The impact of unregulated single room occupancy hotels on the health status of illicit drug users in Vancouver

Abstract

Introduction Single room occupancy (SRO) hotel units represent the most basic shelter provided for low-income individuals living in Vancouver's Downtown Eastside (DTES). While homelessness and marginalized housing in general, have been identified as environments that facilitate HIV risk behaviours, less attention has been paid to the specific context of living in SRO hotels. This analysis was therefore undertaken to describe the characteristics of individuals living in SRO hotels and to explore the association between living in SRO hotels and health status. Methods From January 2003 to November 2004, we enrolled participants into a large community-based cohort study (CHASE Project) involving a baseline questionnaire and data linkages to existing health service registries. Recruitment followed census track data in order to select a representative sample of the community residents. Logistic regression was used to identify socio-demographic, drug use, and health status characteristics independently associated with living in SRO hotels. Results Of the 2574 participants included in this analysis, 1813 (70%) reported living in SROs and 761 (30%) reported living in stable housing. The median age was 42 years (IQ range: 36–49 years). Among residents of SROs, 1108 (61%) had lived in the current SRO for less than 1 year, with the median number of moves in the past year being 5. Variables found to be independently associated with SROs included HIV infection (Adjusted Odds Ratio [aOR], 1.6 = 95% CI: 1.2–2.0), emergency room use (aOR = 1.7, 95% CI; 1.3–2.2), cocaine injection (aOR = 1.9, 95% CI; 1.5–2.5), heroin injection (aOR = 2.0, 95% CI: 1.6–2.3), recent incarceration (aOR = 2.1, 95% CI: 1.7–2.4), having been physically assaulted (aOR = 2.3, 95% CI: 1.7–2.8), crack cocaine smoking (aOR = 2.3, 95% CI: 1.7–2.7), and crystal methamphetamine injection (aOR = 2.9, 95% CI: 1.7–5.8). Conclusions Living in SRO hotels was associated with intensive illicit drug use, and poor health status, including HIV infection. These findings highlight the urgent need to address housing conditions in the DTES that threaten to undermine the harm reduction strategies and drug policy reforms in the City of Vancouver.