Housing First and Unprotected Sex: A Structural Intervention

Elevated prevalence estimates of sexually transmitted infections and sexual risk behaviors have commonly been reported among homeless and precariously housed adults. Research has increasingly recognized the importance and impact of structural factors, such as housing, on risk behaviors. Several researchers have argued that supported housing interventions, such as Housing First (HF), may contribute to reductions in sexual risk behavior. The present study is the first analysis of a randomized controlled trial to examine the effect of HF on unprotected sex among formerly homeless and marginally housed adults with mental illness and complex comorbidities.

Methods. Generalized estimating equations were used to examine between-group differences in unprotected sex.

Results. Compared with treatment as usual, no association was found between HF and unprotected sex over the 24 months of follow-up. Several other variables were significantly and independently associated with unprotected sex.

Conclusion. Results suggest that further interventions are needed to reduce unprotected sex among homeless and unstably housed individuals with mental illness.