The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach

Publication date: Available online 13 August 2018Source: Social Science & MedicineAuthor(s): Omar Galárraga, Aadia Rana, Momotazur Rahman, Mardge Cohen, Adaora A. Adimora, Mirjam-Colette Kempf, Kemi Sosanya, Susan Holman, Seble Kassaye, Joel Milam, Jennifer Cohen, Elizabeth T. Golub, Lisa MetschAbstractUnstable housing, including homelessness, is a public policy concern for all populations, and more critically for people with a serious health condition such as HIV. We measure the effect of unstable housing on HIV treatment biomarkers: viral suppression (viral load < 200 HIV RNA copies per ml) and adequate CD4+ T-cell count (CD4>350 cells per μl). We use panel data (1995–2015) from 3082 participants of the Women's Interagency HIV Study (WIHS) sites in Bronx and Brooklyn (NY), Chicago (IL), Los Angeles and San Francisco (CA), and Washington (DC). The instrumental variable (IV) measures allocations for the Housing Opportunities for People with AIDS (HOPWA) per person newly infected with HIV, and it represents actual availability of housing assistance for HIV-positive persons at the metropolitan area level. Using an extended probit model with the IV, we find that unstable housing reduces the likelihood of viral suppression by 51 percentage points, and decreases the probability of having adequate CD4 cell count by 53 percentage points. The endogeneity-corrected results are larger than naïve probits, which show decreases of 8.1 and 7.8 percentage points, respectively...

Source: Social Science and Medicine - August 13, 2018 Category: Psychiatry & Psychology Source Type: research