Hepatitis C Testing Rates, Communication, and Disclosure Among Homeless Young Adults

Background: Hepatitis C Virus (HCV) infection is an increasing health issue affecting homeless youth (HY). Studies indicate that HCV rates among this population range anywhere between 8-22%, and exceeds HIV in terms of fatality and incidence. Whereas some individual factors associated with HCV are fairly well documented (such as sharing needles), the social context surrounding HCV has not been well understood. Researchers and service providers have recently emphasized understanding communication patterns (i.e. who youth talk to regarding HCV) as well as disclosure decisions (i.e. who youth disclose to if they test positive) in order to guide development of health promotion and risk reduction models for homeless youth specifically tailored to HCV reduction. This study uses egocentric social network data to understand how homeless youth are engaging their social networks around issues associated with HCV.

 Methods: A large sample of homeless and unstably housed young people ages 18-26 (n=411) were surveyed across multiple urban cities in the U.S. Participants were asked multiple questions about their health and healthcare access regarding HCV. Participants also participated in a social network survey where they nominated five closest network contacts and then reported who among these five people they had discussed HCV testing with and disclosed their HCV testing results to (regardless of status).

Results: Overall, 70% of participants had ever been tested for HCV. 40% of all participants had been tested in the past 3 months. 5% were HCV positive however 3% of those that were tested never received their results. The majority of those testing positive for HCV were seeking treatment for their condition from a doctor.  Multivariable results revealed that those who used heroin in past 30 days were five times more likely to be HCV positive (p<0.04) and individuals that experienced homelessness at a later age had lower odds of being HCV positive (OR=0.8, p<0.01). Recent injection drug use increased the odds of ever being tested for HCV (OR=3.5, p<0.04). Identifying as LGBQ also increased the odds of ever being tested (OR=2, p<0.01). White youth were less likely to talk about HCV testing with their network (OR=0.5, p<0.04) but injection drug users (OR=7, p<.01) and HCV positive youth (OR=4 p<.01) were more likely to talk about HCV. Being HCV positive increased the likelihood of disclosing your HCV test results (regardless of positive or negative results; OR=6.5, p<.01). However, white youth were significantly less likely (OR=0.4, p<0.01) to disclose their test results.

Conclusions: Given the recent advances in HCV medical treatment, research regarding HY and their health is imperative. Chronic HCV can result in enduring health problems, including death. HCV is closely related to heroin and injection drug use in this population. Considering virility of the blood borne disease, the efforts to increase knowledge regarding HCV and HCV testing and prevention to reduce further spread should be targeted to HY. Naturally occurring social networks can also offer a fruitful gateway through which HCV awareness and prevention efforts can be bolstered.