Exploring the consequences of housing insecurity on HIV treatment outcomes: Qualitative insights from Kisumu, Kenya

Housing insecurity (HI) is inextricably linked to poor health outcomes. Evidence suggests people living with HIV are more likely to experience poor psychological, physical, and nutritional health challenges. However, how housing insecurity might impact treatment outcomes among people living with HIV is under-explored. We examined the consequences of HI on treatment outcomes among people living with HIV in rural Kenya. Between July and August 2023. we purposively recruited and conducted 30 in-depth interviews and four focus group discussions (n = 35) with adult men and women living with HIV. Guided by grounded theory, the data were analyzed in Dedoose and organised into themes. The structural violence framework was then used to contextualise the findings. We found that HI exacerbated poor health outcomes through perceived adherence challenges and increased occurrence of opportunistic diseases such as malaria, diarrhoea, and cough due to housing conditions. Additionally, we found that the cost of rebuilding and maintaining took away resources from other household needs. Improving HI thus may play a critical role in enhancing HIV treatment outcomes. Given the variety of ways housing, food, water, and HIV affect health, gaining insight into the relationships between these factors has tremendous implications for care and treatment.