The U.S. state of California is experiencing the largest person-to-person outbreak of hepatitis A in the United States since a vaccine to prevent the liver disease became available in 1996.
More than 600 cases have been reported in the state and 21 people have died. According to the California Department of Public Health, most of those infected are homeless or use drugs in places where sanitation has been a challenge.
“There should be more hand-washing and bathrooms,” said a man who has been homeless for more than four years. Identifying himself only as J-el, he lives on Skid Row, an area in downtown Los Angeles known for its homeless population.
WATCH: California Experiences Hepatitis A Outbreak
Far below UN standard
A recent study conducted by Skid Row advocates, organizations and residents found that the area fell short of U.N. refugee camp standards calling for one public toilet for every 20 people.
According to the report, during daytime hours, with a street population of more than 3,600 people, Skid Row is as many as 164 toilets short of the U.N. standard. At night, the Skid Row population drops to about 1,700 people who live on the streets. The city of Los Angeles said there are only six public toilets in the downtown area that are open 24 hours a day.
Critics said illicit activities can occur, which is a reason why some public bathrooms are not open at night.
“They (the city) don’t want to let you use the toilet so it’s a problem here, and it’s somewhat of a problem with us (homeless people) as people (be)cause we mess up the toilet some of us, mess up the toilet, and then … but at the same time, the people who don’t, they get penalized and can’t use it. They got to end up using it out here some place,” said J-el referring to the side of the street as a place where many people who are homeless use as bathrooms.
Unsanitary conditions can become a breeding ground for the hepatitis A virus, said Jeff Klausner, professor of medicine and public health at the University of California, Los Angeles.
“Right now the outbreaks in San Diego and Los Angeles of hepatitis A is being spread by poor sanitation, person-to-person spread, and contaminated, unclean feces or inability for people to wash their hands,” Klausner said.
Enter Lava Mae
One solution is a portable shower provided by the organization Lava Mae.
“We realize from the beginning that there are a lack of hygiene facilities for people living on the streets. It was the driving idea behind what we do and providing showers, providing a place where you can come and get clean and (get) 15 minutes of privacy,” said Paul Asplund, interim regional director of Lava Mae Los Angeles.
Lava Mae’s trailers, which include showers and toilets, are driven around areas with high homeless populations in Los Angeles and San Francisco five to six days a week.
“It always feels good to get a shower,” J-el said.
Others at risk
The homeless population however, is not the only group at risk. Gay men are also contracting hepatitis A, with major outbreaks this year in the United States, Europe, Chile and Australia.
Yet California statistics indicate the homeless population or drug users who have hepatitis A are the most likely to be hospitalized. With compromised immune systems, their condition is aggravated by the inability to wash regularly.
“Hygiene is a right. It’s something every human being deserves,” Asplund said.
On Skid Row, the city of Los Angeles will soon open a hygiene center with eight toilets and six showers. The restrooms will eventually be open 24 hours a day with social services and security.
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