{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:39:12Z","timestamp":1788914352202,"version":"build-2803163510"},"reference-count":59,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2012,1,1]],"date-time":"2012-01-01T00:00:00Z","timestamp":1325376000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Patient Care and STDs"],"published-print":{"date-parts":[[2012,1]]},"abstract":"<jats:p>\n                    Despite the advent of effective antiretroviral therapy (ART), HIV-seropositive injection drug users (IDU) continue to suffer from elevated levels of morbidity and mortality. Evidence is needed to identify social- and structural-level barriers to effective ART. We investigated the impact of homelessness on plasma HIV RNA response among illicit drug users initiating ART in a setting with free and universal access to HIV care. We accessed data from a long-running prospective cohort of community-recruited IDU linked to comprehensive HIV clinical monitoring and ART dispensation records. Using Cox proportional hazards with recurrent events modeling, we estimated the independent effect of homelessness on time to plasma HIV viral load suppression. Between May 1996 and September 2009, 247 antiretroviral na\u00efve individuals initiated ART and contributed 1755 person\u2013years of follow-up. Among these individuals, the incidence density of plasma HIV RNA suppression less than 500 copies\/mm\n                    <jats:sup>3<\/jats:sup>\n                    was 56.7 (95% confidence interval [CI]: 46.9\u201366.0) per 100 person\u2013years. In unadjusted analyses, homelessness was strongly associated with lower rates suppression (hazard ratio=0.56, 95% CI: 0.40\u20130.78,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    =0.001), however, after adjustment for adherence this association was no longer significant (adjusted hazard ratio=0.79, 95% CI: 0.56\u20131.11,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    =0.177). Homelessness poses a significant structural barrier to effective HIV treatment. However, since this relationship appears to be mediated by lower levels of ART adherence, interventions to improve adherence among members of this vulnerable population are needed.\n                  <\/jats:p>","DOI":"10.1089\/apc.2011.0169","type":"journal-article","created":{"date-parts":[[2011,11,22]],"date-time":"2011-11-22T15:08:45Z","timestamp":1321974525000},"page":"60-67","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":105,"title":["Homelessness as a Structural Barrier to Effective Antiretroviral Therapy Among HIV-Seropositive Illicit Drug Users in a Canadian Setting"],"prefix":"10.1177","volume":"26","author":[{"given":"M.-J.","family":"Milloy","sequence":"first","affiliation":[{"name":"St. Paul's Hospital"},{"name":"University of British Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kerr","sequence":"additional","affiliation":[{"name":"St. Paul's Hospital"},{"name":"University of British Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Bangsberg","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Centre for Global Health"},{"name":"Harvard University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Buxton","sequence":"additional","affiliation":[{"name":"University of British Columbia"},{"name":"British Columbia Centre for Disease Control"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surita","family":"Parashar","sequence":"additional","affiliation":[{"name":"St. Paul's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Guillemi","sequence":"additional","affiliation":[{"name":"St. Paul's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Montaner","sequence":"additional","affiliation":[{"name":"St. Paul's Hospital"},{"name":"University of British Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Wood","sequence":"additional","affiliation":[{"name":"St. Paul's Hospital"},{"name":"University of British Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,1,1]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.6.450"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14570-9"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/jurban\/jti076"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1081\/ADA-100100600"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2009.08.003"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199411000-00011"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.7.1207"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1990.00390210032009"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2000.91003.x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.2001.00217.x"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-007-9249-4"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2005.065094"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2007.0011"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2007.00423.x"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9276-x"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9246-3"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0824-5"},{"issue":"1","key":"e_1_3_3_19_2","first-page":"S135","article-title":"Social determinants and the health of drug users: Socioeconomic status, homelessness, and incarceration","volume":"117","author":"Galea S","year":"2002","unstructured":"Galea S, , Vlahov D. Social determinants and the health of drug users: Socioeconomic status, homelessness, and incarceration. Public Health Rep, 2002; 117,Suppl 1:S135\u2013145.","journal-title":"Public Health Rep"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200003100-00008"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2009.0240"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2010.0314"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1086\/424008"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-009-9597-z"},{"key":"e_1_3_3_25_2","article-title":"Adherence and plasma HIV RNA response to antiretroviral therapy among HIV-seropositive injection drug users in a Canadian setting","author":"Nolan S","unstructured":"Nolan S, , Milloy MJ, , Zhang R et al. Adherence and plasma HIV RNA response to antiretroviral therapy among HIV-seropositive injection drug users in a Canadian setting. AIDS Care(in press).","journal-title":"AIDS Care"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-011-9562-9"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.6.547"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.10.1175-b"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.5.550"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200303280-00009"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-10-200311180-00008"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/00042560-200004010-00016"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200102160-00021"},{"key":"e_1_3_3_34_2","first-page":"656","article-title":"Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users","volume":"169","author":"Wood E","year":"2003","unstructured":"Wood E, , Montaner JS, , Yip B et al. Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ, 2003; 169:656\u2013661.","journal-title":"CMAJ"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116813"},{"key":"e_1_3_3_36_2","volume-title":"Modern Epidemiology","author":"Rothman KJ","year":"1998","unstructured":"Rothman KJ, , Greenland S. Modern Epidemiology. New York: Lippincott Williams & Wilkins, 1998."},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.12.043"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2008.12.005"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2004.30445.x"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1023\/B:QURE.0000021315.93360.8b"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2006.090209"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2006.20.48"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-008-9401-5"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0824-5"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03550010077044"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9247-2"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2005.19.326"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1086\/421400"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1080\/10550490290088072"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540120600911428"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32811ebf68"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9336-2"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-009-9643-x"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-9-220"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832b7dca"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69162-9"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b1649"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-005-9000-7"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200666060-00004"}],"container-title":["AIDS Patient Care and STDs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/apc.2011.0169","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/apc.2011.0169","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/apc.2011.0169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T18:00:50Z","timestamp":1777399250000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/apc.2011.0169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,1]]},"references-count":59,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2012,1]]}},"alternative-id":["10.1089\/apc.2011.0169"],"URL":"https:\/\/doi.org\/10.1089\/apc.2011.0169","relation":{},"ISSN":["1087-2914","1557-7449"],"issn-type":[{"value":"1087-2914","type":"print"},{"value":"1557-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,1]]}}}