Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits Among Unhoused Women

Abstract

In the United States, the frequent amalgamation of homelessness, drug use, and exchange of sex for money, shelter, food, or drugs increases the risk of serious health conditions, including trauma and HIV.1 Women who are unhoused have an all-cause mortality 5 to 8 times higher than housed women.2 Seattle, Washington, is facing a housing crisis, with a 31% increase in homelessness from 2008 to 20183 and a growing epidemic of opioid and methamphetamine use. In 2018, these overlapping epidemics created the context for an HIV outbreak in Seattle among unhoused heterosexual people.4 Several US cities have created mobile health clinics in an effort to engage unhoused people in medical care.5 In July 2018, the Safe, Healthy, Empowered (SHE) Clinic was founded to provide care for unhoused women colocated at Aurora Commons, a drop-in community center with a long-standing relationship with unhoused people in Seattle. Patients at the SHE Clinic reflect the unhoused population’s high rates of injection drug use, exchange sex, unplanned pregnancy, and sexually transmitted infections.6 In this cohort study, we evaluated the association between use of the SHE Clinic and the frequency of nonemergent emergency department (ED) visits among women living unhoused who exchange sex and inject drugs.