Finding Ways to Address HIV in the Homeless Community

Addressing HIV in the homeless population is difficult but not impossible and there are three methods to do so, according to a recent review called ‘The impact of homelessness and housing insecurity on HIV,’ published in Lancet HIV.

The first is low-barrier care, which focuses on providing medical care for patients unable to engage in more traditional healthcare, such as making an appointment to see a provider. Low-barrier care clinics offer things like walk-in appointments and social work. Incentives such as clothing or food may encourage people to visit these centers.

The second method is mobile care, in which providers meet the patient in the field.

The last option is long-acting injectable medications, such as Sunlenca (lenacapavir), which is FDA approved as an antiretroviral. Lenacapavir is being investigated as a form of preexposure prophylaxis (PrEP) and research has shown a nearly 100% success rate. However, these drugs can be inaccessible due to price. Countries, including the United States, have paid more than $40,000 per person per year for Sunlenca. Lenacapavir is under review by the FDA as a form of PrEP with a June 19, 2025, PDUFA date.

“I think low-barrier care is the most promising because it's a flexible model and can be done in different ways, in different systems,” Julie Dombrowski, M.D., M.P.H., professor of medicine at the University of Washington, director of HIV treatment initiatives at the public health department of Seattle, King County and lead author, said in an interview with Managed Healthcare Executive. “Even within a conventional HIV clinic, people can make time on certain half days of the week, or with dedicated providers or with nurse-based models, to have walk-in availability for patients.”

Julie Dombrowski, M.D., M.P.H.