The Homeless

At least 643,000 persons were homeless on a given night in 2009, while roughly 1.56 million people, or one in every 200 Americans, spent at least one night in a shelter during 2009 (1). The National Alliance to End Homelessness estimates that 3.4% of homeless people were HIV-positive in 2006, compared to 0.4% of adults and adolescents in the general population (2). One study found that 26% of homeless people report acute health problems other than HIV/AIDS, such as tuberculosis, pneumonia, or sexually transmitted diseases (3).

In their fact sheet entitled Homelessness & Health: What's the Connection, the National Health Care for the Homeless Council states: "People experiencing homelessness have complex health problems. Without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems. Resolving health problems is critical to resolving homelessness." (4)

According to the Health Care for the Homeless Clinicians' Network report, HIV and Homelessness: Recommendations for Clinical Practice and Public Policy: "Homelessness and HIV/AIDS are widespread and intersecting problems that occur in both urban and rural populations throughout the United States. Conditions associated with homelessness make HIV prevention and control especially difficult. Limited access to medical care severely restricts HIV/AIDS prevention, risk reduction, and treatment for homeless persons. Adherence to complex HIV treatment regimens presents special challenges for homeless patients and their caregivers." (5)

Homelessness presents many barriers to healthcare. However, homeless persons can receive effective healthcare if it is delivered in the context of their usual life activities by professional providers who recognize and respect the autonomy of the individual patient and clearly communicate this respect to their patients to foster trust.

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Featured Links

Homelessness & Health: What's the Connection? (PDF)
From the National Health Care for the Homeless Council

Health Care and Homelessness
From the National Coalition for the Homeless

General Recommendations for the Care of Homeless Patients: Summary of Recommended Practice Adaptations (PDF)
From the Health Care for the Homeless Clinicians' Network

Adapting Your Practice: Treatment & Recommendations for the Care of Homeless Patients with HIV/AIDS (PDF)
From the Health Care for the Homeless Clinicians' Network

HIV/AIDS and Homelessness
From the National Coalition for the Homeless

Young, Positive and Homeless
From the AIDS Community Research Initiative of America and Gay Men's Health Crisis

Associations Between Substance Use, Sexual Risk Taking and HIV Treatment Adherence Among Homeless People Living with HIV
From AIDS Care, Volume 21, Issue 6 June 2009, pages 692 - 700

Factors Associated with Adherence to Highly Active Antiretroviral Therapy in Homeless or Unstably Housed Adults Living with HIV
From AIDS Care, Volume 21, Issue 4 April 2009, pages 448 - 455

Situational, Psychosocial, and Physical Health—related Correlates of HIV/AIDS Risk Behaviors in Homeless Men
From the American Journal of Men's Health, 2009;3(1):25-35

Street Smart: Reducing HIV Risk Among Runaway and Homeless Youths
From CDC's Division of HIV/AIDS Prevention

What are Homeless Persons' HIV Prevention Needs?
From the Center for AIDS Prevention Studies, University of California San Francisco

Homelessness and HIV/AIDS
From the National Alliance to End Homelessness

Comorbid TB and HIV in a Chronically Homeless Male: Social Isolation Compounds Stress of Medical Confinement
From the Health Care for the Homeless Clinicians' Network

Best Practices in TB Control: Working with Substance Users and Homeless Populations
From the New Jersey Medical School Global Tuberculosis Institute

Shelters and TB: What Staff Need to Know, Second Edition
From the Curry International Tuberculosis Center

Tuberculosis Transmission in a Homeless Shelter Population—New York, 2000–2003
From CDC's MMWR Weekly; February 18, 2005 / 54(06);149-152

Latent Tuberculosis and Active Tuberculosis Disease Rates Among the Homeless, New York, New York, USA, 1992–2006
From CDC's Emerging Infectious Diseases Journal 2009 July; 15 (7): 1109–1111

Adapting Your Practice: Treatment and Recommendations for Homeless Patients with Chlamydial or Gonococcal Infections
From the Health Care for the Homeless Clinicians’ Network

Crossing to Safety: Transgender Health and Homelessness
From the Health Care for the Homeless Clinicians’ Network

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¹ Sullivan, B. HUD Issues 2009 Annual Homeless Assessment Report To Congress. Washington, DC: U.S. Department of Housing and Urban Development. 16 Jun 2010. [cited 2010 Nov 8]. Available from: http://portal.hud.gov/portal/page/portal/HUD/press/press_releases_media_advisories/2010/HUDNo.10-124.
² National Coalition for the Homeless. HIV/AIDS and Homelessness. Washington, DC; 2009. [cited 2010 Nov 8]. Available from: http://www.nationalhomeless.org/factsheets/hiv. html.
³ National Resource Center on Homelessness and Mental Illness. Who Is Homeless? Newton, MA: U.S. Department of Health and Human Services, Substance Abuse & Mental Health Services Administration; 2003. [cited 2010 Nov 8]. Available from: http://homeless.samhsa.gov/Resource/View.aspx?id=32511.
⁴ National Health Care for the Homeless Council. Homelessness & Health: What's the Connection? (PDF) Nashville, TN; 2010. [cited 2010 Nov 8]. Available from: http://www.nhchc.org/wp-content/uploads/2011/09/Hln_health_factsheet_Jan10.pdf (PDF) .
⁵ Song, J. HIV/AIDS Care for Homeless Patients: Summary of Recommended Practice Adaptations (PDF) . Nashville, TN: Health Care for the Homeless Clinicians' Network, National Health Care for the Homeless Council, Inc.; 2000. [cited 2010 Nov 8]. Available from: http://www.nhchc.org/wp-content/uploads/2011/09/AIDS1.pdf (PDF) .