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Abstract
This commentary explores the relationships between homelessness, drug use and hepatitis
C infection, within the broader context of social exclusion. Although it is difficult
to estimate the number of homeless people who are misusing drugs or the number of
drug users who are homeless, UK and international literature indicate a significant
overlap between the two groups. Homeless drug users (HDUs) tend to experience many
life problems and their situation has been described as a double jeopardy [Neale,
J. (2001). Homelessness amongst drug users: A double jeopardy explored. The International
Journal of Drug Policy, 12, 353-369]. Compounding this, emerging data now show that
HDUs are at increased risk of being infected with the hepatitis C virus (HCV). The
concept of social exclusion is critically reviewed as a means of understanding the
experiences and needs of HDUs infected with HCV and, in light of this, policy and
practice are discussed. It is argued that efforts to tackle broader social problems
are indirectly assisting this vulnerable group, but more joined-up strategies and
targeted measures are still required. These include tackling negative community and
professional attitudes and discriminatory practices; more integrated service provision
and professional training; and drawing HDUs with HCV into policy and practice debates
as advisors, educators and collaborators. To conclude, suggestions for future research
that would help to clarify some of the complexity surrounding the behaviours, experiences
and service needs of HDUs with HCV are made.