Home and health among people living with HIV who use drugs: A qualitative study

Introduction: Housing is a critical determinant of HIV-related outcomes among people living with HIV (PLHIV) who use drugs, including on HIV treatment adherence. Research shows that sense of home may have important implications for mitigating harms associated with low-income housing environments among PLHIV who use drugs, but how this shapes treatment is poorly understood. Methods: Semi-structured interviews were conducted with 31 PLHIV who use drugs recruited from an ongoing prospective cohort in Vancouver, Canada. Recruitment was targeted towards individuals living in single room occupancy housing who had previously reported low treatment adherence. Interviews were co-led with a peer research assistant, and focused on housing conditions, drug use patterns, and HIV management. Interviews were transcribed, analyzed thematically, and interpreted by drawing on concepts of home and place-making. Results: The ability to exert control over housing environments contributed to participants' perceptions of home by fostering feelings of safety and allowing for creation of personalized space. Participants readily identified the importance of housing stability and quality in maintaining health (e.g. food storage, pest-free), including HIV care. However, informed by social-structural mechanisms that undermined agency, negative experiences of home adversely impacted treatment adherence. Conclusions: Findings indicate that sense of home may enable ability to manage HIV care, and is promoted through feelings of security within, and control over, housing environments. Supports in navigating competitive housing markets are needed to address the role that home plays in HIV treatment adherence.