Download Discussion Questions - UCSF Center for AIDS Prevention

Shelter, Health care, And Drug use
associations with Overall health,
especially among Women (SHADOW)
The SHADOW Qualitative Study
Kelly Knight, Jennifer Cohen,
Andrea Scott, and Elise Riley
CAPS Conference
April, 2006
Thinking across the
behavioral-social-structural
divides



HIV is and has been embedded in multiple forms of oppression, such
as social exclusion, racism and sexism, since the beginning of the
epidemic.
The ongoing challenge to HIV programs and research is in responding
effectively to overlapping social vulnerabilities which play out on the
individual and social levels as the HIV risk behaviors of individuals or
groups.
Qualitative methods provide both researchers and providers with keen
insights into the complexity of social vulnerability and HIV risk that are
useful to the development of prevention theory, research and practice
because they can elucidate the social history and context of an
individual and bring their HIV risk environments “to life”.
The case study of HIV,
homelessness and victimization
The SHADOW
qualitative
investigation
demonstrates how
qualitative methods
can be used to
investigate the
interplay between
personal, social, and
structural
vulnerabilities.
Personal/
Individual
Social/
interpersonal
Structural/
environmental
Drug use
Family/children
Housing status
Sexual behavior
Peer groups
HIV status
Mental health
Intimate
relationships
Drug-sex
economy
Research Questions


How do HIV+ women navigate housing
instability?
What are the unique vulnerabilities that
HIV+ women face when they are unstably
housed?
Qualitative Methods

20 women recruited from the REACH cohort

Interviewed for 60-90 minutes

Topics: background, social and sexual
relationships, current housing, recent housing
mobility, safety and housing, financial support,
social service utilization, and drug use
Data Analysis



Interviews were transcribed verbatim
Participant summaries were created from the
interview topic areas
Group analysis meetings discussed individual
summaries and cross-participant emergent
themes
Preliminary findings

Housing instability and HIV infection were highly
linked to intimate partner violence (IPV).

Lifetime histories of housing instability and childhood
physical and sexual victimization were common.


Women described socially isolating from peers to
control drug use and reduce (stranger/peer)
victimization, but unsuccessfully shifting IPV
relationships.
HIV entitlements for housing and cash benefits were
not adequately protecting women from housing
instability and victimization.
Homelessness is different for
men and women
HIV Infection:
Intimate partner violence (IPV)
and housing instability
HIV infection:
Sex work in the drug sex-economy
Why are HIV+ women at risk for
housing instability?
Gender roles and partner
dependency
Legacy of IPV:
On-going housing instability
Directions for Prevention:
individual/clinical




HIV+ women may still have housing
instability
Homelessness and victimization
are relational and historic
Focus on HIV negative unstably
housed women to prevent future HIV
infections
Explore social isolation as a survival
skill (resilience) and weigh cost for the
individual woman
Directions for Prevention:
social/community



Build community advocacy opportunities for
marginally housed women within agencies (i.e.
volunteer programs)
Explore how build safe and supportive peer
support for homeless women
Address IPV, and the psycho-social legacy of
trauma and victimization, directly in HIV
prevention programs
Directions for Prevention:
Structure and Policy



Analyze and amend laws that evict women who
are victims of IPV
Provide couples access to housing with conflict
resolution training and accountability for violent
behavior
Improve health/social services oversight in
access to transitional and permanent housing
Last words :
“I don’t want to die in a
1-room SRO!”
Contact information
Kelly Knight
CAPS-UCSF
415.597.4651
[email protected]
Generation Five: http://www.generationfive.org
Looking to End Abuse Permanently: http://www.leapsf.org/