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Infectious diseases & Homelessness in Canada

Individuals experiencing homelessness are at a higher risk of contracting infectious diseases than the general population. This is in part due to the difficulties this demographic experiences in personal hygiene, food security, accommodation (i.e. crowded and poorly ventilated living space), substance exposure, and access to health care facilities. The reality is that individuals experiencing homelessness have limited options to treat and protect themselves from such exposure. Often they’re left with the choice to either use emergency services - the accessibility for which is an entirely separate issue - or to remain infected and continue this vicious cycle to possibly infect others.


COVID-19 and other respiratory illnesses such as tuberculosis that are transmitted through aerosols have been proven to be the most devastating to the homeless community, which demonstrated the highest risk of contracting diseases and ten times higher chance to die from them.


Next, we have the diseases linked to intravenous drugs, such as hepatitis B and C and HIV-AIDS. Hep B has been shown to affect approximately 32.5% of individuals experiencing homeless and using intravenous drugs. Although vaccination is available for all individuals, it must be administered within six months to have a 95-100% efficacy. The period of vaccine administration is often causing a barrier for those who lack adequate access to health care facilities. In terms of Hep C, one study demonstrated that Torontonians experiencing homelessness are 29 times more likely to contract this disease than the general population. On top of that, in comparison to the general population of having adverse side effects of pain and discomfort at 31% and not having enough energy to do physical activity at 48%, the homeless community’s percentage is 61% and 71%. Although the prevalence of HIV in Canada in 2011 was 0.2%, the homeless community represents one of the most affected groups.


Many other diseases also negatively impact the homeless community. One of the primary diseases they seek medical attention for is skin-related scabies, pediculosis and impetigo.


Oftentimes, whether the disease is chronic or acute, homelessness and disease is a two-way street. Experiencing poverty can contribute to adverse health outcomes as much as health can contribute to poverty. It is estimated that around 235 000 Canadians experience homelessness every year. The number of individuals and the length they experience homelessness is expected to continue to rise in the coming years. Although Canada’s Homelessness Strategy aims to end 50% of chronic homelessness by 2027-2028, developing and implementing strategies to prevent the spread of infectious diseases within the homeless community should be a continuous public health priority.

 

https://www.catie.ca/sites/default/files/SR-People-Living-with-HIV.pdf

https://www.thelancet.com/journals/laninf/article/PIIS1473309901000627/fulltext#back-bib2

https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-7-hepatitis-b-vaccine.html

https://www.homelesshub.ca/about-homelessness/health/infectious-diseases

https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/faqs.html

https://homelesshub.ca/sites/default/files/IncreasingVaccinations.pdf

https://raisingtheroof.org/what-is-homelessness/

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