Journal of Urban Health

, Volume 90, Issue 4, pp 699–716 | Cite as

Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

  • Libby ToppEmail author
  • Jenny Iversen
  • Eileen Baldry
  • Lisa Maher
  • on behalf of the Collaboration of Australian NSPs


High rates of substance dependence are consistently documented among homeless people, and are associated with a broad range of negative outcomes among this population. Investigations of homelessness among drug users are less readily available. This study examined the prevalence and correlates of housing instability among clients of needle syringe programs (NSPs) via the Australian NSP Survey, annual cross-sectional seroprevalence studies among NSP attendees. Following self-completion of a brief, anonymous survey and provision of a capillary blood sample by 2,396 NSP clients, multivariate logistic regressions identified the variables independently associated with housing instability. Nineteen percent of ANSPS participants reported current unstable housing, with primary (‘sleeping rough’; 5 %), secondary (staying with friends/relatives or in specialist homelessness services; 8 %), and tertiary (residential arrangements involving neither secure lease nor private facilities; 6 %) homelessness all evident. Extensive histories of housing instability were apparent among the sample: 66 % reported at least one period of sleeping rough, while 77 % had shifted between friends/relatives (73 %) and/or resided in crisis accommodation (52 %). Participants with a history of homelessness had cycled in and out of homelessness over an average of 10 years; and one third reported first being homeless before age 15. Compared to their stably housed counterparts, unstably housed participants were younger, more likely to be male, of Indigenous Australian descent, and to report previous incarceration; they also reported higher rates of key risk behaviors including public injecting and receptive sharing of injecting equipment. The high prevalence of both historical and current housing instability among this group, particularly when considered in the light of other research documenting the many adverse outcomes associated with this particular form of disadvantage, highlights the need for increased supply of secure, affordable public housing in locations removed from established drug markets and serviced by health, social, and welfare support agencies.


Homeless persons Intravenous substance abuse Needle exchange programs Sentinel surveillance Behavioral risk factor surveillance system 



The ANSPS is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. The Kirby Institute is affiliated with the Faculty of Medicine, University of New South Wales. Lisa Maher is supported by a National Health and Medical Research Council Senior Research Fellowship. The authors wish to acknowledge the fundamental contributions to the ANSPS of the late Dr. Margaret MacDonald; all ANSPS participants; participating NSP staff and site coordinators; past and present members of the National Advisory Group; and laboratory staff at St Vincent’s Centre for Applied Medical Research and the NSW State Reference Laboratory for HIV/AIDS at St Vincent’s Hospital.


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Copyright information

© The New York Academy of Medicine 2012

Authors and Affiliations

  • Libby Topp
    • 1
    Email author
  • Jenny Iversen
    • 1
  • Eileen Baldry
    • 2
  • Lisa Maher
    • 1
  • on behalf of the Collaboration of Australian NSPs
  1. 1.Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research)University of New South WalesNew South WalesAustralia
  2. 2.School of Social Sciences and International Studies, Faculty of Arts and Social SciencesUniversity of New South WalesNew South WalesAustralia

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