Housing status and health care service utilization among low-income persons with HIV/AIDS

OBJECTIVE: To examine the Impact of housing status on health service utiliz ation patterns in low-income HIV-infected adults. DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York Stat e between April 1996 and March 1997. MAIN RESULTS: Six percent of study participants were homeless, 24.5% were " doubled-up," and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physi cian regularly (P = .0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P = .02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit ( P = .007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After m ultivariate adjustment, doubled-up participants were found to make more eme rgency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeles s were shown to use slightly more outpatient care than the stably housed. CONCLUSION: Our study documents differences in health care utilization patt erns across stably housed. doubled-up. and homeless HN-infected persons aft er controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and henc e may he more likely to experience adverse clinical outcomes.