This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.

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Abstract

Objectives. We report HIV seroprevalence and risk factors for urban indigent adults.

Methods. A total of 2508 adults from shelters, meal programs, and low-cost hotels received interviews, blood tests, and tuberculosis screening.

Results. Seroprevalence was 10.5% overall, 29.6% for men reporting sex with men (MSM), 7.7% for non-MSM injection drug users (IDUs), and 5.0% for residual non-MSM/non-IDUs. Risk factors were identified for MSM (sex trade among Whites, non-White race, recent receptive anal sex, syphilis), non-MSM IDUs (syphilis, lower education, prison, syringe sharing, transfusion), and residual subjects (? 5 recent sexual partners, female crack users who gave sex for drugs).

Conclusions. HIV seroprevalence was 5 times greater for indigent adults than in San Francisco generally. Sexual behavior predicted HIV infection better than drug use, even among IDUs.

Homeless and marginally housed persons in the United States are at high risk for HIV owing to high-risk sexual and drug-use behaviors. These populations include high-risk groups such as former prison inmates, crack and other cocaine users, sex workers, certain racial or ethnic minority groups, and persons with major mental illness.

Representative studies of HIV among homeless and marginally housed adults are rare, and estimates of HIV infection and other health problems vary dramatically as a function of sampling strategy. Since many indigent adults are unlikely to be included in traditional household or telephone surveys, HIV estimates are often based on convenience samples of high-risk groups (injection drug users [IDUs], female sex workers) or samples from service, treatment, or institutional sites (shelters, medical clinics). Not surprisingly, HIV prevalence rates vary from 0% to 62%, depending on the target population, geographic area, recruitment site, and sampling strategy. Estimates for the larger indigent urban populations are needed.

This report documents HIV seroprevalence, distribution, and risk factors for a large sample of indigent persons in San Francisco and provides the most comprehensive data on HIV among homeless and marginally housed adults to date. We expect the findings reported here to inform both new and existing HIV prevention efforts that serve these high-risk but hidden populations.¹

What is necessary, Hunts Point. Courtesy of Chris Arnade.

The man took the test in Rikers and learned that he has it. It. He has it.

The name is never said, but it doesn't need to be.

He goes away for drug charges (heroin) a few times per year. When did I get it?

He stares away while he speaks, sets his eyes on a point in the street ahead. Mid-afternoon in the summer, 18-wheelers drive by carrying produce. Mangoes rot in an adjacent dumpster.

Others call to him, men in cars and men walking who slow and gesture to do business somehow. Maybe drugs, maybe copping something from a metal yard. Maybe something else.

He waits for them in the lot of the gas station.

He doesn't tell them, doesn't tell anyone.

Hasn't told anyone, even the other men with whom he crashes beneath the hulk of trucks that line the still streets at night. A camaraderie under the metal frames that move at dawn to rouse those sleeping underneath into days of withdrawal, of stealing, selling, whatever to feel better. In this case, it means nothing.

He thinks he's depressed, doesn't know what to do. This is unnatural. Life, for him, often feels OK.

He's scared.

Do you know the prognosis? Do you know what to do? Where to go?

He didn't think it would happen. He's been living this life for so long.

What are the medications like?

Information is printed, then lost. Hand-copied, then lost. Hand-copied again.

Months pass there, immobile, lost.

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