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Addressing HIV and HCV in Populations Experiencing Homelessness

Endoresed in:

May, 2022

Paper Type:

Position Paper

Authors:

  • Dorisa Meng (McMaster University)
  • Jocelyn Tamura (McMaster University)
  • Rafique Van Uum (McMaster University)

Background:

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.

Recommendations:

  • The Ontario government should expand funding for point-of-care rapid testing for HIV and HCV at sites frequented by at-risk populations (e.g., opioid substitution clinics, supervised consumption sites, pharmacies dispensing methadone, shelters, and hostels) with a target of a 50% increase in the usage of these tests by 2027.
  • The Ontario government should expand disease prevention programs, including accessibility of mental health and sexual health resources, and safe consumption sites (SCS) as measured through annual qualitative surveys of perceived accessibility by target populations.
  • The Ontario government should produce a report detailing a provincial plan to expand financial, technical, and resource support for organizations offering integrated care for homeless populations (e.g., outreach, case management) by 2027.
  • Medical and healthcare professional programs should incorporate additional trauma-informed care and harm reduction principles into professional training, including medical school curricula and continuing medical education, as measured by annual accreditation audits.
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