It is estimated that as many as 21,000 people in the state of Hawai'i may be infected with HCV Most of those infected with viral
hepatitis are unaware they are infected. Complications from viral
hepatitis include
liver cirrhosis and
hepatocellular carcinoma. Hawai'i has the highest incidence of
hepatocellular carcinoma in the United States. In 2003 there were over 6000 homeless and over 155,000 people at-risk of becoming homeless living in the state of Hawai'i. Risk factors for
hepatitis, such as
drug use,
tattoos, sexual contact, and sharing of personal hygiene equipment are more prevalent in the homeless population. To determine the incidence of
hepatitis B and C among a population of homeless individuals, a health fair was held at a Honolulu area homeless shelter with approximately 200 residents. The incidence of
hepatitis B and C was determined by anti-HCV and
HBsAg blood tests. A survey was also conducted regarding risk factors and basic demographics. Fifty-nine homeless adults volunteered for testing and took the survey. Thirty-one (52%) volunteers were born in Micronesia, twenty-four (41%) were born in the United States, two (3%) were born in Samoa, one (2%) was born in the Philippines, and one (2%) was born in the Marshall Islands. Forty adults were tested for
Hepatitis C antibody, three of which tested positive. The primary risk factor among this group was jail time (100%), followed by
illegal drug injection (67%),
tattoos (67%), ear/
body piercing (67%), snorting drugs (33%),
blood transfusions (33%), and a sex partner with
hepatitis (33%). Forty adults were also tested for
HBsAg, One of which tested positive. This was a recent immigrant from Micronesia. Homeless people in Hawai'i are more likely to have
hepatitis B or C because risk factors are common among this population. Additionally a large proportion of Hawai'i's homeless people come from the Pacific Islands, where the prevalence of
hepatitis B is one of the highest in the world. In addition there are significant risks of
hepatitis spread among the homeless and into the general population as many homeless do not realize they are infected. The health fair approach was an effective means for screening homeless people for
hepatitis B and C. Our preliminary information suggests homeless shelters may be a good place for education, screening, and possibly interventions as well.