The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia

Study objective-Administrative databases from the City of Philadelphia that track public shelter utilisation (n=44 337) and AIDS case reporting (n=774 9) were merged to identify rates and risk factors for co-occurring homeless ness and AIDS. Design-Multiple decrement life tables analyses were conducted, and logistic regression analyses used to identify risk factors associated with AIDS amo ng the homeless, and homelessness among people with AIDS. Setting-City of Philadelphia, Pennsylvania, USA. Main results-People admitted to public shelters had a three year rate of su bsequent AIDS diagnosis of 1.8 per 100 person years; nine times the rate fo r the general population of Philadelphia. Logistic regression results show that substance abuse history (OR = 3.14), male gender (OR = 2.05), and a hi story of serious mental disorder (OR 1.62) were significantly related to th e risk for AIDS diagnosis among shelter users. Among people with AIDS, resu lts show a three year rate of subsequent shelter admission of 6.9 per 100 p erson years, and a three year rate of prior shelter admission of 9%, three times the three year rate of shelter admission for the general population. Logistic regression results show that intravenous drug user history (OR = 3 .14); no private insurance (OR = 2.93); black race (OR = 2.82); pulmonary o r extrapulmonary TB (OR = 1.43); and pneumocystis pneumonia (OR = 0.56) wer e all related to the risk for shelter admission. Conclusions-Homelessness prevention programmes should target people with HI V risk factors, and HIV prevention programmes should be targeted to homeles s persons, as these populations have significant intersection. Reasons and implications for this intersection are discussed.