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Schneider JA, Bouris A. Ryan White programming that primarily supports clinical care falls short when core people needs are not met: further evidence from the medical monitoring project. AIDS 2022; 36:1453-1456. [PMID: 35876703 PMCID: PMC9521181 DOI: 10.1097/qad.0000000000003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- John A. Schneider
- Crown School of Social Work Practice and Policy, University of
Chicago
| | - Alida Bouris
- Crown School of Social Work Practice and Policy, University of
Chicago
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2
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Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults. AIDS Behav 2021; 25:165-174. [PMID: 34302283 PMCID: PMC8542003 DOI: 10.1007/s10461-021-03364-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/14/2023]
Abstract
This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18–27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.
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Kerman N, Polillo A, Bardwell G, Gran-Ruaz S, Savage C, Felteau C, Tsemberis S. Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review. Drug Alcohol Depend 2021; 228:109052. [PMID: 34601279 DOI: 10.1016/j.drugalcdep.2021.109052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Harm reduction is a central tenet of Housing First. As the intervention has been shown to stably house people experiencing chronic homelessness across the lifespan with complex behavioural health needs, it is critical to understand the harm reduction outcomes and practices in Housing First. METHODS A systematic review following PRISMA guidelines was conducted of five databases: PsycINFO, MEDLINE, Embase, CINAHL, and Google Scholar. Harm reduction outcomes and practices in Housing First were examined in four domains: substance-related harms, viral health, sexual health, and harm reduction service use. RESULTS A total of 35 articles were included in the review, 23 of which examined harm reduction outcomes and 12 of which investigated harm reduction practices in Housing First. Harm reduction outcome studies focused mostly on nonspecific substance use problems, with Housing First being found to have minimal effects in this domain. More severe harms, such as delirium tremens and substance use-related deaths, have been minimally explored, though preliminary evidence is promising. Viral health, sexual health, and harm reduction service use outcomes were the focus of few studies. Research on harm reduction practices highlighted that Housing First providers experience both flexibility and ambiguity in their work using a harm reduction approach, and the importance of empathetic working relationships for engagement in harm reduction work. CONCLUSIONS Harm reduction outcomes in Housing First remain underexamined and any conclusions of the intervention's impacts in this domain would be premature. Effective harm reduction practices in Housing First require strong working relationships between staff and tenants.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada; University of British Columbia, Department of Medicine, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sophia Gran-Ruaz
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
| | - Cathi Savage
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Charlie Felteau
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Sam Tsemberis
- Pathways Housing First Institute, 1328 2nd Street, Santa Monica, CA, 90403, United States
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Semborski S, Rhoades H, Madden D, Henwood BF. Factors associated with condom and contraceptive use among currently and formerly homeless young adults: Does housing matter? SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100654. [PMID: 34454325 DOI: 10.1016/j.srhc.2021.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/05/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Young adults that experience homelessness (YAEH) are at heightened risk of unplanned pregnancy and contracting STIs, including HIV than their housed counterparts. It is unclear how exiting homelessness into Supportive Housing (SH), the most prominent intervention in homelessness, may shape sexual risk-taking. OBJECTIVE The goal of this study is to explore associations of condom and contraception use with particular interest in the role of partner type (i.e., casual and/or serious) and housing status. METHODS This study includes 143 sexually active YAEH (ages 18-27) who reported engaging in vaginal sex during the past three months: 67 "unhoused" (i.e., street-based, couch-surfers, or staying in emergency shelter), and 76 "housed" from SH programs. Multiple logistic regression examined the relationship of housing status and partner type with condom and contraceptive use. RESULTS Being a parent was associated with higher odds of contraceptive use regardless of housing status, while partner type (i.e., serious or casual partner) was differently associated with condom use by housing status. DISCUSSION Despite documented differences in condom-using behaviors by housing status, findings revealed similar patterns in contraceptive use between the two groups, indicating a possible need for enhanced and targeted service planning for YAEH, particularly among those transitioning to and residing in SH, regarding contraceptive use and prevention.
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Affiliation(s)
- Sara Semborski
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States.
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States
| | - Danielle Madden
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States
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Wenzel SL, La Motte-Kerr W. Life Meaning in a Social Context Among Formerly Homeless Residents of Permanent Supportive Housing. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2021; 32:34-41. [PMID: 37346935 PMCID: PMC10281692 DOI: 10.1080/10530789.2021.1961989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/23/2021] [Accepted: 07/18/2021] [Indexed: 06/23/2023]
Abstract
Objective Experiencing a life of meaning is considered fundamental to "what makes life worth living," yet investigation of life meaning among persons with lived experiences of homelessness is lacking. This study seeks to understand life meaning among formerly homeless residents of permanent supportive housing through an examination of its association with social context. Method Data were collected through interviews with 383 persons with experience of chronic homelessness who were provided permanent supportive housing (PSH). Recruitment of participants occurred through partnerships with 26 providers of PSH in Los Angeles County, California. Multivariate logistic regression models were employed to understand association of life meaning with hypothesized social contextual variables, controlling for demographic and background characteristics. Results Community integration and sense of belonging were significantly and positively associated with life meaning, consistent with findings from previous research involving persons not identified as experiencing homelessness. Conclusions Findings suggest opportunities for service providers to facilitate life meaning among residents of supportive housing. Specific attention to life meaning and its social context is consistent with the World Health Organization's position that well-being is a significant aspect of health.
