Outcomes and Differences in Partner Services (PS) Among Homeless and Non-Homeless Persons Newly Diagnosed with HIV in New York City (NYC), January 2007 – June 2011

Background:  A disproportionate number of New York City’s (NYC) approximately 40,000 homeless are people living with HIV (PLWH). HIV partner services (PS) relies on phone calls, home visits, and letters to reach clients, strategies that are challenging among the homeless. Outcomes for PS may be worse among homeless than non-homeless PLWH.

Objectives:  Compare HIV PS outcomes among homeless and non-homeless PLWH.

Methods:  Since 2006, the NYC Department of Health has increased the number of disease intervention specialists (DIS) embedded at HIV clinics to facilitate PS (from 8 in 2006 to 35 in 2011). DIS uses a standardized questionnaire to collect information during PS investigations at medical facilities, homes, shelters, and other field locations. Homeless was defined as self-reported homelessness (sheltered or street) within 12 months of diagnosis or PS interview.

Results:  From 1/2007-6/2011, 249/301 (83%) homeless and 2,696/3,302 (82%) non-homeless PLWH were interviewed. Homeless were more likely than non-homeless to be US-born, never married, hospitalized at diagnosis, to report incarceration, alcohol/drug use, and to exchange sex for drugs or money (all P <.01). Among homeless, the reason for lack of PS was more likely to be “unable to locate for interview” (69% vs. 38%, P<.0001) and less likely to be “refused interview” (32% vs. 15%, P=0.01). Partners of homeless patients were less likely to be notified (40% vs. 53%, P<.0001); however, those with negative or unknown HIV serostatus were more likely to be HIV-tested (59/80, 74% vs. 789/1140, 69%) and newly HIV-diagnosed following notification (22% vs. 14%).

Conclusions:  DIS placement in HIV clinics led to comparable PS outcomes among notified partners of homeless and non-homeless PLWH and high rate of case-finding among partners of homeless PLWH.

Implications for Programs, Policy, and Research:  HIV-diagnosed homeless persons can be reached for PS at clinical sites, and partnerships with street and shelter-based HIV testing providers is warranted.