Many also contend with addiction, mental illness, and housing instability, all of which contribute to the complexity of treating the disease and increase costs. People living with HIV/AIDS who are homeless have poorer access to medical care, lower use of antiretrovirals, less adherence, higher mortality and poorer clinical outcomes.
For HIV-infected homeless individuals in the Bronx, basic needs, such as food, clothing, and shelter, often supersede considerations regarding routine HIV medical care. Even when basic needs for food and shelter are met for homeless HIV-infected individuals, other factors, such as mental health disorders, drug and alcohol addiction, and lack of insurance, can serve as additional barriers that prevent them from engaging in care for their HIV disease. A majority must overcome not just mental illness but some combination of substance use disorders, criminal justice issues, poverty, unemployment, housing problems, trauma histories, and other complications.
HIV in the Bronx is a disease of poor and traditionally marginalized urban communities, with disproportionate rates of infection in homeless people, injection drug users, and people of color. Lack of information about Antiretro Viral Therapy, lack of access to routine care, and competing life priorities for homeless people are barriers to HIV treatment.
In a city that has a rate of new AIDS diagnoses that is more than three times higher than the national average, the neighborhoods of Highbridge/Morrisania, Hunts Point/Mott Haven and Crotona-Tremont have the 4th, 5th and 6th highest rates in NYC respectively. Highbridge/Morrisania has the 5th highest HIV death rate in the city.
South Bronx residents represent about one in four people with newly diagnosed HIV in NYC, yet they account for more than one in three AIDS deaths, the highest HIV-related death rate in NYC, and is an indication that residents at high risk of HIV infection are learning about and addressing their HIV status too late to maximize the impact of available therapies.
The South Bronx is also among the top three neighborhoods with the highest number of injection drug users with HIV/AIDS.2