Evidence map›Paper›PMID 42462343›Full record

ArticleThe International journal on drug policy2026

"Everybody thinks that it won't happen to them": A mixed-methods study of HIV prevention strategies among people experiencing homelessness who use drugs.

Danielle R Fine, Carlos Sevilla, Angela Ma, Bailey Little, Nora Sporn, Travis P Baggett, Alysse Wurcel

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Article in The International journal on drug policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Danielle R FineDivision of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Mongan Institute, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA. Electronic address: drfine@mgh.harvard.edu.
Carlos SevillaHarvard College, 86 Brattle Street, Cambridge, MA 02138, USA.
Angela MaDivision of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA.
Bailey LittleDivision of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA.
Nora SpornDivision of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA.
Travis P BaggettDivision of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Mongan Institute, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA; Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA 02118, USA.
Alysse WurcelBoston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA.

Funding

The impact of HIV viral diversity and cellular immunity on HIV pathogenesisP30AI060354 · NIAID · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI ROBERT A. PARKER · 2004 to 2026
$94.4M
Peer recovery support for people experiencing homelessness with opioid use disorderK23DA058200 · NIDA · MASSACHUSETTS GENERAL HOSPITAL · PI Danielle Rebecca Fine · 2024 to 2026
$668k
NIAID NIH HHS P30 AI060354NIDA NIH HHS K23 DA058200
6 · The paper itself

Abstract

backgroundHIV disproportionately affects people experiencing homelessness, particularly those who use drugs. Although effective prevention strategies exist, uptake remains suboptimal in high-risk populations. Limited research has examined how this population engages with HIV prevention strategies and the contextual factors shaping behaviors.

methodsWe conducted a mixed-methods study of adults (≥18 years) experiencing homelessness with recent drug use, recruited from three Boston sites (Feb 2024-Jan 2025). Participants completed a survey assessing HIV prevention strategy uptake. A subsample completed in-depth interviews on factors influencing behavior. Guided by the Theoretical Domains Framework, we coded qualitative data and identified themes to help contextualize uptake.

resultsAmong 196 participants, mean age was 48; 61% identified as male and 44% as non-Hispanic White. Forty-two percent reported condomless sex, and among those who had ever injected drugs (n = 123), 24% reported syringe sharing in the prior three months. Only 9% reported current PrEP use, and 12% had ever used HIV self-tests. Qualitative findings highlighted perceived control as a key facilitator, while low perceived HIV risk hindered uptake across strategies. Additional barriers varied by strategy and included partner dynamics and substance use affecting condom use, structural constraints affecting syringe use, and knowledge, stigma, and cost concerns affecting PrEP and self-testing.

conclusionIn this cohort of people experiencing homelessness who use drugs, HIV prevention strategy uptake was suboptimal, with particularly low PrEP and HIV self-testing use. Qualitative findings suggest that interventions to promote HIV prevention strategy uptake in this population should leverage perceived control, address perceived risk, and target strategy-specific interpersonal and structural barriers.

Indexed as

HIV InfectionsIll-Housed PersonsAdultBostonFemaleHumansMaleMiddle AgedNeedle SharingPre-Exposure ProphylaxisSexual BehaviorSubstance Abuse, IntravenousSurveys and QuestionnairesUnsafe SexCondom useDrug useHIV preventionHIV self-testingHomelessPre-exposure prophylaxisSyringe sharing

Identifiers

PMID42462343
PMCPMC13673428

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.