Health Care, AIDS, Homelessness: A Need For Social Change

by Mark Mueller

When it comes to obtaining basic care, homeless people in the United States experience more difficulty than any other segment of the population.  Factors contributing to this difficulty include poverty, lack of housing, and high rates of physical illness and/or debilitating mental conditions.  Other barriers to care include negative stereotypes of homeless people; a lack of drug treatment facilities for indigents and bilingual public assistance personnel; shelters that will not admit families or persons with AIDS; an intimidating bureaucracy with an incredibly large amount of paperwork, and personnel that are often perceived as rude and uninformed.

It is believed that as many as 3,000,000 persons in the United States are homeless.  They are at much greater risk than the so-called “general” population to suffer from physical and sexual assault, malnutrition, TB, hepatitis, food poisoning, AIDS, and other contagious diseases, any one of which may make it extremely difficult to escape from homelessness.  It is also estimated that up to one third of the homeless population may suffer from various forms of extreme mental conditions.

Homeless people in turn, are faced with a highly complex medical care/human service delivery system, infamous for its impersonal, fragmented, and difficult-to-access bureaucracy, in the hope of securing the desperately needed relief to which they are entitled.  Indeed, Western medicine in general has been accused of focusing on the disease, but not communicating with the individual, who is subsequently bereft of social and psychological support.  Homeless individuals pose unique problems to this system such as a high rate of transiency which makes follow-up difficult, and the cyclical concept of time in which daily activities revolve around obtaining food, clothing and shelter, as immediate needs assume primacy over long term care.  Injection drug use, the leading risk factor for transmission of HIV among homeless people, is also a problem. 

Other problems which contribute to limited access to service include lack of health insurance, money and transportation.  According to researchers, “the longer one is homeless, the greater the loss of physical and mental health.  Resocialization is as necessary as physical and mental rehabilitation.”  The problems mentioned above may also act synergetically to promote a deep distrust, contempt and suspicion of what is seen as an inflexible, arrogant and unaccommodating system. 

The high prevalence and continually rising incidence of AIDS in the homeless population serves as an ominous reminder of the urgency of facilitating access to this nation’s health care/service delivery system.  Researchers have stated that although practice of risk behavior required for HIV transmission is “. . .not restricted to any particular group,” homeless people comprise a more demographically susceptible group with regard to practicing risky behavior—sometimes out of necessity (sex in exchange for protection, for example)—as compared with the “general” population.  It is thought that as many as 20% of the homeless population may be infected with HIV, and that as many as 50% of all persons with AIDS may be homeless.  Given the negative stereotypes associated with homelessness, and the stigma attached to AIDS, homeless people with AIDS are often considered the pariahs of society.

There is currently no cure for AIDS, and as mentioned earlier,  incidence/prevalence of HIV/AIDS among the homeless is continually rising.  Furthermore, since the causes of homelessness are deeply rooted in socioeconomics and political economy, this is a problem that we must plan on dealing with for the long term.

According to one researcher, one of the problems with AIDS in the United States is that leadership has had to come from the bottom up.  It is probably safe to say the same thing about homelessness as well.  With regard to AIDS among persons who are homeless, designation of the task is obvious: Stop the transmission of HIV; stop the dying.  But behavior must be changed.  In order to change behavior, the socioeconomic atmosphere which leaves so many people with no choice but to withdraw from society, must be changed.  Housing and jobs are needed, along with at least initial support for the maintenance of each, in order to keep people off the streets.  The question on the NEOCH pin is perhaps quite relevant here: “Excuse me, could you spare a little Social Change?”

Furthermore, it seems that the American public is itself in need of therapy if people with AIDS are to be de-stigmatized in our society.  The community and national leaders must step forward and make the statement that “there is no ‘right’ or ‘wrong’, ‘acceptable’ or ‘unacceptable’ way to contract HIV.  As human beings we need each others’ support in in order to survive; let us get on with the business of caring right NOW--today.