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The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons Living with HIV

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Abstract

HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA.

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Acknowledgments

This study was funded by the Centers for Disease Control and Prevention of the Department of Health and Human Services through a contract (200-2001-0123, Task 9) with Research Triangle Institute, Inc. Funding for tenant-based rental assistance was provided by the Department of Housing and Urban Development. The questionnaire was approved by the US Office of Management and Budget (OMB No. 0920–0628). We would like to thank the many people who made this study a success. The following individuals played a lead role in the design or implementation of the Housing and Health Study (in alphabetical order) include Angela Aidala (Columbia University), Arturo Bendixen (AIDS Foundation of Chicago), Kate Briddell (City of Baltimore, Department of Housing and Community Development), Shahry Deyhimy (City of Los Angeles Housing Department), Paul Dornan (HUD), David Harre (Independent consultant, formerly with HUD), Myrna Hooper (Housing Authority of the City of Los Angeles), Jennafer Kwait (RTI), Fred Licari (RTI), Shirley Nash (City of Chicago Department of Public Health), Scott Royal (RTI), William Rudy (HUD), Ron Stall (University of Pittsburgh), Esther Sumartojo (CDC), and David Vos (HUD). In addition, the following persons were instrumental to the success of the study: Rusty Bennett, Maria Caban, Sylvia Cohn, Lynne Cooper, Jay Cross, Maria DiGregorio, Clyde Hart, Kirk Henny, Kelly Kent, Lee Lam, Eugene Little, Ellen McCarty and Jerusalem House, Joyce Moon Howard, Noelle Richa, Danny Ringer, Randy Russell, Ruth Schwartz, and Tom Spira. This study would not have been possible without the many contributions and support of the collaborating HUD grantee agencies in the participating cities: City of Baltimore Department of Housing and Community Development, City of Chicago Department of Public Health, AIDS Foundation of Chicago, City of Los Angeles Housing Department, Housing Authority of the City of Los Angeles, Shelter Partnership, Housing Authority of the County of Los Angeles, County of Los Angeles Office of AIDS Programs and Policies, Los Angeles Homeless Services Authority. Most importantly, we would like to acknowledge and thank the individuals who volunteered to participate in this study. Their strength and resilience in dealing with the multiple challenges they faced in their lives, in particular those associated with living with HIV, housing instability, and stigma, should be an inspiration to us all.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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  1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton RD NE (MS E-35), Atlanta, GA, 30333, USA

    Richard J. Wolitski, Sherri L. Pals, Daniel P. Kidder & Cari Courtenay-Quirk

  2. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    David R. Holtgrave

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  1. Richard J. Wolitski
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Correspondence to Richard J. Wolitski.

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Wolitski, R.J., Pals, S.L., Kidder, D.P. et al. The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons Living with HIV. AIDS Behav 13, 1222–1232 (2009). https://doi.org/10.1007/s10461-008-9455-4

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