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Affiliation(s)
- Suzanne L. Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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Petering R, La Motte-Kerr W, Rhoades H, Wenzel S. Changes in Physical Assault Among Adults Moving Into Permanent Supportive Housing. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8643-NP8652. [PMID: 31044645 DOI: 10.1177/0886260519844775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
People experiencing homelessness experience high rates of physical assault. While this high risk for victimization is well established, there is no research that examines whether victimization rates change over time as persons transition into permanent supportive housing (PSH). Data are from a longitudinal study of adults moving into PSH in the Los Angeles, CA area. Interviews were conducted prior to or within 5 days of moving in, with follow-up interviews at 3, 6, and 12 months after move-in (n = 370 participants completing all four interviews). Each interview assessed characteristics of past 3-month physical assault. Analyses examined change in rates of assault over time and differences by demographic subgroups. We also present findings on the most common locations and perpetrators of assault. Overall, rates of physical assault decreased after participants entered PSH. Statistically significant differences by subgroups varied by time point. Differences identified include higher rates of physical assault among Latino/a respondents, lower rates among African Americans, and higher rates of physical assault among lesbian, gay, bisexual, and transgender (LGBT) respondents. The most frequent location of assault was outside at baseline, 3- and 6-month time points. Strangers were the most common perpetrator at all time points. Rates of perpetration by neighbors nearly doubled from baseline to the 12-month time point, and inside locations for assault were most common at this time point as well. While PSH is an effective intervention in reducing chronic homelessness, it is important to consider other risks to overall health and well-being, such as physical victimization.
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Affiliation(s)
- Robin Petering
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
| | - Wichada La Motte-Kerr
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
| | - Harmony Rhoades
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
| | - Suzanne Wenzel
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
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Tinland A, Loubiere S, Cantiello M, Boucekine M, Girard V, Taylor O, Auquier P. Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death. BMC Public Health 2021; 21:1294. [PMID: 34215235 PMCID: PMC8254224 DOI: 10.1186/s12889-021-11310-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Homeless people face large excess mortality in comparison with the general population, but little is known about the effect of housing interventions like Housing First (HF) on their mortality. Aims of the study 1) to explore 2-years mortality among homeless people with severe mental illness (SMI) included in French HF randomized controlled trial (RCT). 2) To examine causes of death among homeless participants. Methods For 703 participants of HF RCT: 353 in experimental group (HF) and 350 in control group (Treatment As Usual - TAU), any proof of life or death and causes of death were collected with a thorough retrospective investigation among relatives, institutions and administrative databases. Data collection took place from March to June 2017. Results 4.8% (n = 34) of the study participants died over the study period. Mean age of death was 40.9 (+/− 11.4) years. The overall 2-years mortality rate was 0.065 in the HF group (n = 23) versus 0.034 in the TAU group (n = 11). Mortality was associated with medications for opioid use disorder in multivariate Cox analysis (HR: 2.37, 95%CI 1.15–5.04, p = 0.025). Those in HF group seem to be more at risk of death compared to TAU group, mainly during the first 6 months of being housed, although the difference did not reach significance (HR: 0.49, 95%CI 0.24–1.01, p = 0.054). Violent deaths occurred in 52.2% of HF group’s deaths versus 18.2% of TAU group’s deaths, this excess being explained by 34.8% (n = 8) deaths by overdoses in HF group versus none in TAU group. Limitations 1) 8.7% (n = 2) people in HF group died before HF intervention but were analyzed in intention-to-treat. 2) No proof of life or death has been found for only 0.6% in HF group (n = 2) but for 9.5% people in TAU group (n = 33) that could be anonymous deaths. 3) Undetermined causes represented 8.7% of deaths in HF group versus 36.4% in TAU group. 4) The small number of events (deaths) in the study population is a limitation for statistical analysis. Conclusions Due to important limitations, we cannot conclude on HF effect on mortality, but our results nevertheless confirm that the vulnerability of long-term homeless people with SMI persists after accessing independent housing. Earlier intervention in the pathways of homelessness should be considered, alongside active specific support for addictions. Trial registration Ethics Committee Sud Mediterrannée V n° 11.050: trial number 2011-A00668–33: 28/07/2011. Clinicaltrials ID NCT01570712: 4/4/2012.
