Homeless veterans in the United States have a significantly higher prevalence of infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) compared to non-homeless veterans, investigators report in the online edition of Clinical Infectious Diseases. Prevalence of these viral infections was up to three times higher among homeless veterans compared to non-homeless veterans.
“Veterans who use homeless services clearly comprise a population with increased prevalence of HIV, HCV and HBV,” comment the authors. “A veteran’s involvement with homeless services provides a unique opportunity for engagement with other healthcare services, potentially using an integrated, co-located clinic model in a comprehensive approach.”
It is well established that HIV, HCV and HBV disproportionately affect armed forces veterans in the United States. Homeless individuals are at particularly high risk of infection with these blood-borne viruses due to overlapping risk factors, including mental health disorders and substance abuse.
However, there are few data on the prevalence of HIV, HCV and HBV among homeless veterans. Investigators from the Department of Veterans Affairs (VA) designed a retrospective study comparing testing and prevalence rates of these infections between homeless and non-homeless veterans who received care in 2015.
Data were obtained from the Veteran Affairs Corporate Data Warehouse. Veterans with at least one visit to a VA homelessness service were defined as homeless, with all other veterans defined as non-homeless.
In 2015, approximately 243,000 veterans received homeless services from the VA and 5,425,000 non-homeless veterans were in care.
Homeless veterans were younger (50 vs 61 years), with a large proportion identifying as black (39% vs 15%), fewer identified as white (46% vs 67%) and a higher proportion were female (11% vs 8%).
Testing rates for all three infections were higher among homeless than non-homeless veterans: HIV, 64% vs 37%; HCV, 78% vs 60%; HBV, 53% vs 28%.
Prevalence of HIV, HCV and HBV in tested patients was higher in homeless compared to non-homeless veterans: HIV, 2.3% vs 1.5%; HCV, 15.3 vs 4.5%; HBV, 1.8% vs 1.3%.
Overall population prevalence (tested and un-tested patients) was also higher among homeless than non-homeless veterans: HIV, 1.5% vs 0.44%; HCV, 12.1% vs 2.7%; HBV, 0.99% vs 0.44%.
“While homeless veterans face competing priorities including housing, comorbid medical conditions, and a myriad of social barriers to maximizing their health, these data suggest that comprehensive, wrap-around services for homeless veterans combined with treatment of HIV and HCV for co-infected individuals might be necessary to address these major determinants of health simultaneously,” write the authors. “The unique structure of VA allows for the integration of healthcare delivery with homeless services to better meet the needs of homeless veterans living with HIV, HCV and HBV moving forward.”
Noska AJ et al. Prevalence of HIV, HCV and HBV among homeless and non-homeless United States veterans. Clin Infect Dis, online edition, 2017.