Long-term homelessness linked to more advanced HIV: Canadian study

A Vancouver study of homelessness in its Downtown Eastside neighbourhood has revealed that the longer a person with HIV remains homeless the more likely he or she will have a more compromised immune system accompanied by greater health risks.

“Longer duration of homelessness was independently and negatively associated with the likelihood of exhibiting a non-detectable viral load,” say the study’s authors from the British Columbia Centre for Excellence in HIV/AIDS at St. Paul’s Hospital in Vancouver and the Division of AIDS, Department of Medicine, at the University of British Columbia.

Advances in HIV treatment over the past generation have drastically reduced the rates of HIV/AIDS-associated morbidity and mortality, at least among those who receive treatment.

Highly active antiretroviral therapy or HAART has been successful to the point where health policies are now aiming to decrease the presence of HIV in the general population by actively seeking out persons with HIV and assisting them in accessing free treatment.

But studies have shown that homelessness can have a distinct effect on one’s ability to receive HAART treatment, due to a range of barriers, behavioural, social and structural, that make adherence to treatment difficult, especially for the homeless who use drugs.

The Vancouver study is the first to identify a link between length of homelessness, drug use and a higher viral load of those infected with HIV (viral load defines the amount of HIV virus in a person’s blood, with the goal of treatment being to lower HIV viral load to undetectable levels).

The study used data from interviews conducted between May 1996 and June 2014 with 922 highly active antiretroviral therapy-exposed participants in Vancouver’s Downtown Eastside and found that of those participants who were homeless, a longer duration of homelessness was linked to lower odds of viral load non-detectability. Researchers see this trend as indication that properly addressing the prevalence of HIV will require more resources geared towards housing the homeless.

“Our findings suggest that interventions that seek to promptly house homeless individuals, such as Housing First approaches, might assist in maximizing the clinical and public health benefits of antiretroviral therapy among people living with HIV/AIDS,” say the study’s authors.

Homelessness continues to be a serious concern in Canada’s urban centres, even as municipalities ramp up their efforts to address the problem. Over 235,000 Canadians either access homeless emergency services or sleep outside each year, according to a State of Homelessness in Canada 2014 report by research and advocacy group, the Homeless Hub.

The group blames the decline in availability of affordable housing as a central contributor to the problem, arguing that national investment in housing has decreased by 46 per cent over the past 25 years.

A recent report by Raising the Roof says that child and family homeless is the fastest growing segment within the homeless population, with family use of shelters rising by 50 per cent over the past decade and the average length of stay increasing to more than 50 days on average.

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