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Affiliation(s)
- Aurélie Tinland
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France. .,Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.
| | - Sandrine Loubiere
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Matthieu Cantiello
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Vincent Girard
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Owen Taylor
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
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8
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Henwood BF, Rhoades H, Redline B, Dzubur E, Wenzel S. Risk behaviour and access to HIV/AIDS prevention services among formerly homeless young adults living in housing programmes. AIDS Care 2020; 32:1457-1461. [PMID: 31791132 PMCID: PMC7263964 DOI: 10.1080/09540121.2019.1699643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
Young adults who experience homelessness have high rates of sexually transmitted infections (STIs) including HIV. Homelessness services programmes that provide housing to young adults have the capacity to reduce STI risk profiles. This study analysed data from 140 formerly homeless adults who moved into a housing programme in Los Angeles County between the ages of 18 and 25 years to investigate risk behaviour and access to HIV/AIDS prevention services. More than three quarters of participants reported sexual activity (vaginal or anal sex) in the prior 3 months, with 63% reporting any unprotected vaginal or anal sex, 29% reporting unprotected sex with a nonserious partner, 40% reporting multiple partners, and 11% reporting exchange sex. About three quarters reported a past-year HIV test. About half of the sample had never heard of pre-exposure prophylaxis (PrEP), 12% had heard of it but didn't know what it was, 25% reported knowing a little bit, and 15% said they knew a lot about PrEP. Slightly more than 4% of the overall sample reported being HIV positive. These findings suggest that housing programmes may be a prime location to implement HIV prevention services.
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Affiliation(s)
- Benjamin F. Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Brian Redline
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Eldin Dzubur
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Zhong Y, Beattie CM, Rojas J, Farquhar XP, Brown PA, Wiewel EW. Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014-2017. Am J Public Health 2020; 110:1068-1075. [PMID: 32437285 DOI: 10.2105/ajph.2020.305660] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017.Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]).Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length.Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.
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Affiliation(s)
- Yaoyu Zhong
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Christopher M Beattie
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - John Rojas
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - X Pamela Farquhar
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Paul A Brown
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Ellen W Wiewel
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
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10
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Padilla M, Frazier EL, Carree T, Luke Shouse R, Fagan J. Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States - Medical Monitoring Project, 2009-2015. AIDS Care 2019; 32:594-599. [PMID: 31650855 DOI: 10.1080/09540121.2019.1683808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homelessness is a challenge to retention in HIV care and adherence to antiretroviral therapy. We describe the sociodemographic and behavioral characteristics of HIV-positive adults who reported recent homelessness. The Medical Monitoring Project is a complex sample survey of HIV-positive adults receiving medical care in the United States. We used weighted interview and medical record data collected from June 2009 to May 2015 to estimate the prevalence of depression, substance use, and HIV risk behaviors among adults experiencing recent homelessness. From 2009 to 2015, 8.3% of HIV-positive adults experienced recent homelessness. Homeless adults were more likely than housed adults to have major depression, to binge drink, use non-injection drugs, use injection drugs, and smoke. Over 60% of homeless adults were sexually active during the past year, with homeless adults reporting more condomless sex with an HIV-negative or unknown status sex partner than housed adults. Programs attempting to improve the health outcomes of HIV-positive homeless persons and reduce ongoing HIV transmission can focus on providing basic needs, such as housing, and ancillary services, such as mental health counseling or substance abuse treatment and counseling.
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Affiliation(s)
- Mabel Padilla
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma L Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamara Carree
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,ICF International, Atlanta, GA, USA
| | - R Luke Shouse
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fagan
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wenzel SL, Rhoades H, LaMotte-Kerr W, Duan L. Everyday discrimination among formerly homeless persons in permanent supportive housing. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2019; 28:169-175. [PMID: 32952378 PMCID: PMC7500539 DOI: 10.1080/10530789.2019.1630959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Accepted: 06/09/2019] [Indexed: 06/11/2023]
Abstract
Experiences of discrimination are associated with poor health and are particularly common among persons experiencing homelessness. Permanent supportive housing (PSH) provides a foundation for improved well-being among persons with homelessness histories, but research on discrimination among this population is lacking. We examined changes in experiences of, and perceived reasons for, everyday discrimination when persons moved into PSH. 421 adults in Los Angeles County completed baseline (pre-housing), 3-, 6- or 12-month post-housing structured interviews. Generalized linear mixed models (GLMM) examined change in discrimination outcomes, controlling for demographic characteristics. Everyday discrimination experiences decreased significantly when persons moved from homelessness into PSH, and remained consistently lower across the first year in PSH. Reports of homelessness/poverty, race/ethnicity, and neighborhood as reasons for discrimination also decreased from baseline levels. PSH may offer respite from everyday discrimination, but the persistence of discrimination and particularly racism in society requires structural solutions addressing implicit bias and systemic inequities.
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Affiliation(s)
- Suzanne L. Wenzel
- Corresponding author: , 669 West 34 Street, Los Angeles, CA 90089, 213.740.0819
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