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Drug treatment and intensive case management programs are needed to reduce HIV risk among homeless women

Homeless women who abuse drugs and alcohol are more vulnerable to contracting the human immunodeficiency virus (HIV) that causes AIDS due to risky behaviors such as trading sex for drugs or using injection drugs, according to a recent study. The researchers also found that homeless women with case managers were less likely to inject drugs than those who did not have access to case management services. Also, homeless women who could not obtain drug treatment were more likely to trade sex for drugs than women who were able to obtain drug treatment.

Drug treatment programs and intensive case management programs should be implemented to reduce HIV risk among homeless women. On-site intensive case management programs at homeless shelters or other relevant facilities can promote and sustain access to medical and drug treatment services, suggest Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles, and her colleagues. Their study was supported in part by the Agency for Healthcare Research and Quality (HS08323).

The researchers analyzed data from interviews with 974 homeless women aged 15 to 44 in Los Angeles County. They determined whether psychiatric symptoms (depression, substance use, psychosis) were associated with HIV risk behaviors (that is, injection drug use, unprotected sex, and trading sex) and whether homeless women who had contacts with health or substance abuse treatment services were less likely to engage in HIV risk behaviors than those without such contacts.

Even though the majority of women had a case manager or regular source of care, there was a high rate of HIV risk behavior. Within the previous year, 8 percent of women had used injection drugs, 64 percent had engaged in unprotected sex, and 22 percent had traded sex for either drugs, food, or housing. Homeless women who were drug abusers were nearly 10 times as likely to trade sex as other homeless women, and those with alcohol dependency were 5 times as likely to inject drugs. Homeless women with case managers were less likely to inject drugs. Neither depression nor psychosis symptoms were associated with HIV risk behaviors, perhaps because substance abuse masked their impact.

See "Psychiatric symptoms, health services, and HIV risk factors among homeless women," by Amy M. Kilbourne, Ph.D., Brooke Herndon, M.D., Ronald M. Andersen, Ph.D., and others, in the Journal of Health Care for the Poor and Underserved 13(1), pp. 49-65.

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