July 17, 2003
The University of California-Los Angeles RAND Access to Health Care for Homeless Women of Reproductive Age Study, a probability cluster sample of homeless women in LA County, provided the sample for this analysis. A review of LA County social and service directories and conversations with expert informants identified 236 shelters and 93 meal programs serving homeless women. The authors conducted fieldwork in six waves from January 1997 through September 1997. The authors scheduled waves to ensure that they visited each site in all four quarters of the monthly cycle.
The sampling unit is a homeless woman's visit to a shelter or soup kitchen, which is defined as a single site visit by a homeless woman to one of four study sites. Of the total 2,428 woman-visits identified, 1,668 woman-visits met the study criteria for homelessness. A total of 1,465 agreed to be interviewed at the time of the visit. The authors completed 974 unique, non-repeat interviews and subsequently weighted each woman-visit to take into account the frequency with which she used shelters or meal programs. The main outcome measure was receipt of an HIV test in the past year.
The analyses of the prevalence and predictors of HIV testing among homeless women are guided by an adapted version of the Behavioral Model for Vulnerable Populations, which posits that independent predictors of health service use can be categorized into three groups: predisposing, enabling, and need variables.
The rate of HIV testing in this probability sample of homeless women in LA County is among the highest reported of any population studied. Despite this good news, it is alarming that a substantial minority of homeless women with indications for HIV testing have not received this service. For example, 23 percent who reported a pregnancy in the past year, 26 percent who had been diagnosed with an STD, and 16 percent who traded sex had not been tested for HIV in the past year. Overall, this study, which documents an HIV seroprevalence of greater than 1 percent, suggests that providers should offer and encourage HIV testing for all homeless women in LA County. Further research should survey providers to determine what HIV testing guidelines they are actually using.
Public Health Reports
May-June 2003; Vol. 118: P. 261-269; Brooke Herndon, M.D.; Steven M. Asch, M.D., M.P.H.; Amy M. Kilbourne, Ph.D.; MingMing Wang, M.P.H.; Martin Lee, Ph.D.; Suzanne L. Wenzel, Ph.D.; Ronald Andersen, Ph.D.; Lillian Gelberg, M.D., M.S.P.H.