Influence of Jail Incarceration and Homelessness Patterns on Engagement in HIV Care and HIV Viral Suppression among New York City Adults Living with HIV/AIDS
OBJECTIVES:
Both
homelessness and incarceration are associated with housing instability, which
in turn can disrupt continuity of HIV medical care. Yet, their impacts have not
been systematically assessed among people living with HIV/AIDS (PLWHA).
METHODS:
We
studied a retrospective cohort of 1,698 New York City PLWHA with both jail
incarceration and homelessness during 2001-05 to evaluate whether frequent
transitions between jail incarceration and homelessness were associated with a
lower likelihood of continuity of HIV care during a subsequent one-year
follow-up period. Using matched jail, single-adult homeless shelter, and HIV
registry data, we performed sequence analysis to identify trajectories of these
events and assessed their influence on engagement in HIV care and HIV viral
suppression via marginal structural modeling.
RESULTS:
Sequence
analysis identified four trajectories; 72% of the cohort had sporadic
experiences of both brief incarceration and homelessness, whereas others
experienced more consistent incarceration or homelessness during early or late
months. Trajectories were not associated with differential engagement in HIV
care during follow-up. However, compared with PLWHA experiencing early bouts of
homelessness and later minimal incarceration/homelessness events, we observed a
lower prevalence of viral suppression among PLWHA with two other trajectories:
those with sporadic, brief occurrences of incarceration/homelessness (0.67, 95%
CI = 0.50,0.90) and those with extensive incarceration experiences (0.62, 95%
CI = 0.43,0.88).
CONCLUSIONS:
Housing
instability due to frequent jail incarceration and homelessness or extensive
incarceration may exert negative influences on viral suppression. Policies and
services that support housing stability should be strengthened among
incarcerated and sheltered PLWHA to reduce risk of adverse health conditions.
Below: Four non-overlapping groups of jail
incarceration/homelessness trajectories according to sequence analysis among
1,698 adults living with HIV/AIDS who spent at least one night in a New York
City jail and at least one night at a New York City single adult homeless
shelters in January 2001–May 2005. This
figure describes trajectories of jail incarceration and homelessness in January
2001–May 2005. 4 trajectory groups represent distinct trajectories that were
identified by sequence analysis and each individual belongs to one of 4 groups.
Legend: Yellow color: Community-dwelling; Blue color: incarceration; Red color:
homelessness
- 1Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
- 2CUNY School of Public Health, City University of New York, New York, New York, United States of America.
- 3Monitoring and Evaluation, Corporate Contributions, Johnson & Johnson, New Brunswick, New Jersey, United States of America.
- 4ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
- 5The PhD program in Sociology, Graduate Center, City University of New York, New York, New York, United States of America.
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