The primary goal of the proposed study is to assess the impact of housing type, drug use, social isolation, PTSD, dissociation, depression, manic episodes and HIV serostatus on the risk behavior and victimization of poor and marginally housed women. In addition to the 105 HIV-infected women recruited during the first study phase, we will recruit an additional 45 HIV-positive women and 150 HIV-negative women in the same manner. We will do this in order to identify whether victimization and risk behavior patterns differ between women who are at risk to become HIV-infected and those who are already infected. We will no longer collect data on homeless and marginally housed men. Guided by Chu's model of revictimization, we will test whether predictors of victimization differ between women who do and do not report a history of childhood sexual abuse;we will also test whether the impact PTSD and dissociation on victimization are modified by depression, manic episodes, or housing status. Guided by the Rhodes approach to HIV risk as a function of structural barriers, we will conduct qualitative interviews regarding SRO hotels as potential high-risk environments, additional structural barriers regarding the context in which risk occurs, and intentional social isolation. This will be one of the first longitudinal studies of victimization and risk behavior to focus on indigent women and structural barriers. Understanding changes over time will facilitate the development of structural interventions and sustainable trauma service provision that will assist service providers in finding or creating safer housing for their clients, helping clients understand how their current situation still leaves them vulnerable, and offering alternate options

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Deeds, Bethany
Project Start
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Meacham, Meredith C; Bahorik, Amber L; Shumway, Martha et al. (2018) Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women. AIDS Behav :
Meacham, Meredith C; Ramo, Danielle E; Kral, Alex H et al. (2018) Associations between medical cannabis and other drug use among unstably housed women. Int J Drug Policy 52:45-51
Kim, Jin E; Flentje, Annesa; Tsoh, Janice Y et al. (2017) Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 94:514-524
Young, Dmitri A; Shumway, Martha; Flentje, Annesa et al. (2017) The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator. Psychol Trauma 9:613-621
Flentje, Annesa; Shumway, Martha; Wong, Lauren H et al. (2017) Psychiatric Risk in Unstably Housed Sexual Minority Women: Relationship between Sexual and Racial Minority Status and Human Immunodeficiency Virus and Psychiatric Diagnoses. Womens Health Issues 27:294-301
Riley, Elise D; Kral, Alex H; Cohen, Jennifer et al. (2016) Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women. J Womens Health (Larchmt) 25:936-43
Wong, Lauren H; Shumway, Martha; Flentje, Annesa et al. (2016) Multiple Types of Childhood and Adult Violence Among Homeless and Unstably Housed Women in San Francisco. Violence Vict 31:1171-1182
Riley, Elise D; Evans, Jennifer L; Hahn, Judith A et al. (2016) A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs. Am J Public Health 106:915-7
Riley, Elise D; Cohen, Jennifer; Dilworth, Samantha E et al. (2016) Trichomonas vaginalis infection among homeless and unstably housed adult women living in a resource-rich urban environment. Sex Transm Infect 92:305-8
Riley, Elise D; Shumway, Martha; Knight, Kelly R et al. (2015) Risk factors for stimulant use among homeless and unstably housed adult women. Drug Alcohol Depend 153:173-9

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