Few studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior. Homelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors.
Despite the extensive literature supporting a link between homelessness, injection drug use, and injection-related risk behavior, gaps remain. The temporality of these relationships has not been assessed in a number of prior studies. Further, we and others have demonstrated that IDUs exhibit complex patterns of drug injection throughout their lifetime (Genberg et al., 2011b) and frequently transition in and out of injection drug use (Galai et al., 2003). Homelessness may be an important trigger for relapse among those who have stopped injecting, and for injection-related risk behavior among those who are persistent injectors. Prior studies have also not distinguished between those homeless for shorter vs. longer periods of time, which may differently impact risk.
The objectives of this study were: (1) to assess the temporal relationship between homelessness and injection drug use among current and former IDUs, (2) to assess whether homelessness differently impacts sustained injection drug use among active injectors vs. relapse among those who have stopped injecting; and (3) to assess the temporal relationship between homelessness and injection-related risk behavior among persistent injectors.