Shelter, Health care, And Drug use associations with Overall health, especially among Women SHADOW

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• Shelter, Health care, And Drug use associations
  with Overall health, especially among Women
  (SHADOW)
• The SHADOW Qualitative Study
• Kelly Knight, Jennifer Cohen,
• Andrea Scott, and Elise Riley
• CAPS Conference
• April, 2006

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• Thinking across the behavioral-social-structural
  divides
• HIV is and has been embedded in multiple forms of
  oppression, such as social exclusion, racism and
  sexism, since the beginning of the epidemic.
• The ongoing challenge to HIV programs and
  research is in responding effectively to
  overlapping social vulnerabilities which play out
  on the individual and social levels as the HIV
  risk behaviors of individuals or groups.
• Qualitative methods provide both researchers and
  providers with keen insights into the complexity
  of social vulnerability and HIV risk that are
  useful to the development of prevention theory,
  research and practice because they can elucidate
  the social history and context of an individual
  and bring their HIV risk environments to life.

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Structural/environmental
Social/interpersonal
Personal/individual
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The case study of HIV, homelessness and
victimization

• The SHADOW qualitative investigation
  demonstrates how qualitative methods can be used
  to investigate the interplay between personal,
  social, and structural vulnerabilities.

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Research Questions

• How do HIV women navigate housing instability?
• What are the unique vulnerabilities that HIV
  women face when they are unstably housed?

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Qualitative Methods

• 20 women recruited from the REACH cohort
• Interviewed for 60-90 minutes
• Topics background, social and sexual
  relationships, current housing, recent housing
  mobility, safety and housing, financial support,
  social service utilization, and drug use

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Data Analysis

• Interviews were transcribed verbatim
• Participant summaries were created from the
  interview topic areas
• Group analysis meetings discussed individual
  summaries and cross-participant emergent themes

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Preliminary findings

• Housing instability and HIV infection were highly
  linked to intimate partner violence (IPV).
• Lifetime histories of housing instability and
  childhood physical and sexual victimization were
  common.
• Women described socially isolating from peers to
  control drug use and reduce (stranger/peer)
  victimization, but unsuccessfully shifting IPV
  relationships.
• HIV entitlements for housing and cash benefits
  were not adequately protecting women from housing
  instability and victimization.

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Homelessness is different for men and women

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HIV Infection Intimate partner violence (IPV)
and housing instability
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HIV infection Sex work in the drug sex-economy
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Why are HIV women at risk for housing
instability? Gender roles and partner dependency
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Legacy of IPVOn-going housing instability
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Directions for Prevention individual/clinical

• HIV women may still have housing instability
• Homelessness and victimization are relational and
  historic
• Focus on HIV negative unstably housed women to
  prevent future HIV infections
• Explore social isolation as a survival skill
  (resilience) and weigh cost for the individual
  woman

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Directions for Prevention social/community

• Build community advocacy opportunities for
  marginally housed women within agencies (i.e.
  volunteer programs)
• Explore how build safe and supportive peer
  support for homeless women
• Address IPV, and the psycho-social legacy of
  trauma and victimization, directly in HIV
  prevention programs

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Directions for Prevention Structure and Policy

• Analyze and amend laws that evict women who are
  victims of IPV
• Provide couples access to housing with conflict
  resolution training and accountability for
  violent behavior
• Improve health/social services oversight in
  access to transitional and permanent housing

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Last words I dont want to die in a 1-room
SRO!

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Contact information

• Kelly Knight
• CAPS-UCSF
• 415.597.4651
• kelly.knight_at_ucsf.edu
• Generation Five http//www.generationfive.org
• Looking to End Abuse Permanently
  http//www.leapsf.org/