Social conditions and the link to health: Violence, discrimination, and HIV risk behavior among homeless women

This cross-sectional study examined the relationship between the social environment and homeless women's behavioral risk for HIV infection (N = 105). More specifically, this study assessed the relationship between a passive response to unfair treatment, discrimination, and violence to HIV risk behavior in a sample of sheltered homeless women. Unfair treatment and discrimination were assessed with a measure that was adapted from a previously published measure (developed by N. Krieger and Kaiser Family Health Foundation). Violence was defined as physical harm by a family member, family friend, stranger, or partner, and the age of first harm. HIV risk was defined as sex without a condom with a male partner in the last 12 months, and any lifetime regular injection drug use or crack/cocaine use.; The women in this study were older (41 years mean age) and reported a mean of 2.76 years homeless. Sixty-two percent of the women reported being sexually active within the last 12 months. Four percent reported always using condoms or barriers with male or female main partners, while 59% reported always using condoms with a casual male partner. Thirty-five percent reported any lifetime regular use of crack/cocaine and 18% reported any lifetime regular use of injection drugs. Over two-thirds of the sample (84%) reported experiencing violence. Violence was consistently associated with HIV risk behavior, however, the associations were not statistically significant. Further, respondents reported experiencing discrimination when accessing medical care, getting tested for HIV, and getting testing and treatment for STDs.; Results indicate that risk for HIV behavior among this sample of women is high. Additionally, history of violence, unfair treatment, and the experience of discrimination were frequently reported among this group of women. The development of risk reduction interventions for homeless women must consider the context of risk and the social conditions that may contribute to behavioral risk for HIV infection. Moreover, the social condition, and not merely an individual's behavior, may be an appropriate place for an intervention to reduce HIV risk among homeless women.