Exploring the Increased Health Issues Due to Lack of Living Spaces among Homeless Injecting Drug Users (IDUs) in Delhi and National Capital Region (NCR)

Introduction: Injection drug use and homelessness are two significant intertwined public health problems. There is a need to understand the healthcare and social well-being needs of homeless Injecting Drug Users (IDUs) in the urbanized world. This study aims to explore the living conditions, assess the usability of the public services, and understand their needs in Delhi and the National Capital Region (NCR) for holistic health care and wellbeing.

Methods: A rigorous literature review was conducted to understand the existing evidence and frame a semi-structured questionnaire in consultation with community representatives. In-depth interviews (n=12) were conducted among IDUs in Delhi and NCR. The participants were recruited through snowball sampling. The interviews were transcribed, and thematic analysis was conducted.

Results: There is an absence of data on homeless IDUs residing in shelter homes in Delhi/NCR. The limited access to shelter compels homeless IDUs to sleep in filthy conditions, increasing their risk of infectious diseases. The participants reported seeking overnight shelter but complained about ill sleeping conditions leading to water-borne, water-washed, and water-based diseases, musculoskeletal conditions, infections due to pest infestation, and parasitic bites. The financial constraints further limited the access to essential and other healthcare services, forcing them to travel long distances to scattered facilities that often provide inadequate care. The continued harassment from security personnel and exclusion from government social welfare schemes owing to documentation concerns results in limited access and usability of services.

Conclusion: The living conditions of homeless IDUs significantly enhance their health risks. Inefficient services and a disregard for their actual needs further limit their ability to seek proper care. There is a need to develop public health interventions to provide holistic healthcare and well-being services to this population.