Infectious diseases in homeless people

On census night in 2001 there were close to 27 000 homeless people in New South Wales (NSW). Almost 25% of these people were young people between 12 and 18 years old. The rate of homelessness was higher for Aboriginal people than non-Aboriginal people, and higher in coastal, and rural and remote areas of NSW than in Sydney. Within Sydney, the rate of inner-city homelessness was six times higher than in the outer suburbs.¹

Many risk factors are associated with homelessness, including financial burdens and limited housing options. Mental health problems, often combined with drug or alcohol abuse, are common. For young people one of the main causes identified for being homeless is family breakdown. This may involve substance abuse by parents, or physical or sexual abuse of the young person.^1,2

The multiple causes and complexities of homelessness mean that the provision of adequate housing alone is often not enough. A co-ordinated approach to the management of homelessness needs to address mental and physical health, addiction issues and social isolation.³

Homeless people may be predisposed to infections because of their general poor health with lowered immunity, living conditions and poor hygiene.⁴ There may be several causes of poor health, including the prevalence of alcohol abuse, injecting drug use and heavy tobacco use, which are higher in the homeless than in the general population.⁴

Long-term alcohol abuse can cause liver damage, gastrointestinal bleeding, anaemia and neuropathies. Injecting drug use increases the risk of developing bloodborne and sexually transmitted infections. Heavy tobacco use can cause vascular disease and poor circulation, and is also a risk factor for developing chronic lung conditions and susceptibility to pneumonia. Poor nutrition can also contribute to lowered immunity.

Overcrowding in shelters or other temporary accommodation may expose people to infections and conditions where it is often not possible to maintain adequate hygiene. Homeless people are more likely to sustain injuries and be victims of violent crime, but are less likely to seek treatment, leading to the development of bacterial infections. Standing or walking for long periods, poorly fitting shoes, poor hygiene, poor circulation and poor sensation contribute to skin breakdown and the development of infections.

Mental illness may also contribute to the development of infectious diseases due to behaviours that may result in poor hygiene, injury, difficulty with seeking medical care and compliance with treatment. Other risks factors for the homeless include unsafe sex practices associated with multiple sexual partners or sex work, which increase the risk of sexually transmitted infections.

The Supported Accommodation Assistance Program (SAAP) was established to combine homelessness programs run by state, territory and Commonwealth governments under one nationally co-ordinated program. SAAP is Australia’s primary response to homelessness, and funds non-government organisations to provide accommodation and related support services.⁵

The community sector plays a large role in the care of the homeless. These non-government organisations provide grassroots care for some of the most disadvantaged in our community. Funding for these organisations is often provided through a mix of government funding and grants, and donated funds.

Non-government organisations are providing services that address many issues associated with homelessness. The Matthew Talbot Hostel, run by the St Vincent de Paul Society, is the largest hostel for homeless men in Australasia and provides medical care as part of its services. The Kirketon Road Centre, part of the South East Sydney Illawarra Area Health Service, provides outreach and centre-based services for the homeless, sex workers and injecting drug users, to prevent and minimise HIV/AIDS and other transmissible infections.