Abstract
Homelessness is an increasing public health problem. Because of poor living conditions and limited access to healthcare systems, homeless persons are exposed to many communicable infections. We summarize the intervention measures reported to be efficient for the control and the prevention of common transmissible infections among homeless populations. Evidence suggests that appropriate street- or shelter-based interventions for targeted populations are the most efficient methods. Depending on the populations targeted, these interventions may include education, free condom distribution, syringe and needle prescription programs, chest radiography screening for tuberculosis, directly observed therapy for tuberculosis treatment, improvement of personal clothing and bedding hygiene, and widespread use of ivermectin for scabies and body louse infestation. Systematic vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diphtheria is strongly recommended. National public health programs specific to homeless populations are required.
Highlights
Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit
The risk for HIV infection is higher in the following populations of homeless people: those engaged in sexual behavior such as sex work, receptive anal sex, and having multiple sexual partners; those who find it more difficult to use or obtain condoms (6,10); and those who use drugs in shooting galleries or who share syringes or other drug paraphernalia (6)
An intervention program targeting homeless and crack-using African American women provided them with psychoeducational information and skills training on how to reduce HIV risk and drug use; the program significantly (p = 0.03) reduced the number of unprotected sex acts among participants, compared with control participants, at 6 months after the program was started (19)
Summary
LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Epidemiologic studies of homeless populations have reported the following prevalence rates for infectious diseases: 6.2%–35% for HIV infection (6,9–13), 17%–30% for hepatitis B virus (HBV) infection (9,10), 12%–30% for hepatitis C virus (HCV) infection (9,10), 1.2%–6.8% for active tuberculosis (TB) (3,4), 3.8%–56% for scabies (11,12), 7%–22% for body louse infestation (5,11,13,14), and 2%–30% for Bartonella quintana infection (5,15), which is the most common louse-borne disease in urban homeless. The prevalence of these transmissible diseases among the homeless varies greatly according to living conditions. In this review, which concentrates on the primary communicable infections commonly associated with homelessness, we summarize the main intervention measures reported to be efficient in controlling and preventing these infections
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