HIV-Risk Practices Among Homeless and Low-Income Housed Mothers

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Original Research

HIV-Risk Practices Among Homeless and Low-Income Housed Mothers

J Fam Pract. 1999 November;48(11):859-867

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Data Analysis

We examined differences in demographic and behavioral characteristics between homeless and low-income housed women, as well as between the high and low HIV-risk groups, using chi-square tests for categorical variables and the t test for continuous variables. All statistical tests were 2-tailed. To develop a model of factors associated with HIV-risk practices, we used a stepwise logistic regression model to control for potentially confounding variables that might influence the principal outcome of high-risk practices for HIV infection. The variables entered into the model included age, race, housing status, income, any lifetime mental health disorder, self-esteem score, hopelessness score, social supports, age at first sexual intercourse, number of lifetime partners, childhood sexual abuse, adult partner violence, HIV knowledge, and self-perception of HIV risk. We selected variables for inclusion in the regression model on the basis of univariate associations with high-risk behavior or the possibility of a priori confounding. The variables controlled for in the final model included race, housing status, HIV knowledge, history of childhood sexual abuse, adult partner violence, both childhood sexual abuse and adult partner violence, self-perception of HIV risk, and lifetime prevalence of any DSM-III-R disorder, excluding substance abuse.

Results

A total of 220 homeless mothers and 216 low-income housed mothers completed all interview sessions. In examining differences in demographic, mental health, social support, and victimization history characteristics between the groups, we found homeless mothers were significantly younger than low-income housed mothers and less likely to have completed high school or received a general equivalency diploma Table 1. Homeless women had significantly lower annual incomes and had moved a greater number of times in the past 2 years. Homeless mothers experienced significantly more emotional distress than their housed counterparts and scored lower on the self-esteem index. Rates of childhood and adult victimization were high in both groups.

Risk for HIV Exposure

Differences in HIV knowledge, risk perception, and risk-related practices between homeless and housed mothers are presented in Table 2. Overall, levels of knowledge about HIV transmission were good and did not differ significantly between homeless and housed mothers. Three questions related to HIV transmission yielded the greatest percentage of incorrect responses. Half of homeless and housed mothers believed that HIV could be contracted from kissing an infected person. More than a fourth of both groups believed they could catch HIV from being coughed on, and 28% and 30% of homeless and housed women, respectively, believed that HIV could be contracted by using public toilets. Another area of misconception involved measures to prevent HIV transmission, with half of both sets of mothers incorrectly answering items related to diaphragm and spermicide effectiveness in preventing HIV. Fifteen percent of both groups were unaware that condom use can prevent HIV transmission.

Several differences in sexual practices were observed between homeless and low-income housed mothers. The mean age and distribution of first sexual contact was younger for homeless women. Homeless women had significantly more lifetime partners and were also more likely to have had multiple partners in the last 6 months. Among homeless women with multiple sexual partners during the last 6 months, 63% reported at least one occasion when condoms were not used; 81% of low-income housed mothers with multiple partners reported unprotected sex. Approximately 75% of homeless and housed mothers reported at least one barrier to condom use.

Significantly more homeless women than low-income housed women had been tested for HIV. Women with poor HIV knowledge were significantly less likely than those with good HIV knowledge to have been tested (65% vs 79%). Women who did not know their risk of HIV exposure were tested with less frequency than those who claimed to know their risk (61% vs 80%). Overall, approximately 75% of women in the entire sample reported they had made some changes in their sexual behavior because of HIV.

Frequent alcoholism was higher among low-income housed women than the homeless. Although overall rates of cocaine and heroin use were low, homeless women were significantly more likely to report frequent cocaine or heroin use and have a history of intravenous drug use Table 2.

Factors Associated with High-Risk Practices

Overall, 171 women (39% of the total study sample) were classified as being at high risk for HIV, with significantly more homeless than housed mothers in this category. The characteristics of the sample according to HIV-risk classification are shown in Table 3. African American women were significantly more likely to be considered at high risk. Women with mental health problems as reflected by higher rates of depression, posttraumatic stress disorder, emotional distress, lower self-esteem, and hopelessness, or a diagnosis of lifetime alcohol/substance abuse were more likely to be considered at high risk.