Homelessness is not a problem exclusive to urban areas, but the poor living in cities are especially vulnerable to being left without shelter. Overcrowding, inadequate housing, unemployment, policies directed against the poor and working class, gentrification, and, in the United States, the de-institutionalization of mental hospitals in the 1970s have all been cited as factors contributing to urban home-lessness (Baer, Singer, & Susser, 1997; Glasser, 1994; Hopper, 1988). In particular, poor urban youth are at risk for homelessness. Facing sexual or physical abuse, inadequate family resources, or rejection because of sexual identity, some youth may choose to or be forced to leave home (Clatts, Davis, Sotheran, & Atillasoy, 1998; Glasser, 1994).

In developing countries, the number of homeless people in urban areas has grown exponentially in the last few decades: the result of forced rural to urban migration due to the increasing precariousness of subsistence farming (Baer et al., 1997), and to population increases in rural areas (McDade & Adair, 2001). Often homeless people in developing and industrialized countries occupy settlements or squatter settlements, which lack adequate sanitation, infrastructure, or basic health care systems (Baer et al., 1997; Rubenstein & Lane, 1990). Being homeless, or having inadequate shelter has been linked to heightened vulnerability to infectious disease, especially HIV and tuberculosis, alcoholism, malnutrition, and exposure to violence (Clatts & Davis, 1999; Farmer et al., 1996). Lacking shelter, food, resources, or all three, homeless people may resort to activities such as theft, robbery, selling illicit drugs, or sex trading for survival (Bourgois, 1995; Clatts et al., 1998; Clatts & Davis, 1999; Glasser, 1994; Schoepf, 1992; Waterston, 1993).

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