People who live on the street (habitantes de calle): health risks and how to reach them
- Safe practice
People who live on the street get sick more and reach care late; the nurse goes to them, builds trust and links them to services step by step.
What it is
Ley 1641 de 2013 defines a person living on the street (habitante de la calle) as someone who makes the street their place to live, permanently or for a time, and sets the guidelines of a public social policy whose first component is comprehensive health care; Decreto 1285 de 2022 adopted the policy for 2022–2031. MinSalud's 2021 health guideline describes their most documented problems (HIV, TB, sexually transmitted infections, mental disorders and substance use, plus skin, gastrointestinal and oral problems, malnutrition and viral hepatitis) and the barriers: missing identity documents, low affiliation, fear of being judged or arrested, distance of services and stigmatising attitudes of staff. The nurse reaches them with outreach, low-threshold services and patient, respectful follow-up.
What it requires
- MinSalud's guideline reports that about 70% of people living on the street identified in five cities were affiliated to the health system in 2016, against 94.66% of the general population in 2018.
- Many women living on the street suffer sexual violence, which adds to their risk of infection.
- CDC notes that crowded, poorly ventilated shelters favour TB spread and that moving between shelters disrupts treatment.
- Open RN describes three ways homelessness harms health: problems caused by it, problems that cause it and problems hard to treat because of it.
Components
- Outreach: the team goes to streets, shelters and soup kitchens.
- Low threshold: walk-in care, flexible hours, no long paperwork.
- Integrated care: mental health, substance use and primary care in the same place.
- Basic needs: food, hygiene, clothing and transport linked to health care.
- Affiliation and identity: the census list and help to obtain documents.
How it is applied (and why)
- Introduce yourself, explain what you offer and ask permission — trust comes before any procedure.
- Start with what the person asks for (a wound, pain, food) — meeting the felt need opens the door.
- Look for cough lasting weeks, fever, weight loss and skin lesions — TB and infections are frequent.
- Offer rapid tests and sputum samples where the outreach programme provides them — diagnosis on the street avoids losses.
- Use brief interventions and harm-reduction strategies for substance use — abstinence is not a condition for care.
- Ask about violence, especially for women and LGBTI people — on the street violence becomes normal.
- Help with identity documents and affiliation through the census list — without them access stays limited.
- Agree where and when you will see the person again and record it — continuity depends on keeping the date.
In nursing practice
- Moving between shelters can interrupt TB treatment; coordinate with the TB programme so the person can continue and finish it (CDC).
- After a hospital stay there is often no home for recovery, which leads to readmissions; plan discharge with social services.
- Hypothermia, injuries and malnutrition are common: check temperature, skin and weight at each contact.
- Staff stigma makes people avoid services; respectful language and a calm approach keep them in care.
Common mistakes
- Requiring a document or abstinence before giving care.
- Treating the person's hygiene or appearance as a reason to delay care.
- Discharging to the street without a plan with social services.
- Promising follow-up and not keeping the date, which breaks trust.
Test yourself
Think of the answer, then tap the question to see it.
Which law sets the guidelines for the public social policy for people living on the street in Colombia?
Ley 1641 de 2013; Decreto 1285 de 2022 adopted the policy for 2022–2031.
Which health problems are most documented among people living on the street, according to MinSalud?
HIV, tuberculosis, sexually transmitted infections, mental disorders and substance use disorders.
Why do shelters matter for tuberculosis control?
Crowding and poor ventilation favour spread, and moving between shelters interrupts treatment, so shelters need screening and work with the TB programme.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Ley 1641 de 2013 (política pública social para habitantes de la calle) (Secretaría General del Senado de la República, Colombia, 2013); Lineamiento para la atención integral en salud de la población en situación de calle (Ministerio de Salud y Protección Social, Colombia, 2021); Nursing: Mental Health and Community Concepts, 17.2 Vulnerable Populations (homeless people) (Open RN (Ernstmeyer & Christman, eds.), Chippewa Valley Technical College; LibreTexts, 2022); TB risk and people experiencing homelessness (Centers for Disease Control and Prevention, 2024).
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Representative model, for educational purposes only.