Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women

Elise D. Riley, Kelly Moore, James L. Sorensen, Jacqueline P. Tulsky, David Bangsberg, Torsten B. Neilands

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Some gender differences in the progression of human immunodeficiency virus (HIV) infection have been attributed to delayed treatment among women and the social context of poverty. Recent economic difficulties have led to multiple service cuts, highlighting the need to identify factors with the most influence on health in order to prioritize scarce resources. The aim of this study was to empirically rank factors that longitudinally impact the health status of HIV-infected homeless and unstably housed women. Study participants were recruited between 2002 and 2008 from community-based venues in San Francisco, California, and followed over time; marginal structural models and targeted variable importance were used to rank factors by their influence. In adjusted analysis, the factor with the strongest effect on overall mental health was unmet subsistence needs (i.e., food, hygiene, and shelter needs), followed by poor adherence to antiretroviral therapy, not having a close friend, and the use of crack cocaine. Factors with the strongest effects on physical health and gynecologic symptoms followed similar patterns. Within this population, an inability to meet basic subsistence needs has at least as much of an effect on overall health as adherence to antiretroviral therapy, suggesting that advances in HIV medicine will not fully benefit indigent women until their subsistence needs are met.

Original languageEnglish (US)
Pages (from-to)515-522
Number of pages8
JournalAmerican Journal of Epidemiology
Volume174
Issue number5
DOIs
StatePublished - Sep 1 2011
Externally publishedYes

Fingerprint

HIV
Poverty
Health
Crack Cocaine
San Francisco
Structural Models
Virus Diseases
Hygiene
Health Status
Statistical Factor Analysis
Mental Health
Therapeutics
Economics
Medicine
Food
Population

Keywords

  • health status
  • HIV
  • homeless persons
  • women

ASJC Scopus subject areas

  • Epidemiology

Cite this

Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. / Riley, Elise D.; Moore, Kelly; Sorensen, James L.; Tulsky, Jacqueline P.; Bangsberg, David; Neilands, Torsten B.

In: American Journal of Epidemiology, Vol. 174, No. 5, 01.09.2011, p. 515-522.

Research output: Contribution to journalArticle

Riley, Elise D. ; Moore, Kelly ; Sorensen, James L. ; Tulsky, Jacqueline P. ; Bangsberg, David ; Neilands, Torsten B. / Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. In: American Journal of Epidemiology. 2011 ; Vol. 174, No. 5. pp. 515-522.
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