March 21, 2006

BIRMINGHAM, AL — HIV-positive individuals who also are alcoholics are more likely to use the hospital during periods of homelessness, according to researchers from the University of Alabama at Birmingham (UAB) and Boston Medical Center. The study appears online in the journal BMC Health Services Research.

Co-author, UAB Assistant Professor of Medicine Stefan Kertesz, M.D., M.Sc., and colleague Theresa Kim, M.D., of Boston Medical Center, studied HIV-positive individuals with alcohol addiction. They sought to understand whether the condition of homelessness itself tended to increase hospital and emergency department utilization.

They followed 349 persons with HIV and alcohol addiction in Boston for two-and-a-half years. Thirty-nine percent experienced homelessness at least once during the study period. Periods of homelessness were associated with doubling the rate of emergency room visits and hospitalizations. The effect of homelessness on increasing hospital use remained substantial, even when characteristics such as depression, addiction severity and the stage of HIV infection were taken into account.

Kertesz said that while previous research suggested the homeless make increased use of hospital services, they chose to investigate an especially impaired group of people to clarify whether homelessness itself, or the associated problems of HIV, alcohol addiction and depression could account for increased hospital utilization.

“In a sense, we were trying to test the claim that homelessness, by itself, takes a toll on the health care system,” Kim added. “It would appear that for this population, the lack of housing does translate into an increased burden for hospitals.”

Kertesz and Kim agree such findings may have impact on policy. In recent years, the federal government has urged communities to focus on housing chronically homeless persons who have such severe mental illnesses as schizophrenia, an approach sometimes called “Housing First.” Nationally, communities have not uniformly applied this policy to individuals with addiction problems.

Kertesz said tenants who drink or use drugs could be a challenge for housing managers.

“Some people worry that direct housing could leave the addictive disorder unaddressed. Our data can’t resolve that concern, but they do highlight a community cost to leaving someone with HIV and alcohol addiction out on the streets.”

The research was supported by grants from National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and conducted at Boston Medical Center, the University of Alabama at Birmingham and Smith College (Mass.).