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Researcher investigates health disparities faced by women living with HIV who experience homelessness

For people living with human immunodeficiency virus (HIV), lack of stable housing can be a significant barrier to medical care, adherence to antiretroviral medication, and viral suppression. In Miami-Dade County, lack of affordable housing and expensive rental markets, coupled with large proportions of people living with HIV who are uninsured and live in poverty, make for a challenging HIV care landscape. In Miami-Dade County, the majority of women living with HIV are racial/ ethnic minorities, many of whom live in poverty. To promote viral suppression among women in Miami-Dade and to improve national HIV outcomes, strategies must be geared to address the situations of these women particularly Black/African American, Hispanic, and Black/ Haitian women who are living with HIV.

 “The evidence is pretty clear that individuals who experience homelessness or are unstably housed have worse outcomes in HIV care and treatment” said Sofia B. Fernandez, post-doctoral associate in Stempel College’s FIU-Research Center in Minority Institutions (RCMI). “Yet, issues related to housing instability are often overlooked and can be difficult to detect. This can be particularly true for women who often experience less obvious forms of homelessness and housing instability such as staying in overcrowded homes, moving frequently, and exchanging sex for shelter.”

Fernandez was recently awarded a two-year period of support from the National Institute of Health (NIH) for her research focusing on improving health outcomes among women living with HIV who experience homelessness and housing instability. The project was awarded as a supplement to an existing grant, led by Dr. Mary Jo Trepka, which focuses on identifying women-centered care practices for women in Miami-Dade County. 

“My research will focus specifically on women who experience homelessness and housing instability while in care because we believe this is an underlying and persistent mechanism that not only perpetuates but also exacerbates disparities that exist in access, care, and treatment for women living with HIV in our community,” Fernandez said.

Among women experiencing homelessness and housing instability, competing demands of fulfilling basic needs such as housing, transportation, and caregiving can pose as a substantial barrier to accessing and maintaining their health care. Faced with competing demands to meet basic housing needs, women living with HIV who experience homelessness or housing instability may be forced to make choices between attending to immediate or family needs and adhering to their medical care. Fernandez’s research will focus on examining housing as both a social and structural determinant of health, and one contributing to health disparities along the HIV care continuum.

Fernandez’s research will focus on identifying groups of women with similar housing characteristics in order to develop risk-related profiles. She will explore how patterns in housing predict retention in care and viral suppression. Fernandez will also be exploring the unique experiences of housing instability, giving particular attention to the socio-cultural norms and values among women of differing racial and ethnic backgrounds that may influence their prioritization of competing needs while in care. “Our goal is to develop a deeper understanding not only of how women with HIV who experience homelessness and housing instability manage their care, but also what factors drive their medical decisions so that we can better address their needs and, ultimately, improve their outcomes in care,” Fernandez continued. 

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