Health status and risk behaviors of homeless people in San Juan, Puerto Rico

Background: Public health faces the tremendous challenge of homelessness, a situation likely to interconnect with problems like physical and mental health conditions, drug use and other negative health-related outcomes. This study aimed to describe the health status of individuals attending institutions that offer services for the homeless in San Juan, Puerto Rico (PR). Methods: We performed a cross-sectional survey of individuals aged 21-82 years enrolled in two community base organizations (CBOs) that offer services for the homeless in San Juan. Face-to-face interviews collected information on socio-demographic characteristics, substance use, health status, and access to medical care. Descriptive statistics were generated for variables of interest. Results: The study group consisted of 100 adults with a mean age of 46.0±11.3 years; of these, 93.0% were males, and 62.0% had completed high school. The distribution of the residential status was as follows: 56.0% on-the-street homeless, 9.0% transitionally housed and 35.0% housed. Nearly half (47%.0) reported fair or poor physical health. The most prevalent self-reported health conditions were depression (44.0%), anxiety disorder (32.0%) and HCV infection (18.0%). Among 54 drug users, 63% reported recent use of at least two drugs. Marijuana (57.4%), crack (48.1%) and cocaine (35.2%) were the most widely used substances. Access-to-care factors revealed that 54.0% received drug or alcohol treatment, 36.0% were unable to access health care services, and 23.0% were uninsured. Conclusions: Findings suggest that there is a need for greater access to health care and for more aggressive prevention and treatment programs targeting homeless adults in San Juan.