Beyond Shelter: The Interconnected Health Risks of Houselessness

4 min readApr 2, 2024

By: Jordan La

According to the National Institute of Health (NIH), houseless individuals are characterized into three categories: (1) People without a place to reside; (2) People in persistent poverty, forced to move constantly, and who are houseless for even brief periods of time; (3) People who have lost their housing due to personal, social, or environmental circumstances [1]. On any given day, hundreds of thousands of individuals across the United States grapple with a housing crisis of some kind. Some are fortunate to seek programs that assist by providing shelter; however, those who are not able to seek help find themselves on the streets, in abandoned buildings, or in other places not suitable for human habitation. As the housing crisis has steadily escalated in recent years, and is projected to continue to, a pressing question emerges: what are the detrimental health effects associated with houselessness?

It is known that houselessness is connected to a myriad of factors that negatively intertwine together to impact one’s health. Whether the reality of being houseless is new or familiar to an individual, one is prone to a decline in physical and mental well-being [1]. A common mental illness houseless people usually battle is chronic schizophrenia, and as their disability worsens, their ability to cope with their surroundings — or the ability of those around them to cope with their behavior — becomes severely strained [2].

When patients are treated for schizophrenia using neuroleptic medications, they may become too drowsy which interferes with their alertness against the dangers on the streets [3]. The side effects of these medications increase vulnerability to exploitation, which can result in becoming a victim of theft, assault, or manipulation. Such an event could ultimately lead to compromised treatment adherences, resulting in worsening of their condition and the commencement of a deadly cycle.

In addition to other persistent mental health crises in the houseless community, substance abuse often becomes a coping mechanism for dealing with pressure. However, this coping mechanism can exacerbate health challenges in the future. Consistent drug abuse leads to increased susceptibility to infections like HIV, AIDS, and Hepatitis. With this in mind, it is not surprising that individuals in the houseless population have general infection rates 3.84 times higher when compared to housed individuals [4].

Houseless individuals that are associated with HIV/AIDS transmission tend to find themselves in high-risk settings, such as using unsterile syringes for drug administration, or unsafe sex and ‘survival sex’, the act of exchanging sex for food, shelter, or money [5]. Engaging in ‘survival sex’ evidences the economic desperation and lack of access to essential resources that push individuals into risky situations to meet their basic needs. This ultimately becomes a public health concern as the risk of sexually transmitted infections and blood borne infections poses a risk to the broader community.

Though very important, treating houseless individuals for HIV/AIDS presents unique challenges that can hinder effective management of the condition. The lack of access to nutritious food, clean water, and hygiene facilities, which are all essential for supporting HIV/AIDS treatment, can hinder the effectiveness of medications, weaken the immune system, and contribute to disease progression. Additionally, those who are living with HIV/AIDS may face stigma and discrimination. The negative stigmas and the discrimination that comes along with HIV/AIDS creates a lack of trust in healthcare providers, resulting in not disclosing one’s HIV status or accessing support services.

It is also worth mentioning that those who are houseless normally seek medical help in emergency departments, due to not having a primary care physician. This is concerning because once treated, the only end result is to release the patient back onto the street [1]. The unstable housing crisis leads to continued health risks when individuals return to unsanitary living conditions on the streets. This can fundamentally impact their quality of life, well-being, and sense of dignity, creating the endless cycle of emergency room visits.

When dissecting the issues of houseless individuals, we uncover that these challenges are a multifaceted crisis encompassing physical, mental, and social dimensions. The interconnectedness of houselesseness with mental illness, substance abuse, HIV/AIDS, and stigma creates a complex web of challenges that hinder effective management and exacerbate health disparities. The lack of access to stable housing, nutritious food, healthcare services, and social support contributes to a cycle of poor health outcomes and increased vulnerability among houseless individuals. With the rising numbers of houseless individuals steadily growing, it is time for society to address the root causes of houselessness, provide comprehensive support, and dismantle systemic barriers that perpetuate health inequalities among vulnerable populations.

Jordan graduated from UCLA in 2023 with a major in Human Biology & Society and is a current THINQ fellow.

Beyond Shelter: The Interconnected Health Risks of Houselessness

Written by THINQ at UCLA