Background
Latino/a/x and Spanish-speaking populations in the U.S. are disproportionately impacted by HIV, with outcomes often worsened by housing instability. We examined whether housing stability associates with HIV treatment engagement and adherence, and the role of resilience on this association.
Methods
Between January 2020 and August 2023 (off and on during COVID-19 waves), 72 people with HIV (PWH) were recruited from a community HIV clinic in East Los Angeles. Participants were primarily Latino/Hispanic (80%), cis-male (80%), and 58.6% foreign-born. Online surveys were collected in Spanish and English in-person, over the phone, or remotely and included measures of housing stability, HIV care engagement, resilience, and ART adherence. Of the participants, 19 completed qualitative 1-on-1 interviews. Housing stability was assessed on a 10-point scale (1 =not at all sure, 10 =very sure of stability over following year). Engagement in HIV care was scored on a 10-item scale, rating perceived connection to HIV care from 1 (not true) to 5 (true almost all the time). Correlation and regression analyses explored these relationships with subgroup comparisons by language.
Results
Housing stability was positively associated with engagement in HIV care (r =.28, p =.026) and resilience (r =.27, p =.041). Unadjusted linear regression analysis by language showed housing stability was strongly associated with engagement in care for Spanish speakers (B =1.6, p =.004) but not for English speakers. Resilience did not directly moderate the housing-HIV care engagement relationship. Logistic regression showed that better engagement in HIV care was linked to a 13% reduction in the likelihood of 4-day ART treatment interruption. Qualitative interviews echoed these findings. Participants frequently highlighted housing security as crucial for HIV care engagement.
Conclusion
Housing stability bolstered PWH’s ability to engage in HIV care and treatment adherence, especially among Spanish-speaking Latino/a/x PWH, highlighting resilience. Housing instability is a structural determinant that demands policy-level and community interventions critical for ending the HIV epidemic in marginalized communities. Culturally and linguistically tailored interventions that address housing stability and foster resilience may substantially improve care retention and health outcomes for Latinx individuals with HIV, offering a critical avenue for reducing HIV disparities in vulnerable communities.