Researchers examined more than 40 research papers assessing the levels of HIV, hepatitis C and TB among homeless people from 1984 to 2012 and found that although there is considerable variation between countries and regions, homeless people have a much higher likelihood of having one of these potentially fatal and debilitating diseases. There are thought to be more than 650 000 homeless people in the USA and around 380 000 in the UK, with rates of family homelessness increasing in the USA and youth homelessness rising in the UK.
In the USA, the prevalence of TB is at least 46 times greater in the homeless population than the general population, and the prevalence of hepatitis C infection is over four times greater. In the UK, the prevalence of TB is at least 34 times greater in homeless people than in the general population, and the prevalence of hepatitis C infection is nearly 50 times greater. For HIV, studies suggest rates up to 20 times higher in US homeless people than in the general population (no UK studies were found). Similar patterns were observed in most other countries for which data were available.
Dr Seena Fazel, a Wellcome Trust Senior Research Fellow in Clinical Science at the University of Oxford, says: “Infections in homeless people can lead to community infections and are associated with malnutrition, long periods of homelessness, and high use of medical services. Because absolute numbers of homeless people are high in some countries, improvements in care could have pronounced effects on public health.”
The authors focused on the prevalence of HIV, hepatitis C and TB because preliminary work revealed that these are the most heavily studied infectious diseases among homeless populations. However, they point out that high rates of other infectious diseases – such as hepatitis A and B, diphtheria, foot problems and skin infections – have been reported in some studies, suggesting that further research is urgently needed to assess the scale of the problem and allow public health efforts to be appropriately targeted.
“Screening for tuberculosis should be done through active case-finding – it should not be restricted to symptomatic people presenting to health services, which happens less and later in marginalised groups than in general populations,” adds Dr Fazel.
The researchers argue that more effective treatment and management should be considered, including syringe and needle exchange programmes, first-aid centres in large cities, and annual snapshot interventions of homeless populations.
Image: Rough sleeper in London. Credit: Deadly Sirius on Flickr
Beijer U et al. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Lancet Infect Dis [epub 20 August 2012].