Illustrations by Alex McPhail, BA (Hons)
Hello reader! My name is Kyra, my pronouns are she/her and I reside in the geographical confines of what is currently known as Canada. This post was written on the traditional territory of the Anishinabewaki, Attiwonderonk, & Mississauga First Nations, in what is currently known as London, Ontario. I want to acknowledge my privilege as a white cis-woman, with access to post secondary education, stable healthcare and comfortable housing. My intention is to utilize my education and this platform 1) to help increase awareness of important topics in women’s health and 2) to explore social determinants of health and their impact on women. I do not intend to speak on behalf of communities that I do not belong to, and I hope to be corrected if my writing is misrepresentative. I am committed to lifelong learning, and continuously educating myself on responsible and effective allyship.
Over the past year, we have all been living in fear of the COVID-19 pandemic. Stay home, stay apart, wash your hands - this is the advice we have been given to avoid contracting and spreading the virus. What happens to people who are unable to follow these guidelines?
In this post we will discuss the impact of COVID-19 on houseless persons. We will talk about:
Unhoused Persons during COVID-19
Unhoused persons have been disproportionately affected by the pandemic (1*). There has been an increased need for shelters and social programs due to job loss and financial instability. However, shelters have not been able to meet this increased need for their services. To adhere to social distancing and building capacity guidelines, shelters are unable to house as many people as they were able to before the pandemic (2*). Paradoxically, this means that we are unable to care for unhoused peoples when they need us the most.
Limiting the spread of COVID-19 among unhoused populations is also challenging. It is common for unhoused persons to live in communal living spaces that make it easier for disease to spread. These include formal spaces, such as shelters and halfway houses, and informal spaces such as encampments. Communal living spaces make it difficult to practice social distancing and basic hygiene. Additionally, these living conditions have high population turnover, which creates higher risk of COVID-19 exposure within these communities (3).
Unhoused persons face barriers to accessing healthcare and social services which means they are less likely to receive testing for the virus. If an unhoused person contracts COVID-19, they are unlikely to receive proper treatment. Unhoused persons are more likely to have risk factors that can worsen the effects of COVID-19, including underlying conditions such as heart disease, lung disease, and addiction (3). These conditions can cause more severe disease in infected individuals and increases their risk of dying from COVID-19. Overall, unhoused persons younger than 65 have a 5-10 times higher risk of death by any cause than the general population (1).
Women Experiencing Houselessness
No research currently exists that centres women’s experiences with houselessness and/or vulnerable housing during the COVID-19 pandemic. However, prior research shows that unhoused women experience unique challenges. Women in Canada have a higher burden of poverty, housing need, and domestic violence; while bearing greater childcare responsibilities. For women who are unhoused, it is more difficult to access the resources necessary to assist with these burdens. This is especially true for women who were previously incarcerated, women who are recent immigrants, and women who identify as BIPOC, disabled, and LGBTQ2S+. (5).
Across Canada, only 13% of all shelter beds are dedicated to women. Women are less likely to seek co-ed shelter beds for fear of safety. Unstable housing is unsafe for women - 90% of unhoused women and gender diverse peoples have experienced physical and/or sexual violence. Additionally, women with children are less likely to use resources designed for unhoused people for fear of child welfare programs removing their children if they identify as unhoused (5). Compared to men, women are more likely to engage in sex work in order to obtain income, shelter, and other resources (3). COVID-19 has reduced the ability of sex workers to engage in these activities, leaving this population more vulnerable than ever.
The research on unhoused women is limited, largely because women experience houselessness differently than men (4*). Women are less likely to appear in shelters and on the street, where the majority of houselessness data is collected (9*). This leads to unhoused or vulnerably housed women being underreported in housing statistics.
Underreporting has resulted in women being invisible in housing statistics. These ‘invisible’ women have unique needs that are not currently reflected in available services. The greater visibility of men in statistics of unhoused populations has led to the creation of male-centred policies and services that fail to provide adequate support for women (5). For example, a study of Los Angeles found that compared to men, unhoused women had more chronic physical and mental health conditions and were less likely to have caseworkers and healthcare providers in their support networks (10*).
Improving Conditions for Unhoused Persons During COVID-19 and Beyond
The quality of life of unhoused persons during the COVID-19 pandemic can be improved in several ways. Coordination between health providers and shelter systems can help ensure that healthcare needs of unhoused persons are better met. This should include better access to health information and treatment services for both preventative and curative care. Offering priority testing to unhoused persons can also help with disease monitoring within shelters. Additionally, creating specific ‘isolation shelters’ for people with suspected or confirmed COVID-19 cases can help prevent spread (3).
Advancing support for unhoused persons needs to improve. Government and service providers should refocus research efforts to improve how unhoused persons are sheltered. National data on ‘invisible’ unhoused populations needs to be collected so that we can better understand the needs of these individuals. As previously mentioned, the ‘invisible’ unhoused population is thought to be mostly women. This is especially important in rural, remote, and Northern communities. The majority of research and resources for unhoused populations has been focused on urban areas. As a result, there is a lack of frameworks for research on rural, remote, and Northern communities. Research practices need to be developed in order to determine the scope of unhoused persons in these communities and their needs to develop proper support systems(6*).
