Homelessness and Tuberculosis Transmission in Urban America

Homelessness and Tuberculosis Transmission in Urban America

Katie O’Sullivan


Among industrialized countries, the U.S has arguably struggled most with alleviating homelessness, ever since the issue breached the federal policy agenda in the 1970s. Homelessness is associated with a diverse range of risk factors that increase an individuals vulnerability to infectious disease: poor living conditions, compromised mental and physical health, and risky behaviour such as intravenous drug use. Within the U.S, the re-emergence of tuberculosis in the 1990s disproportionately affected the homeless in urban areas. This paper critically reviews the effects of homelessness on tuberculosis transmission in cities across the United States. I approach the peer-reviewed literature with three objectives: to determine first what risk factors and transmission mechanisms characterize TB cases among the urban homeless, second, what methods have been used to monitor transmission, and third, what treatment techniques have proven most effective for managing trans- mission. The literature effectively addresses these objectives through descriptive case studies in cities throughout the U.S, though does not satisfactorily contextualize observed trends within broader-level social, political, and economic forces, which are together changing what it means to be homeless in urban America. Specifically, efforts to monitor and treat the new tuberculosis should account for the new homeless in light of differential effects of treatment noncompliance, multi-drug resistant strains, concurrent infection with HIV/AIDS, and behaviour on the health risk of these populations.

Link to full article: Homelessness and Tuberculosis Transmission in Urban America

Katie is finishing her B.A Honours degree in Geography, and looks forward to co-founding a small organic vegetable farm this summer in New Mexico! Besides agriculture, she is interested in the impacts of urban policy on health and environmental equity worldwide.

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