EU Citizens and Homelessness

This chapter provides a description of the implementation of the European citizens’ survey, led by the French team from Aix Marseille University, as part of the HOME_EU project. The French team set out to use a telephone survey and quantitative research methods to investigate the opinions and experiences of European citizens in relation to homelessness, in addition to use a contingent valuation method to elicit the value respondents placed on the Housing First model as a potential solution to long-term homelessness. Data collection covered a 10-month period (March to December 2017). The survey produced results for European citizen’s knowledge, attitudes and practices (KAP) in relation to homelessness, willingness to pay (WTP) for the Housing First model, and the prevalence of homelessness among the ‘survey and the WP2 as a whole close the chapter.info:eu-repo/semantics/publishedVersio

Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

IntroductionCertain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless.MethodsThe study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted.ResultsA total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases.ConclusionThe study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed

Home as a base for a Well-Lived Life: Comparing the capabilities of homeless service users in housing first and the staircase of transition in Europe

Nussbaum’s Central Capabilities refer to the elements of a well-lived life, and many adults who experience homelessness are deprived of these capabilities. The study aim was to investigate whether service users experience different homeless services as affording or constraining capabilities. We conducted semi-structured interviews with homeless service users (n = 77) in Housing First (HF) and staircase services (SS) in eight European countries. We used thematic analysis to identify three themes: autonomy and dependency, the relational impact of living arrangements, and community interaction and stigma. While SS participants were able to address their bodily integrity and health, their higherorder capabilities were constrained by their homeless situations. HF participants described home as a base from which they could enact a wide range of capabilities indicative of a well-lived life. We conclude that housing-led service models with appropriate supports are key to affording service users’ capabilities. Practical and policy implications are discussed.Orizoninfo:eu-repo/semantics/publishedVersio

Factors associated with providers’ work engagement and burnout in homeless services: A cross‐national study

The complexity of homeless service users' characteristics and the contextual challenges faced by services can make the experience of working with people in homelessness stressful and can put providers' well-being at risk. In the current study, we investigated the association between service characteristics (i.e., the availability of training and supervision and the capability-fostering approach) and social service providers' work engagement and burnout. The study involved 497 social service providers working in homeless services in eight different European countries (62% women; mean age = 40.73, SD = 10.45) and was part of the Horizon 2020 European study "Homelessness as Unfairness (HOME_EU)." Using hierarchical linear modeling (HLM), findings showed that the availability of training and supervision were positively associated with providers' work engagement and negatively associated with burnout. However, results varied based on the perceived usefulness of the training and supervision provided within the service and the specific outcome considered. The most consistent finding was the association between the degree to which a service promotes users' capabilities and all the aspects of providers' well-being analyzed. Results are discussed in relation to their implications for how configuration of homeless services can promote social service providers' well-being and high-quality care.info:eu-repo/semantics/publishedVersio

Working with people experiencing homelessness in Europe

In Europe, the widespread transition from the Traditional Staircase (TS) model to the Housing First (HF) model is transforming the way social service providers work with people experiencing homelessness. This study examined social service providers’ perspectives in both models regarding factors that facilitate or hinder their work. Data were collected through 17 photovoice projects involving 81 social service providers from eight European countries. The results show factors affecting social service providers’ work at three levels: systemic, organizational, and individual. Professionals in TS and HF identified similar topics; however, TS providers discussed more obstacles to work. Implications for practice are discussed.Comissão Européiainfo:eu-repo/semantics/publishedVersio

Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

Introduction: Certain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless. Methods: The study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted. Results: A total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases. Conclusion: The study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed

HIV disclosure and unsafe sex among HIV-infected women in Cameroon: Results from the ANRS-EVAL study

Encouraging seropositive people to voluntarily disclose their serostatus has been promoted as a key component of HIV prevention. Among other reasons, HIV disclosure to one's main partner is believed to be an incentive for serodiscordant couples to practice safe sex. The present article investigated this issue by conducting a cross-sectional survey of a large sample of HIV-infected women attending HIV care centers in Cameroon (N = 1014). Overall, 86.3% of these women had disclosed their serostatus to their main partner. With respect to sexual activity with their main partner during the previous three months, 35.0% had practiced abstinence and 47.4% only safe sex, whereas 17.6% had engaged in unsafe sex at least once. HIV disclosure to one's main partner was related to safe sexual practices in multivariate analysis. Some of the factors associated with disclosure and safe sex were illustrative of the positive roles of improved access to care and women's empowerment. On the contrary, beliefs overestimating the effectiveness of antiretroviral therapies were quite widespread among respondents and predictive of both concealment of HIV status and unsafe sex.HIV Disclosure Unsafe sex Women Cameroon AIDS care

Decentralization of HIV care in Cameroon: Increased access to antiretroviral treatment and associated persistent barriers

Context The national antiretroviral treatment (ART) program in Cameroon has reached one of the highest rate of coverage in Western and Central Africa (58% of the estimated eligible HIV-infected population in June 2008).Objectives To assess the extent to which decentralized delivery of HIV care at the district level has contributed to increased access to ART.Methods Comparison of ART-treated and non-ART-treated in the sub-sample of medically eligible HIV-positive patients (n = 2566) in the cross-sectional ANRS-EVAL survey was carried out among patients seeking HIV care in 14 hospitals at central level (Yaoundé, Douala and capitals of 8 provinces) and 13 at district levels. Logistic regressions and multivariate analysis were carried out to identify factors related to non-access to ART at both levels of care.Results Only 7% of eligible patients did not have access to ART. After adjustment for time since initial HIV diagnosis and CD4 counts (at initiation of treatment for those ART-treated and at time of survey for those who were not), younger and male patients, as well as those who only had a primary level education were less likely to be ART-treated at central but not at district level, whereas those who were unemployed were less likely to be treated at both levels. Patients were less likely to be treated in central hospitals with higher workload per medical staff member and absence of task shifting policy, and in district hospitals with non-availability of equipment for CD4 counts and larger size (150 beds or more).Conclusion Main persisting barriers in access to ART in Cameroon are rather due to insufficient access to HIV testing and difficulties in patients' referral to ART delivery centers after HIV diagnosis, since the overwhelming majority of eligible patients already seeking HIV care had effective access. However, health systems strengthening (HSS) is still needed to overcome some remaining barriers in access to ART and to guarantee its long-term sustainability.HIV/AIDS Decentralization Cameroon Antiretroviral treatment Health services

Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial – DAiP study

International audienceBackground: Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France

Cumulative incidence of SARS-CoV-2 infection within the homeless population: insights from a city-wide longitudinal study

Objectives The aim of this study was to determine the risk factors associated with SARS-CoV-2 infection in a cohort of homeless people using survival analysis. Seroprevalence in the homeless community was also compared with that of the general population.Design Cohort study.Setting Data were collected across two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face survey.Participants All homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible.Primary outcome measures Occurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population.Results A total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% (4.7–7.3) during the first session to 18.9% (16.0–21.7) during the second one, compared with 3.0% (1.9–4.2) and 6.5% (4.5–8.7) in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 (1.18–3.15)), being an isolated parent (1.64 (1.07–2.52)) and having contact with more than 5–15 people per day (1.84 (1.27–2.67)). By contrast, smoking (0.46 (0.32–0.65)), having financial resources (0.70 (0.51–0.97)) and psychiatric or addictive comorbidities (0.52 (0.32–0.85)) were associated with a lower risk.Conclusion We confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters. There is growing evidence that, in addition to usual preventive measures, public policies should pay attention to adapt the type of accommodation and overall approach of precariousness.Trial registration number NCT0440813