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.”