Homelessness and the Association with Future Substance Use and STI/HIV Risk Behaviors among Urban Gay, Bisexual, and other Men who have Sex with Men (MSM): A Longitudinal Analysis

Introduction:Homelessness is associated with an increased risk of syphilis, HIV, and other STIs and disproportionately impacts sexual and gender minorities.Method:Data for this analysis came from a longitudinal cohort study of 285 urban gay, bisexual, and other men who have sex with men (MSM). The study aimed to (1) describe the prevalence of homelessness over time (2) identify characteristics associated with homelessness, and (3) measure associations between recent homelessness and substance use and STI/HIV risk behaviors three months later. Participants were recruited from clinical and non-clinical settings and attended a baseline visit and study visits every three months for up to 18-months. Data was collected between July 2018 and September 2020. Descriptive analyses and mixed-effects logistic regression models were utilized.Results:One-third of participants (94) reported experiencing homelessness throughout the study. Homelessness was significantly and independently associated with increased risk for future drug/alcohol use before/during sex (aOR: 3.8, 95% CI: 1.7, 8.6), methamphetamine use (aOR: 6.3 95% CI: 2.6, 15.2), injection drug use (adjusted odds ratio (aOR): 3.7, 95% CI: 1.0, 13.1), and sex exchange (aOR: 12.7; 95% CI: 5.5, 29.4).Conclusion:Interventions to reduce homelessness are necessary to lower risk of substance use and STI/HIV risk behaviors.