Homelessness and health share an intricate and bidirectional relationship.1 Poor health status is a major risk-factor for homelessness.2 Likewise, homelessness is associated with greater overall morbidity and mortality when compared to the general population.2 Chronic sexually transmitted and blood-borne infections (STBBI) such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are key health concerns in homeless populations in Ontario (See Table 1), with greater prevalence than in the general population.

Patterns of chronic infection among homeless populations reflect greater exposure to routes of disease transmission. Injection drug use (IDU), inconsistent use of sexual barrier methods, multiple recent sexual partners, and sex work can increase the risk for transmission of HIV and HCV.3,4 These demographics pose distinct risk-factors, but also have compounding effects and intersections. Preexisting health comorbidities and HIV-HCV co-infection can make homeless populations vulnerable to more severe and complex disease trajectories.3,4 This Position Paper will outline recommendations focused on screening, prevention, treatment, and medical education to address chronic infection in populations experiencing homelessness in Ontario.