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HIV-positive individuals with alcohol problems are more likely to use the hospital

Boston University : 13 March, 2006  (Technical Article)
HIV-positive individuals with alcohol problems are more likely to use the hospital during periods of homelessness, according to researchers from Boston Medical Center. The study currently appears online in the journal BMC Health Services Research.
Lead author Theresa Kim, MD, a faculty member at Boston Medical Center, worked with collaborators in Boston and in Birmingham (Ala.), studying HIV-positive individuals with alcohol abuse. They sought to understand whether the condition of homelessness itself tended to increase hospital and emergency department utilization.

The authors followed 349 persons with HIV and alcohol problems in Boston for 2-1/2 years. Fully 39 percent experienced homelessness at least once during the study period. Periods of homelessness were associated with a doubling in the rate of emergency room visits and hospitalizations. The effect of homelessness on increasing hospital use remained substantial, even when characteristics like depression, addiction severity and the stage of HIV infection were taken into account.

“Previous work has suggested that the homeless make increased use of hospital services,” said Kim. “But we studied an especially impaired group of people to clarify whether homelessness itself, or the associated problems of HIV, alcohol abuse and depression could account for this tendency. In a sense, we were trying to test the claim that homelessness, by itself, takes a toll on the health care system,” she added.

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

According to co-author Stefan Kertesz, MD from the University of Alabama at Birmingham, tenants who drink or use drugs can be a challenge for housing managers. “Additionally, 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 abuse out on the streets”

“It would appear that for this population, the lack of housing does translate into an increased burden for hospitals,” Kim added.

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.). The article “Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems” appears online at:
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