.

    Article  PubMed  CAS  Google Scholar 

  23. Brudney K. Homelessness and TB: a study in failure. J Law Med Ethics. 1993;21:360–7.

    PubMed  CAS  Google Scholar 

  24. Bangsberg D, Tulsky JP, Hecht FM, Moss AR. Protease inhibitors in the homeless. JAMA. 1997;278:63–5.

    Article  PubMed  CAS  Google Scholar 

  25. Messeri P, Weinberg G. Community Health Advisory and Information Network: The introduction of combination therapies. Update report #1. New York: Joseph Mailman School of Public Health, Columbia University; 1997.

    Google Scholar 

  26. Community HIV Prevention and Primary Care Initative. The AIDS Institute, New York State Department of Health. 1996;57–91.

  27. Cunningham WE, Rana HM, Shapiro MF, Hays RD. Reliability and validity of self-report CD4 counts in persons hospitalized with HIV disease. J Clin Epidemiol. 1997;50:829–35.

    Article  PubMed  CAS  Google Scholar 

  28. Fleishman JA, Sia DC, Hellinger FJ. Correlates of medical service utilization among people with HIV infection. Health Serv Res. 1994;29:527–48.

    PubMed  CAS  Google Scholar 

  29. Markson LE, Houchens R, Fanning TR, Turner BJ. Repeated emergency department use by HIV infected persons: Effect of clinic accessibility and expertise in HIV care. J Acq Immune Defic Syndr Hum Retrovirol. 1998;17:35–41.

    CAS  Google Scholar 

  30. New Medicaid reimbursement rates for HIV primary care visits. Albany, NY: New York State Department of Health; 1991. Health Facility Series: H-86, D & TC - 45, HMO-39 89-99.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Meredith Y. Smith PhD, MPA.

Additional information

This research was supported by grant #NYS HRI 656-03-FED awarded to the AIDS Institute, New York State Department of Health (NYSDOH) by the Health Resources and Services Administration under the Special Projects of National Significance Program.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, M.Y., Rapkin, B.D., Winkel, G. et al. Housing status and health care service utilization among low-income persons with HIV/AIDS. J GEN INTERN MED 15, 731–738 (2000). https://doi.org/10.1046/j.1525-1497.2000.91003.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2000.91003.x

Key Words

Navigation