Food insecurity, income loss, healthcare access, and other exacerbated social inequalities among people experiencing homelessness during the COVID-19 pandemic in Brazil (2021–2023)

Abstract

BackgroundDuring COVID-19, the number of people experiencing homelessness increased, further exacerbating the violation of basic rights necessary for human survival. Thus, the study aimed to investigate the inequalities associated with income loss and food insecurity among people experiencing homelessness during the COVID-19 pandemic in Brazil.MethodsA cross-sectional study was conducted in 24 Brazilian state capitals and the Federal District among the homeless population using a validated instrument. Descriptive analyses and binary logistic regressions were performed.ResultsAmong 1512 homeless participants (median age:37, range:18–89), 39.4% had incomplete primary education, 83.7% earned below minimum wage or had no income, 56.5% received government aid, and 87.1% used the Sistema Único de Saúde (Brazilian Public Health System-SUS). During the pandemic, 42.0% faced food difficulties, and 26.3% experienced income loss. Across Brazilian macroregions, lack of employment affected four regions, with high SUS dependency and food scarcity. In the North (72.7%) and Northeast (51.9%), most lacked government aid, while in the Midwest (51.6%), temporary income loss prevailed. In regression analyses, men, black/mixed race, those married or in a stable union, government aid recipients, and SUS users had greater difficulty acquiring food during COVID-19. Men with incomplete high school or higher education and income above minimum wage were less likely to suffer temporary income loss, and black/mixed race individuals and those living on the streets were more likely.ConclusionsThe study showed how socioeconomic factors increased income loss and food acquisition difficulties during COVID-19, exacerbating vulnerability and social inequities for the people experiencing homelessness.