Background Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates. Methods A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms. Results We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic. Conclusion This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.

Early pregnancies are often linked to precarious situations. Even if Belgium has seen a decrease in teenage pregnancies, in the former mining region of the Hainaut there are still twice as many births to young women under 20 compared to the national rate. Colfontaine is one of the poorest cities in Belgium. Last year, one of the local high schools counted 10 pregnant teenagers out of 450 students. Médecins du Monde was already present in the city at the time with a mobile health clinic called the Médibus. In response, we carried out a mapping of the local sexual and reproductive health actors. The lack of accessibility to social and health structures capable of welcoming teenagers anonymously and free of charge quickly emerged as a problem, the nearest family planning center being located 30 minutes away by bus. In September 2019, in partnership with 5 local health actors, we decided to reshape the Médibus into the Adobus in order to offer family planning consultations, health promotion and harm reduction activities at the high school once a week. In addition to offering health information services, we also aim to detect teenagers experiencing vulnerable situations such as addiction, violence, gender issues and refer them to appropriate services. Halfway through the project, we met 430 teenagers in 14 afternoons. The most common reasons for consultation (N = 310) were questions related to contraception for 29% and to sexually transmitted infections for 24,5%. 70,9% of teenagers received condoms and 13 girls were tested for pregnancy. One girl received a morning-after pill. 3 teenagers with addiction problems and 17 victims of violence were detected. The teams referred 18 teenagers to other services. The success of this outreach project confirms the need for information regarding sexual and reproductive health for teenagers living in precarious situations as well as the need to develop reachable and affordable sexual and reproductive health services in semi-rural areas. Key messages Outreach is an efficient approach to respond to teenagers’ needs in poor semi-rural areas. Outreach facilitated the detection of early pregnancies, addiction and violence issues among teenagers.

In order to address the growing needs of the undocumented migrant population living in the Maximilian Park in Brussels, Médecins du Monde and 8 other organisations created The Humanitarian Hub in January 2018 where migrants can access medical care among other services. From January to February 2018, only 5 women out of 1483 patients visited The Humanitarian Hub regarding sexual & reproductive health and none asked about contraception. In response, a voluntary demedicalized midwifery clinic was implemented to build trust with the women and offer them contraception. At our field teams’ request, operational research was conducted. We used a mixed methodology, including retrospective quantitative analysis of patient files and field observations made during participant observation sessions. These observations helped us better understand the barriers women face in accessing contraception and how migration complicates its usage. By implementing gender-sensitive consultations, the number of women patients rose from 5,4% to 10,6% in 2018. Between March 2018 and March 2019, 144 women consulted midwives regarding their sexual & reproductive health. Quantitative analysis on pre-exposure contraception on 52 files showed that 4 used a contraception, 25 women requested one, 4 refused it, 19 discussed it with the midwife, and among them, 8 agreed to try it. The most common reasons for the 80 consultations analysed were requesting contraception (62,5%), including morning-after pills (12,5%) and fear of pregnancy (32,5%). The most common contraceptive method was the pill (63,6%) followed by injections (30,3%). Our medical team saw 29 women with unwanted pregnancies, which confirms the importance of focusing on contraception options for migrant women, although addressing this may be difficult in medical consultations. It also supports the need to implement demedicalized midwifery consultations to facilitate sensitive discussions with migrant women. Key messages Our research shows that contraceptive use is a particularly sensitive challenge in the irregular migrant women population due to the particularities of their lives. The development of demedicalized midwifery consultations helps professionals give irregular migrant women feasible advice on contraception in regard to their unique situations.