Association Between Housing Instability and HIV Care Outcomes among People with HIV in the United States.

BACKGROUND:People with HIV disproportionately experience homelessness and other forms of housing instability. Understanding how housing status influences HIV clinical outcomes remains limited, especially among individuals engaged in care. METHODS:We evaluated associations between housing status and HIV care markers using clinical data and patient-reported measures from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort of adults receiving HIV care across the US, between 2019-2025. We used relative risk regression and linear regression to estimate associations between self-perceived housing instability and outcomes including HIV viral suppression (<200 copies/mL), self-reported antiretroviral therapy (ART) use and adherence (visual analog scale), and CD4 cell count, adjusted for demographic characteristics, year, and site. RESULTS:Among 6,873 individuals in clinical care, nearly 10% reported some form of housing instability at their most recent visit: 4.6% "Unstable," 3.3% "Homeless," and 1.7% "Don't know." Compared to stably housed individuals, the prevalence of viral suppression was lower among those experiencing homelessness (PR=0.82, 95% CI: 0.77-0.89) and unstable housing (PR=0.94, 95% CI: 0.90-0.98), as was the prevalence of ART use, mean ART adherence, and mean CD4 count. Results were similar when stratified by substance use and depression and when compared to a community-based cohort of people with HIV. CONCLUSION:Housing instability is associated with a lower prevalence of HIV viral suppression even among individuals engaged in clinical care. These results highlight lack of access to stable housing as a structural barrier to successful management of HIV and to ending the HIV epidemic in the US.