How COVID-19 has impacted access to healthcare and social resources among individuals experiencing homelessness in Canada: a scoping review

Impact of COVID-19 on individuals experiencing homelessness: Lessons learned and recommendations for practitioners

The COVID-19 pandemic, which brought about unprecedented changes globally, shed light on the significant disparities faced by persons experiencing homelessness (PEH). These individuals faced an elevated risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to factors such as lack of safe housing, limited access to hygiene and sanitation, and communal living situations. The unique challenges, vulnerabilities, and effects of COVID-19 on PEH is discussed, as well as lessons learned from these experiences, recommendations for practitioners, and the ongoing implications for addressing homelessness.

Access to care and impact on HIV treatment interruptions during the COVID-19 pandemic among people living with HIV in British Columbia

INTRODUCTION

The COVID-19 pandemic has changed healthcare service delivery. We examined the overall impact of COVID-19 on people living with HIV in British Columbia (BC), Canada, with a special focus on the potential impact of COVID-19 on antiretroviral treatment interruptions (TIs).

METHODS

Purposive sampling was used to enrol people living with HIV aged ≥19 years across BC into the STOP HIV/AIDS Program Evaluation study between January 2016 and September 2018. Participants completed surveys at baseline enrolment and 18 and 36 months later. Additional COVID-19 questions were added to the survey in October 2020. TIs were defined as >60 days late for antiretroviral therapy (ART) refill using data from the BC HIV Drug Treatment Program. Generalized linear mixed models were used to examine trends in TIs over time and associations with reported health service access.

RESULTS

Of 581 participants, 6.1%-7.7% experienced a TI during each 6-month period between March 2019 and August 2021. The frequency of TIs did not statistically increase during the COVID-19 epidemic. Among the 188 participants who completed the COVID-19 questionnaire, 32.8% reported difficulty accessing healthcare during COVID-19, 9.7% reported avoiding continuing a healthcare service due to COVID-19-related concerns, and 74.6% reported using virtual healthcare services since March 2020. In multivariable analysis, the odds of a TI in any 6-month period were not significantly different from March to August 2019. None of the reported challenges to healthcare services were associated with TIs.

CONCLUSIONS

Although some participants reported challenges to accessing services or avoidance of services due to COVID-19, TIs were not more likely during COVID-19 than before.

Factors That Contribute to the Mental Health of Black Youth during COVID-19 Pandemic

BACKGROUND

The mental health of Black youth during the COVID-19 pandemic is potentially influenced by various systemic factors, including racism, socioeconomic disparities, and access to culturally sensitive mental health support. Understanding these influences is essential for developing effective interventions to mitigate mental health disparities.

METHODS

Our project used a community-based participatory (CBP) research design with an intersectional theoretical perspective. An advisory committee consisting of fourteen Black youth supported all aspects of our project. The research team consisted of experienced Black researchers who also trained six Black youths as research assistants and co-researchers. The co-researchers conducted individual interviews, contributed to data analysis, and mobilized knowledge. Participants were recruited through the advisory committee members and networks of Black youth co-researchers and sent an email invitation to Black community organizations. Forty-eight Black identified were interviewed between the ages of 16 and 30 in Canada. The data was analyzed thematically. We kept a reflexive note throughout all aspects of the project.

RESULTS

Participants reported significant challenges with online schooling, including a lack of support and access to resources. Lockdowns exacerbated stress, particularly for those living in toxic living/home environments. Financial burdens, such as food insecurity and precarious employment, were prevalent and exacerbated mental health challenges. Additionally, experiences of anti-Black racism and police brutality during the pandemic heightened stress and anxiety among participants.

CONCLUSIONS

The findings underscore the complex interplay of systemic factors in shaping the mental health of Black youth during the COVID-19 pandemic. Addressing these disparities requires targeted interventions that address structural inequities and provide culturally competent support to mitigate the impact on mental well-being.

The collateral damage of the COVID-19 pandemic on homeless people in the Netherlands; a qualitative study on the impact of health and care

Introduction

People experiencing homelessness, also in the Netherlands, experience poorer physical and mental health compared to the general population and suffer from unmet health needs that are strongly related to their unfavorable social situation. This makes them especially vulnerable to negative consequences of a public health emergency such as the COVID-19 pandemic. This qualitative study aims to provide insight into the experiences of people experiencing homelessness with the impact of the pandemic on their health and lives.

Methods

We performed semistructured interviews at 3 different times in the first 2 years of the pandemic including, respectively, 67, 55, and 53 persons. Interviews focused on their experienced mental and physical health, their experiences with the public health measures taken, and the care they received during the pandemic.

Results

In each round of interviews, the self-reported mental health was lower than before. In the last round approximately half felt mentally unhealthy. Mental health was negatively impacted due to livelihood insecurity, loss of social contact and poor accessibility to social and medical care. Twenty-four hour shelter locations with smaller dormitories had a positive impact on mental health.

