Access to hygiene facilities and experiences of hygiene-related disease: A pilot study of unsheltered individuals in Tucson, Arizona

Unsheltered individuals have limited access to restroom facilities. With this, many unsheltered individuals are forced to urinate, defecate, and engage in other hygiene practices outdoors. They may also lack access to necessary hygiene toiletries or wait to urinate or defecate until they are able to gain access to a facility. These challenges can lead to health issues, like urinary tract infections (UTIs), diarrhea, rashes, etc. The study objective was to understand the relationship between lack of access to basic hygiene facilities and health effects among unsheltered individuals. A verbal survey (English and Spanish) was used to explore the relationship between hygiene and unsheltered status. In Fall 2022, a researcher accompanied the homeless outreach team from El Rio Health, a Federally Qualified Health Center in Tucson, Arizona to verbally consent and recruit participants. Thirty consenting unsheltered adults ranging in ages from 29 to 68 years old participated in the study. Access to water was the greatest reported hygiene barrier, followed by access to soap, concerns for privacy, and concerns for safety. Eleven of thirty participants experienced a UTI at least once since becoming unsheltered and nine of thirty experienced a yeast infection at least once, with female participants having a statistically significant (p < 0.05) higher rate of occurrence than male participants. In addition, 19/30 of participants experienced a rash at least once and 17/30 of participants experienced diarrhea at least once. However, 20/30 of participants did not seek medical care for their health-related issues. Low healthcare utilization when there is a high need for care highlights the importance of community outreach and care for those experiencing homelessness. Next steps include replicating the project on a larger scale to determine generalizability.