Prevalence of hav ab, hev (igg), hsv2 igg, and syphilis among sheltered homeless adults in tehran, 2012.

Elahe Malek makan,1,* Reyhameh khosravi zadeh haghighi,2 Seyed mohamad sadegh hashemi nobandegani,3



Homeless includes people who have no place to sleep and sleep in public or private shelters. they are including mental health disorders, alcoholics1 and in iran, mostly injecting drug users, and immigrants.2 the life expectancy of homeless people is much shorter than the general population, and rates of infectious diseases are higher among them.3 high risks of infectious diseases among homeless people are related to their living condition, poor sanitation and living within the group that makes them susceptible to many communicable diseases, outbreaks of hiv, tuberculosis, and viral hepatitis have been reported among them in many countries.1,3,4 homeless people are also at higher risk than the general population for viral hepatitis and syphilis due to social and behavioral factors that influence the occurrence of these diseases.5-7 homeless people are at high risk for viral hepatitis (a, b, and c) because their lifestyles might include injection drug use (idu) and poor hygiene, but data on hepatitis e virus (hev) and hepatitis a virus (hav) prevalence among them are limited.7-9 syphilis and herpes simplex virus type 2 (hsv2) are common sexually transmitted infections (stds).10,11 treponema pallidum infects at least 12 million persons annually. hsv2 seropositive persons have a lifelong risk of infecting their sexual partners.12 genital ulcer disease due to both syphilis and hsv2 is associated with an increased risk of obtaining hiv.11 findings of a previous study among homeless people of this study showed a high prevalence of hiv among them.7 there is no precise estimate on the number of homeless people and the rate of their risky behaviors in iran. due to a lack of updated information on infectious diseases, and the absence of a study on the situation of infectious diseases among homeless people in iran, the aim of this study was to investigate the prevalence of hav, hev, hsv2 and syphilis among sheltered adult homeless people in tehran and to evaluate the high-risk behaviors associated with these infections among them.


In this cross-sectional study, 596 homeless were recruited in tehran. a researcher-designed questionnaire was used to study demographic data. using enzyme-linked immunoassay, and rapid plasma reagin (rpr) test, we evaluated the seroprevalence of hav anti-body, hev igg, herpes, hsv2 igg, and syphilis among sheltered homeless in tehran. the associations between the participant’s characteristics and infections were evaluated using logistic regression and chi-square.


a total of 569 homeless, 78 women (13.7%) and 491 men (86.3%) were enrolled into the study from june to august 2012. their age mean was 42 years and meantime of being homeless was 24 months. seroprevalence of syphilis, hev igg, hsv2 igg and hav ab was 0.55%, 24.37%, 16.48%, and 94.34%, respectively. history of drug abuse was reported in 77.70%; 46.01% of them were using a drug during the study and 26.87% of them had history of intravenous drug abuse. among people who had intravenous drug abuse, 48.25% had history of syringe sharing.


the prevalence of hav, hev and hsv2 were higher than the general population while low prevalence of syphilis was seen among homeless peoples who are at high risk of sexually transmitted infection (std). our findings highlighted that significant healthcare needs of sheltered homeless people in tehran are unmet and much more attention needs to be paid for the health of homeless people.


Hepatitis a virus (hav), hepatitis e virus (hev), herpes simplex virus type 2 (hsv2), syphilis, home