Homelessness can be defined as:
- Primary homelessness – people without conventional accommodation, sleeping rough or in improvised dwellings
- Secondary homelessness – people frequently moving from one temporary shelter to another
- Tertiary homelessness – those staying in substandard accommodation (caravan parks, boarding houses).[43]
Internationally and within Australia, there are high rates of homelessness among people with HIV and relatively high rates of HIV among the homeless.[44] It has been recognised that many people with HIV live without the support of family and friends that people who are unwell can generally expect to receive, increasing their risk of disease progression.[45] People experiencing homelessness are at risk of disengagement from medical and health care and are therefore less likely to be diagnosed with HIV, linked to specialist care, retained in care, prescribed ART and to achieve viral suppression.[46][47] With poor access to clean water, a bathroom, safe storage, money and transport, it can be difficult for homeless people to take ART and attend appointments.[48] A flexible, holistic nursing approach based on a social model of health, and incorporating assertive outreach, can help ensure homeless clients can attend appointments, maintain a continuous supply of antiretrovirals and maximise their adherence. These are important elements of engaging and retaining them in care and therefore improving their chances of achieving viral suppression and better long-term health outcomes.[49]