Influence of Housing Status on Health Outcomes for Reproductive-Age Women With and Without HIV in the Southern United States.

Abstract

Background: Housing instability is a modifiable determinant of health outcomes among people with HIV. Reproductive-age women face unique challenges and are underrepresented in HIV research. We characterized housing status among reproductive-age women with and without HIV (WWH/WWoH) and evaluated its associations with health outcomes.

Setting: The Study of Treatment and Reproductive Outcomes (STAR) examines women ages 18-45 years old with and without HIV in six Southern US sites.

Methods: We analyzed baseline data from March 2021-August 2023. We compared demographic, psychosocial, and clinical characteristics by HIV and housing status. We examined associations between housing status and health outcomes using logistic regression models, adjusting for age, race, socioeconomic status, depressive symptoms, and illicit drug use.

Results: Among 759 women (473 with HIV, 286 without HIV), 64.4% had stable housing, 28.9% had dependent housing, and 6.9% had unstable housing. In adjusted models, unstably/dependently housed women were significantly less likely to attend a healthcare visit in the last year compared to stably housed women (OR 0.40, Cl 0.18-0.90). Unstably/dependently housed WWH were significantly more likely to miss at least one HIV visit in the past year (OR 2.35, Cl 1.02-5.41) and be virally non-suppressed (OR 2.92, Cl 1.08-7.87) than stably housed WWH.

Conclusion: Housing instability was associated with adverse health outcomes, even after adjusting for traditional sociodemographic and psychosocial risk factors. This emphasizes its role as a key health determinant that must be addressed. Further research to assess the potential pathways for this association will inform acceptable and scalable housing interventions to improve outcomes for reproductive-age women.