IMPACT OF A POSITIVE HEPATITIS C

Impact of a positive hepatitis C diagnosis on homeless injecting drug users



Impact of a positive hepatitis C diagnosis on homeless injecting drug users

In order to understand the relationship between homelessness, drug use and Hepatitis C, it is useful to begin by acknowledging that homelessness—like drug use—is a vague concept which varies over time and place. Thus, definitions commonly encompass a wide variety of living situations, including sleeping on the street; staying in temporary forms of accommodation (such as hostels or bed and breakfast hotels); and living in overcrowded, substandard or insecure accommodation (for example, staying temporarily with friends or relatives). Beyond this, definitions of homeless are at least to an extent socially, culturally and psychologically constructed. For example, some might consider that travelling people are homeless, whilst travelling people might themselves dispute this.

Such definitional complexity means that estimating the number of homeless people who are misusing drugs or the number of drug users who are homeless is extremely difficult. Calculations inevitably depend on the definitions of homelessness (and drug use) adopted, when and where studies were undertaken, the populations sampled, and the research methods used. Thus, a study of 1000 predominantly young homeless people in hostels, day centres and on the streets of London in the mid-1990s reported that 88% were taking at least one drug and 35% were heroin users (Flemen, 1997). A slightly later survey of homeless people in Glasgow reported that 25% were dependent on at least one drug and 18% were dependent on heroin (Kershaw, Singleton, & Meltzer, 2000). Meanwhile, a study of rough sleepers in Edinburgh found that more than half were regularly using illicit drugs; the proportion rising to two-thirds amongst those under 26 years (Owen & Henry, 2001).

Notwithstanding the difficulties of providing precise estimates of how many individuals are actually HDUs, international data (Smart & Adlaf, 1991; Downing-Orr, 1996; Robertson, Zlotnick, & Westerfelt, 1997; March, Oviedo-Joekes, & Romero, 2006) confirm the overlap between homeless and drug-using populations. This, however, is unsurprising when the main risk factors for both homelessness and problematic drug use are considered. Separate reviews reveal many joint risks, including family breakdown; sexual or physical abuse in childhood; growing up in care; offending behaviour; imprisonment; lack of a social support network; school exclusion; low educational attainment; and poor mental health (Hutson & Liddiard, 1994; Klee & Reid, 1998; Lloyd, 1998; Christian & Gilvarry, 1999; Fitzpatrick, Kemp, & Klinker, 2000). An additional risk factor for homelessness is substance misuse and an additional risk factor for problematic drug use is homelessness. For some, drug misuse is a factor in causing homelessness; for others, homelessness can induce drug misuse or exacerbate an existing drug problem (Neale, 2001).

From this, it is not difficult to see why I have previously argued that the combination of homelessness and problematic drug use constitutes a double jeopardy (Neale, 2001). HDUs tend to experience complex, multiple, interconnected problems and have high support needs (Reid & Klee, 1999; Craig & Hodson, ...