Access to healthcare services for people living with HIV experiencing homelessness – a literature review

Abstract

Objective: People living with HIV (PLHIV) who are homeless or at risk of homelessness experience significantly worse health outcomes than those in stable housing. They are more likely to be diagnosed late, use substances, engage in high–risk sexual activities and have difficulty adhering to treatments. This review identifies strategies described and evaluated in the international social science literature which can improve access to HIV–treatment and care for PLHIV who are homeless or at risk of homelessness, to inform policy and service development in Australia.

Setting: The principle research question addressed in this review is:

•  What strategies enhance the ability of PLHIV who are homeless to access health care services, in particular community nursing services?

A literature review of social science research relating to the research question in the international and Australian
contexts was conducted.

Primary argument: No literature was identified that addressed access to community nursing services for PLHIV experiencing homelessness in Australia, and very little internationally. Community–based nursing organisations are well–placed and experienced in engaging marginalised groups in health care. Specific interventions need not always be developed: rather, better use could be made of existing services that utilise assertive outreach models of care and co–location with other services.

Conclusion: HIV–specialist community nursing services could be better integrated with homelessness services to enhance access to care, link PLHIV into the health system and keep them engaged in care. The absence of research on engagement with HIV specialist community nursing services demands exploration.