Vulnerability of Homeless People in Tehran, Iran, to HIV, Tuberculosis and Viral Hepatitis

Abstract

BackgroundHomeless people are at risk of contracting communicable infectious diseases, as they indulge in risky behaviours and lifestyle. This study was conducted to determine the prevalence of the aforementioned infections and related risk behaviours among homeless people in Tehran.MethodsIn this study a convenience sample of 593 homeless individuals was studied. The ELISA method was used for the detection of HIV, HCV and HBV. Clinical symptoms, sputum cultures, acid fast bacilli smears, and chest X-rays were used to identify active pulmonary tuberculosis, and the Interferon Gamma Release Assay (IGRA) test was used to identify latent tuberculosis.ResultsThe prevalence of HIV, HBV, HCV and latent tuberculosis was 3.4%, 2.6%, 23.3% and 46.7%, respectively. Active pulmonary tuberculosis was found in 7 persons (1.2%). Injection drug use was an independent risk factor for HIV, HCV and HBV infections. Older people had a higher proportion of Mycobacterium tuberculosis infection (OR: 2.6, 95%CI: 1.9, 3.7) and HCV positivity (OR: 1.7, 95% CI: 1.1, 2.5).ConclusionOur findings highlighted that much more attention needs to be paid to the health of homeless people.

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study

“…Differences in prevalence can be explained, in addition to different endemicity profiles between countries, by variations in the population characteristics and risk behaviors, especially injection drug use. In fact, in this study, the prevalence of injection drug use (8.7%) was low compared to the studies conducted in Iran (27.6%) [15], England (34.0%) [9], and USA (28.2%) [5]. …”

“…These individuals are at increased risk for hepatitis C, mainly due to sharing needles and syringes [38]. In this study, injection drug use was strongly linked to HCV exposure, as found in the general population of Brazil [4] and several other studies conducted on homeless people [15, 18, 30, 32, 39]. In addition, among men who reported injection drug use, more than half (57.1%) reported sharing drug paraphernalia (data not shown).…”

“…Considering homeless men in other geographic locations, the prevalence of anti-HCV was lower than that estimated in countries such as Iran (25.1%; 95.0% CI: 21.0–28.5%) [15], England (27.0%; 95.0% CI: 19.0–37%) [9], and USA (31.0%; 95.0% CI: 26.6–35.7%) [5]. Differences in prevalence can be explained, in addition to different endemicity profiles between countries, by variations in the population characteristics and risk behaviors, especially injection drug use.…”

“…Studies have shown a high prevalence of HCV among homeless men, ranging from 25.1 to 34.3% in Asia [15, 16], 19.0 to 26.5% in Europe [9, 17], and 4.84 to 66.0% in North America [18, 19]. In 2012, a global systematic review and meta-analysis estimated a prevalence of 21.0% (95% CI: 13.0 to 28.0%) in homeless men [12].…”

Smear positive pulmonary tuberculosis and associated factors among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia

“…In addition, relatively lower prevalence of TB in Iran might be due to lower prevalence of HIV infection (3.4 %) [15]. However, TB prevalence in this study is lower than studies conducted among homeless individuals in USA (6.1 %) [28], Seoul, South Korea (24.86 %) [13], North-eastern Poland (4.13 %) [29] and Colombia (7.9 %) [30], the difference might be due to difference in study design and setting, sample size and laboratory diagnosis method used.…”