There is also an extreme lack of research on LGBTQ2S+ individuals' experience with being unhoused. It has been shown that unhoused LGBTQ2S+ adults are more likely to experience mental health challenges, and have higher rates of HIV and substance use. However, the majority of studies on HIV in unhoused LGBTQ2S+ adults has focused on cisgender males, so this information may not be applicable to the LGBTQ2S+ community as a whole (7). It is difficult to find accurate counts of LGBTQ2S+ adults experiencing houselessness, information about available support and programming, and research on LGBTQ2S+ exits from houselessness†.
Information on BIPOC experiences with being unhoused in Canada is even more limited. BIPOC communities are extremely underrepresented in Canadian houselessness research. According to Canadian census data from 2016, 30% of unhoused persons identified as Indigenous (8). Only 5% of people in what is currently Canada identify as Indigenous, suggesting that Indigenous Peoples experience higher rates of houselessness This census also reported that 14% of unhoused people identified as newcomers to Canada. However, no census data was collected for Black persons or other people of color. There is almost no research regarding BIPOC experiences with entry and exits into houselessness† or information about culturally-sensitive supports and programming specifically for BIPOC folks.
It is crucial that research within BIPOC and LGBTQ2S+ communities is improved so that information about prevalence, pathways in and out of houselessness, and specific programming and housing needs can be collected. However, we must recognize that research is just the first step. We highlight this here because historically oppressed groups are vulnerable to extractive, colonial research practices – that is, research that extracts knowledge and data from these communities without actually enacting policies to help them. We need to use research to create supportive housing models that meet the needs of women and gender diverse folks experiencing houselessness. We need to apply an intersectional lens to develop policies and services that are tailored to diverse groups that may experience unique challenges due to houselessness (5).
†Exiting houselessness refers to the transition from being unhoused or experiencing vulnerable housing to a state of being housed.
Some of the data available and used to inform this post compares women and men. The term “women” is used when referring to cisgender women or where research did not specifically mention the gender identity of women included.
*These sources do not specify the gender identity of the women included. Historical representation leads us to believe only cisgender women were included.
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References
Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health [Internet]. 2020 April [cited 2021 Jan]; 8(4):186-7. Available from: [https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30053-0/fulltext
Xie E, Bond A, Hayman K, Hulme J, Sheikh Hm Orkin A. COVID-19 and Persons Experiencing Homelessness or Vulnerable Housing [Internet]. Canadian Association of Emergency Physicians. [cited 2021 Jan 18]. Available from: https://caep.ca/wp-content/uploads/2020/03/COVID-19-and-homelessness-CAEP-updated-0321-1.pdf
Perri M, Dosani N, Hwang H. COVID-19 and people experiencing homelessness: challenges and mitigation strategies. CMAJ [Internet]. 2020 Jun [cited 2021 Jan]; 192(20): 16-19. Available from:https://www.cmaj.ca/content/cmaj/192/26/E716.full.pdf
Government of Canada. Guidance for providers of services for people experiencing homelessness (in the context of COVID-19) [Internet]. Government of Canada; 2020 Jun [updated 2020 Aug 14; cited 2021 Jan 18]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/homelessness.html
Schwan K, Versteegh A, Perri M, Caplan R, Baig K, Dej E, Jenkinson J, Brais H, Eiboff F, Chaleshtari TP. The state of women’s housing need and homelessness in Canada: a literature review [Internet]. The National Women’s Housing and Homelessness Network; 2020 [cited 2021 Jan 18]. Available from: http://womenshomelessness.ca/literature-review/
Schiff JW, Schiff R, Turner A, Bernard K. Rural Homelessness in Canada: Directions for Planning and Research. JRCD [Internet]. 2015 [cited Jan 2021]; 10(4): 85-106. Available from: https://journals.brandonu.ca/jrcd/article/download/1230/293
Ecker J, Aubry T, Sylvestre J. A review of the literature on LGBTQ adults who experience homelessness. J Homosex [Internet]. 2017 Dec [cited Jan 2021]; 66(3): 297-323. Available from: https://www.tandfonline.com/doi/full/10.1080/00918369.2017.1413277
Employment and Social Development Canada. Everyone Counts 2018: Highlights - Report [Internet]. Government of Canada; 2018 [updated 2020 Aug 31, cited 2021 Jan 18]. Available from: https://www.canada.ca/en/employment-social-development/programs/homelessness/reports/highlights-2018-point-in-time-count.html#1
Fotheringham S, Walsh CA, Burrowes A. ‘A place to rest’: the role of transitional housing in ending homelessness for women in Calgary, Canada. A Journal of Feminist Geography [Internet]. 2013 Jun [cited 2021 Jan]; 21(7): 834-53. Available from: https://www.tandfonline.com/doi/full/10.1080/0966369X.2013.810605?casa_token=DbyWVah3aMoAAAAA%3AB6JSChz5G0BPYnser487zcTLtYOkiHf5WFV12icP-TcsqTzth2yqdPesc9QpywrCgXY6J6rEp1kz1g
Winetrobe H, Wenzel S, Rhoades H, Henwood B, Rice E, Harris T. Differences in Health and Social Support between Homeless Men and Women Entering Permanent Supportive Housing. Womens Health Issues [Internet]. 2017 Jan [cited 2021 Jan]; 27(3):286-93. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435523/
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