Housing First and Unprotected Sex: A Structural Intervention

Previous studies have found a high prevalence of sexually transmitted infections and associated risk behaviours among homeless and marginally housed adults. Although individual-level characteristics and their association with risk behaviours have traditionally been a major focus of research, the importance of structural factors, such as housing, that impact these behaviours have received increasing attention. Supported housing interventions like Housing First (HF) have been argued to potentially contribute to reductions in sexual risk behaviours. Using an experimental design, the present study investigated the effect of HF on unprotected sex among homeless adults with mental illness with a treatment as usual (TAU) comparison group. Over the 24 months of follow-up, no association was found between HF and unprotected sex when compared to TAU. Several other variables were independently associated with unprotected sex. Results indicate that in conjunction with HF, additional interventions are needed to reduce unprotected sex among homeless individuals with mental illness.