Among adults living with HIV, unstable housing is a barrier to health. Stably- and unstably-housed adults living with HIV were assessed for over 25 months. At baseline, unstably-housed adults living with HIV had a more recent HIV diagnosis, higher viral loads, worse physical and mental health, lower rates of antiretroviral therapy use and insurance coverage, and higher rates of hard drug use than stably-housed adults living with HIV. At follow-up, the health of both groups was similar, but unstably-housed adults living with HIV reported significantly more hard drug use and mental health symptoms when compared to the stably-housed adults living with HIV. Drug and mental health risks decreased for both groups, but decreases in unprotected sex were greater among unstably-housed adults living with HIV.