Healthcare seeking behaviours of homeless substance users residing in the Gauteng Province of South Africa during COVID-19 lockdowns.

Abstract

Homelessness continues an upward trajectory of being a global social security problem affecting both developed and developing countries. The World Population review estimates that Nigeria has the highest numbers of homeless people in the world in 2023, followed by Pakistan, Egypt, Syria, among others, whereas the Human Sciences Research Council estimates that between 100,000 and 200,000 people live on the streets of South Africa. Gauteng province alone accounts for 25 000 with Johannesburg having 15, 000 while Tshwane has 10,000. Studies have shown that homeless people have a high level of morbidity and mortality with an average life expectancy of 45 - 47 years old among men living more than ten years on the street. Evidence suggest that homeless people are often denied access to even the most basic assistance including healthcare, which could have been worse during COVID-19 pandemic. This study assessed the homeless substance users’ healthcare seeking behaviors during the Covid-19 lockdowns in Gauteng, South Africa. A qualitative approach using an exploratory design, assessed referrals based on suffering from symptoms of Covid-19 during the lockdown period between 2020 and 2022. Data was collected from 25 homeless substance users in the City of Tshwane in Gauteng, through unstructured interviews. After transcribing intelligent verbatim and translating recordings, the principal researcher did thematic data analysis without computer software data analysis programmes. Three themes based on the study objectives included, types of healthcare services used, the determinants of the health seeking behaviours adopted by homeless substance users, and challenges experienced while seeking healthcare. Of the twenty-five participants, ranging from twenty-one to fifty years old, thirteen suffered from Covid-19 symptoms. Five used formal healthcare systems and eight informal healthcare systems. Older participants accessed healthcare services, while less of the younger population used them. Challenges faced entailed marginalization, stigmatization and lack of social support. Since this study was delimited to Gauteng province, findings cannot be generalised nationally. The study can also be carried out in other provinces with high number of substance users such as the Western Cape. The Department of Social Development should include capable substance users in training healthcare programmes aimed at persuading this key population group to use formal health care.