WASH needs for the rural homeless

a stock photo of a volunteer passing out bottle waters to the homeless

In the US, 2.3 to 3.5 million people experience homelessness every year. While often considered an urban issue, it’s a problem that is growing in rural areas, where substance use can serve as a catalyst for homelessness. New research led by Rollins investigators and published in PLOS Water highlights the substantial barriers to accessing water, sanitation, and hygiene (WASH) services among people experiencing homelessness in rural areas.

To help combat this significant and growing issue, the authors call for developing place-based, stigma-free access to WASH facilities in rural areas, with specific focus placed on meeting the sanitary needs of women and people who inject drugs.

“Limited WASH access is not only concerning from an infectious disease transmission standpoint, but also from a dignity and human rights standpoint,” says April Ballard, an environmental health PhD student and lead author on the article. “WASH, when sufficient, provides us the space to care for ourselves and have dignity.”

The investigators conducted exploratory research on people experiencing homelessness in rural Appalachian Kentucky to better understand barriers to WASH resources and unique challenges facing this population, particularly in relation to substance use.

“The important link between WASH and substance use is rarely recognized, despite the fact that harm reduction approaches to injection drug use ask people to use clean water to mix or dilute drugs and clean their skin and hands prior to injecting,” says Ballard. “Our findings reveal nuances that researchers and practitioners should consider. For example, how can we ask people to perform these behaviors when they may not even have access to clean drinking water or a shower?”

The authors recommend that rural areas build onto the new public WASH infrastructure established during the COVID-19 pandemic and to provide public sanitation facilities equipped with showers, restrooms, and laundry access, as well as free hygiene and menstrual products. They also recommend that these services be spread throughout rural communities and for access to facilities to be made available unconditionally (i.e. no ID requirements or felony or drug background checks) alongside harm reduction services.—Kelly Jordan