Search tips
Search criteria 


Logo of jurbhealthspringer.comThis journalToc AlertsSubmit OnlineOpen ChoiceThis journal
J Urban Health. 2004 December; 81(4): 618–629.
PMCID: PMC3455922

Homelessness and HIV risk behaviors among injection drug users


This article uses data from an 8-year study of injection drug users to examine whether homelessness independently influenced the likelihood of engaging in human immunodeficiency virus (HIV) risk behaviors. Fixed effects regression analyses are used to estimate the associations between four different housing contexts and four different behaviours related to transmitting HIV infections. Results showed that 16% of the study group experienced homelessness at some point during the study, and that homelessness was significantly associated with a higher likelihood of frequenting shooting galleries (odds ratio=2.05), but did not have a significant effect on sharing syringes, sharing other injection drug paraphernalia, or participating in paid sex. These results provide limited support for positing homelessness as independently associated with increased levels of HIV-related risk behavior among injection drug users and highlights the need for more research that examines the housing dynamics among this population.

Keywords: AIDS, HIV risk behavior, Homelessness, Injection drug use

Full Text

The Full Text of this article is available as a PDF (106K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002;92:758–768. [PubMed]
2. Galea S, Vlahov D. Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Rep. 2002;117(suppl)):135–145. [PMC free article] [PubMed]
3. Allen DM, Lehman JS, Green TA, et al. HIV infection among homeless adults and runaway youth, United States, 1989–1992. AIDS. 1994;8:1593–1598. [PubMed]
4. Culhane DP, Gollub E, Kuhn RS, Shpaner M. The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilization in Philadelphia. J Epidemiol Community Health. 2001;55:515–520. doi: 10.1136/jech.55.7.515. [PMC free article] [PubMed] [Cross Ref]
5. Magura S, Nwakeze PC, Rosenblum A, Joseph H. Substance misuse and related infectious diseases in a soup kitchen population. Subst Use Misuse. 2000;35:551–583. [PubMed]
6. Susser E, Valencia E, Conover S. Prevalence of HIV infection among psychiatric patients in a New York City men’s shelter. Am J Public Health. 1993;83:568–570. [PubMed]
7. Torres RA, Mani S, Altholz J, Brickner PW. Human immunodeficiency virus infection among homeless men in a New York City shelter: association with Mycobacterium tuberculosis infection. Arch Intern Med. 1990;150:2030–2036. doi: 10.1001/archinte.150.10.2030. [PubMed] [Cross Ref]
8. Empfield M, Cournos F, Meyer I, et al. HIV seroprevalence among homeless patients admitted to a psychiatric inpatient unit. Am J Psychiatry. 1993;150:47–52. [PubMed]
9. Shlay JC, Blackburn D, OKeefe K, Raevsky C, Evans M, Cohn DL. Human immunodeficiency virus seroprevalence and risk assessment of a homeless population in Denver. Sex Transm Dis. 1996;23:304–311. doi: 10.1097/00007435-199607000-00011. [PubMed] [Cross Ref]
10. Shultz JM, Greer PJ, Lalota M, et al. HIV seroprevalence and risk behaviours among clients attending a clinic for the homeless in Miami/Dade County, Florida, 1990–1996. Popul Res Policy Rev. 1999;18:357–372. doi: 10.1023/A:1006232827339. [Cross Ref]
11. Zolopa AR, Hahn JA, Gorter R, et al. HIV and tuberculosis infection in San Francisco homeless adults: prevalence and risk factors in a representative sample. JAMA. 1994;272:455–461. doi: 10.1001/jama.272.6.455. [PubMed] [Cross Ref]
12. Metsch LR, McCoy CB, McCoy HV, et al. HIV-related risk behaviors and seropositivity among homeless drug-abusing women in Miami, Florida. J Psychoactive Drugs. 1995;27:435–446. [PubMed]
13. Smereck GAD, Hockman EM. Prevalence of HIV infection and HIV risk behaviors associated with living place: on-the-street homeless drug users as a special target population for public health intervention. Am J Drug Alcohol Abuse. 1998;24:299–319. [PubMed]
14. Patrick DM, Strathdee SA, Archibald CP, et al. Determinants of HIV seroconversion in injection drug users during a period of rising prevalence in Vancouver. Int J STD AIDS. 1997;8:437–445. doi: 10.1258/0956462971920497. [PubMed] [Cross Ref]
15. Siegal HA, Carlson RG, Falck R, et al. HIV infection and risk behaviors among intravenous drug users in low seroprevalence areas in the Midwest. Am J Public Health. 1991;81:1642–1644. [PubMed]
16. Andia JF, Deren S, Kang SY, et al. Residential status and HIV risk behaviors among Puerto Rican drug injectors in New York and Puerto Rico. Am J Drug Alcohol Abuse. 2001;27:719–735. doi: 10.1081/ADA-100107664. [PubMed] [Cross Ref]
17. Metraux S, Culhane DP, Raphael S, et al. Assessing homeless population size through the use of emergency and transitional shelter services in 1998: results from the analysis of administrative data in nine US jurisdictions. Public Health Rep. 2001;116:344–352. doi: 10.1016/S0033-3549(04)50056-0. [PMC free article] [PubMed] [Cross Ref]
18. Song JY, Safaeian M, Strathdee SA, Vlahov D, Celentano DD. The prevalence of homelessness among injection drug users with and without HIV infection. J Urban Health. 2000;77:678–687. doi: 10.1007/BF02344031. [PMC free article] [PubMed] [Cross Ref]
19. Culhane DP, Metraux S. Assessing relative risk for homeless shelter usage in New York City and Philadelphia. Popul Res Policy Rev. 1999;18:219–236. doi: 10.1023/A:1006187611323. [Cross Ref]
20. Shinn M. Family homelessness: state or trait? Am J Community Psychol. 1997;25:755–766. doi: 10.1023/A:1022209028188. [PubMed] [Cross Ref]
21. Allison PD. Logistic Regression Using the SAS® System. Cary, NC: SAS Institute Inc.; 1999.
22. Latkin C, Mandell W, Vlahov D, et al. Your place, and no place: behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore, Maryland. Am J Community Psychol. 1994;22:415–430. [PubMed]
23. Celentano DD, Vlahov D, Cohn S, et al. Risk factors for shooting gallery use and cessation among intravenous drug users. Am J Public Health. 1991;81:1291–1295. doi: 10.2105/AJPH.81.10.1291. [PubMed] [Cross Ref]
24. Carlson RG. Shooting galleries, dope houses, and injection doctors: examining the social ecology of HIV risk behaviors among drug injectors in Dayton, Ohio. Hum Organ. 2000;59:325–333.
25. Bourgois P. Just another night in a shooting gallery. Theor Cult Soc. 1998;15:37–66.

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine