Overall 29% of respondents indicated that they either had or were recovering from an alcohol problem. A further 71% indicated that this was not a health problem that they experienced. Of those who reported that they have or are recovering from an alcohol problem; 9% suggested that they received adequate assistance to deal with their habit; 12% reported that they required additional help to that they received and a further 7% indicated that they did not receive support but that they would benefit from accessing such services. Help obtained from specialist alcohol services included help to stop drinking (6%) assistance with controlling intake (6%); reduction in use of alcohol (4%) and access to medical care in relation to impact of alcohol use (4%). In contrast, on being asked what assistance they would require from specialist alcohol services, respondents indicated that 12% wished for help in controlling their alcohol intake; 6% wanted to reduce their intake and 8% each wanted to help to stop drinking entirely and to manage the health impacts caused by alcohol use.
Accordingly a slight mismatch can again be identified in terms of help received and desired by services users; suggesting scope exists for enhancing services to meet the needs/desires of homeless service users. Again we suggest that a potential exists to work with former homeless, substance and alcohol using people to provide peer support in reducing dependency on alcohol and illicit
substances.
4.16 Communicable Diseases and Vaccinations
This element of the survey asked respondents a series of questions in relation to testing for and treatment of a range of conditions such as TB, Hepatitis and sexually transmitted diseases as well as contraception use. Respondents were extraordinarily open and willing to respond to these very personal questions with only a small number of non-responses to this section of the survey.
49 When asked if vaccination had been given for Hepatitis A and B, 16% and 21% (respectively)
indicated that they had received such a vaccination. Around 25% of respondents were unsure and approximately 50% indicated ‘no’ on each occasion with a very small number of ‘did not respond’ found.
When asked about receipt of ‘flu vaccinations – an important form of immunisation given the prevalence of chest infections and often poor conditions experienced by homeless people only 18% of respondents indicated that they had receive a ‘flu vaccination in the previous 12 months; 18% were unsure and 51% were clear that they had not received such protection.
Testing for Hepatitis C had not been carried out for 51% of respondents (a further 12% did not respond and 10% declined to answer. Of those who had been tested 16% were HepC – and 8% were HepC+.
Similarly, of those asked about TB screening. 12% did not respond; 8% did not wish to answer; 14% tested negative for TB and a concerning 8% were found to be TB+; enhancing risk for other
homeless people with whom they come into contact, for example in night shelter or squats. On being asked whether they had been tested for HIV; 10% of respondents did not wish to provide an answer in relation to their screening status; 10% declined to answer; 22% of those who were tested were HIV- and 8% were found on screening to be HIV+. Given that we are predominantly dealing with a White British, non-injecting, heterosexual population this finding must be regarded as being worthy of some concern in terms of population health within the study area and consideration should be given to rolling out additional screening and provision of advice in an accessible manner via trusted homeless health/support services.
Treatment for identified communicable diseases - Whilst overall a small percentage of respondents were found to test positive for the conditions detailed above and not all respondents replied to questions pertaining to treatment options; it is still noteworthy and of concern that 2% of those who reported screening positively for Hepatitis C; 4% of those found to be TB+ and 4% of those found to be HIV+ indicated that they were not offered treatment or advice for their conditions. An urgent need therefore exists to monitor, trace and offer treatment for homeless people found to test positive for the above conditions, utilising appropriate and trusted outreach services familiar with working with homeless populations. Once again it is worth reiterating that these respondents may have multiple conditions and represent a small group of ‘hard to reach’ service users at significant risk of transmitting communicable diseases amongst themselves and the wider population.
4.17 Sexual Health
Whilst clearly not all respondents may be sexually active, Chart 33 presents findings from the question pertaining to sexual health screening. Overall 67% report not having undertaken sexual health screening the previous 12 months whilst 22% have accessed such services. 10% of
50 Chart 33: Take-up of sexual health screening in the previous 12 months
Given that there is abundant evidence that homeless/roofless people, (particularly women) are likely to engage in unsafe sex, sometimes in exchange for a place to stay, it was considered relevant to explore issues of sexual health and knowledge of where and how to access contraception in the local area.
71% of respondents indicated that they were aware of how and where to access contraceptive advice in the local area, whilst 22% of respondents were unsure. Again whilst this service may potentially not be relevant for a high percentage of respondents it is important that wider
awareness and information sharing exists in relation to sexual health and screening services amongst the local homeless population.
On being asked where they would seek to access contraceptive or sexual health advice, 47% of homeless respondents indicated that they would see a nurse or GP; 40% a specialist sexual health or genital-urinary service and 8% a homeless support service. Access issues to these services, particularly for those of NFA thus require guidance and information packaged in an accessible format to ensure that service delivery matches service users need.
4.18 Specialist Women’s Health Services
Whilst women account for a very small percentage of homeless health service users at 12% of respondent (6 cases) (see above) only one respondent indicated that she had accessed cervical screening in the previous three years indicating that a gap in service provision exists and should be considered when devising appropriate services for this sector of the population. Similarly no women had accessed breast-screening services via their GP or specialist women’s health agencies. Whilst the population of homeless women interviewed are all under the age for routine breast screening it is suggested that access to women’s health services including cervical and breast screening should be made available to homeless women on a routine and opportunistic basic to avoid preventable deaths.
51 4.19 Accommodation Data
The concluding section of the questionnaire focused on the accommodation situation of
respondents to the survey and should be read in close conjunction with the demographics of the sample outlined above. Inevitably the accommodation status of the service user has significant impacts on both physical and mental health status and regardless of whether a client is currently homeless or accommodated in a hostel the health implications of prior homelessness and/or risk of ongoing ‘revolving door’ homelessness (particularly for those with substance misuse and/or mental health issues) cannot be underestimated. Chart 34 provides information on the current
accommodation situation of participants.