Addressing Health Needs and HIV Risk Behaviors among Middle Age and Older Homeless Women
Background: The United States faces consistently high rates of homelessness; in large urban cities, such as Los Angeles County, recent reports indicate that over 50,000 people were homeless and 23% were women. Among homeless women in particular, estimates of drug use have ranged from 26% to 50%; moreover, only 52% of homeless women reported having access to condoms and/or birth control. Less is known about middle age and older homeless women who may have unique health needs and may be at risk for HIV due to drug use and lack of consistent condom use.
Methods: Utilizing CBPR methods, a two-phased study was developed. In phase one, a descriptive, qualitative study among older homeless women (N=20; ages 43-62) was conducted; women were eligible if they were: (a) > 40 years of age; (b) homeless; (c) pre-frail or frail; (d) free of evidence of acute, psychotic hallucinations, and (e) English-speaking. Content analysis was utilized; codes and subcategories were developed based on line-by-line coding and reviewed by several researchers. Trustworthiness of the data was established by using credibility, transferability, dependability and confirmability. Building upon phase one, phase two focused on the development of a pilot intervention for homeless women in collaboration, discussion and development with community partners.
Results: In phase one, several themes emerged which included 1) healthcare access, seeking and management; 2) lack of information about sex and sexual decision making; 3) lack of availability of food options and healthy eating; 4) seeking employment and support systems; and 5) areas of future program planning. Participants discussed program planning which included having those who experienced homelessness to be involved in the program delivery; further, challenges negotiating sex and sexual decision making were described. In phase two, a two-group, six session intervention and attention control program was designed by the researchers and formerly homeless community health workers (CHWs) from the community. Working in tandem with the partner site, CHWs were trained to lead six sessions. Topics presented included Hepatitis A, B, C and HIV transmission, drug use, chronic health conditions, nutrition, etc.
Implications: Utilizing the hallmarks of CBPR and working with the community-based partner site, these study findings provide a foundation for future work with this community which should build upon a CHW-delivered intervention designed to address drug use and dependency, HIV risk behaviors and health needs among middle age and older prefrail and frail homeless women.