Conclusion and recommendations

Most preventive measures taken during the pandemic negatively impacted the mental health of people experiencing homelessness but some improved their health. We recommend special attention to the effects on mental health when planning measures for pandemic control and we recommend to implement 24-h shelter and smaller dormitories.

Exploring Frontline Shelter Staff Perspectives on the Healthcare Needs of Clients Experiencing Homelessness

PURPOSE

To examine healthcare service development needs for persons experiencing homelessness from the perspective of frontline staff at a homeless shelter in Montreal, Quebec.

DESIGN

Qualitative descriptive design.

METHODS

Purposive sampling, semi-structured interviews with frontline shelter staff (n = 8), and thematic analysis.

FINDINGS

Themes included: 1) Challenges meeting healthcare service needs in a shelter environment. 2) Visions for improving healthcare services while accounting for health issues and barriers to care. 3) Participants' own knowledge gaps around health and healthcare services.

CONCLUSIONS

Future research should emphasize this group's crucial role in homelessness healthcare services development.

Vaccine acceptance, determinants, and attitudes toward vaccine among people experiencing homelessness: a systematic review and meta-analysis

BACKGROUND

COVID-19 has caused millions of deaths globally, with vulnerable populations such as people experiencing homelessness (PEH) at higher risk. This systematic review and meta-analysis aims to identify the prevalence and key factors contributing to vaccine acceptance experienced by PEH.

METHODS

The protocol of this study was registered in PROSPERO (CRD42023391659). We included studies that reported relevant information about vaccine acceptance or vaccine hesitant/refusal among PEH. Eight databases were systematically searched in January 2023. Meta-analysis was conducted for the prevalence of vaccine acceptance, vaccine uptake, and factors associated with vaccine acceptance. Attitudes toward vaccines were combined into bar charts.

RESULT

A total of 29 papers were included in this systematic review and 19 papers were included for meta-analysis. The pooled prevalence of COVID-19 vaccine acceptance among PEH was 66% (95%CI: 58%-73%). Our meta-regression showed vaccine acceptance was significantly increased over time. Moreover, subgroup meta-analysis showed that PEH were more likely to accept the COVID-19 vaccine after June 2021 (78%, 95%CI: 65%-86%) compared with earlier period (56%, 95%CI: 54%-59%). Subgroup meta-analysis also revealed that women and participants without underlying medical condition (chronic diseases) were significantly less likely to accept the COVID-19 vaccine, compared to men and those with medical conditions, respectively.

CONCLUSION

The study emphasizes the need for targeted public health interventions aimed at increasing vaccine acceptance among PEH, especially at the early stage of the pandemic, among females, those without underlying medical conditions, being Black (in Canada and the USA), and young people. These interventions should address the common concerns of vaccine safety, adverse effects, effectiveness, and distrust in health care systems. In addition to offering vaccinations in different areas convenient to them, education programs could be established to increase vaccine acceptance among PEH.

Homelessness in the district of Nipissing of Ontario, Canada before, at the onset and during the COVID-19 pandemic: a trend analysis (2018-2021)

BACKGROUND

Homelessness is a growing social concern experienced across Canada. In Ontario, specifically in the District of Nipissing, the issue has become larger with an increasing number of homeless individuals. Previous research has described the demographic composition of the homeless population both in the Nipissing District of Ontario and in the city of North Bay. However, no studies have examined homelessness in this region before, at the beginning and during the COVID-19 pandemic. This research investigates structural and individual-level barriers and factors that are associated with becoming homeless or remaining homeless.

METHODS

This study utilizes data from the 2018 (n = 147), 2020 (n = 254), and 2021 (n = 207) homelessness enumeration surveys, conducted in the District of Nipissing, Ontario by the District of Nipissing Social Services Administration Board. This study employs quantitative, descriptive analyses to examine trends and socio-demographic variations in the reasons of homelessness, barriers to housing, episodic and chronic homelessness before, at the beginning, and during the COVID-19 pandemic.

RESULTS

The results revealed a rise in the proportion of male homeless (57% vs. 64%), and first-time homelessness among those aged 35-44 (3%, vs. 15%) and 55-64 (1% vs. 5%) at the onset and during the pandemic. The sleep location of homeless individuals was also influenced by the pandemic, where emergency shelter use dropped to half during 2020-2021(33% vs. 17%), while the use of locations (hotel/motels) where proper pandemic protocols and social distancing were possible increased sharply from 2 to 12% of homeless individuals. With the onset of the pandemic, chronic homelessness and one-episodic homelessness increased, suggesting that individuals are becoming homeless and staying homeless for prolonged periods. The barriers to housing during the pandemic were largely addiction, substance use and the inaccessibility of safe and secure rental units, while the corresponding barriers before the pandemic were mainly low income.

CONCLUSIONS

The rise in male homelessness, age at first-time homelessness and interpersonal conflict causing homelessness at the onset and during the pandemic suggest that policy makers need to focus on providing homeless supports to these groups of homeless populations at the time of pandemic.