New study finds major disparities in water, bathroom access in San Diego-Tijuana region

SAN DIEGO (FOX 5/KUSI) — As San Diego contends with an affordable housing crisis, a new study from UC San Diego and San Diego State University highlights the implications of another shortage disproportionately impacting the region’s unhoused residents: public restrooms.

The study, which was published in the International Journal for Equity in Health last month, looked at water, sanitation and hygiene access in San Diego and Tijuana at the height of the pandemic — a time when access to these resources were critical to public health and safety.

They specifically zeroed in on whether people who use injectable drugs, as well as those who are unhoused, had reliable water and lavatories. They interviewed hundreds of people in Tijuana and San Diego between 2020 and 2021, when COVID-19 infections were at their peak.

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Unsurprisingly, researchers found that the vast majority of people interviewed did not have access to an acceptable toilet or hand washing station at the time. More than half of respondents also said they did not have a place where they could regularly shower.

Only 38 percent of participants reported regular access to a bathroom, either to relieve themselves or to wash their hands, while only about 46 percent said they had regular access to a shower.

“[Water, sanitation and hygiene] access among [people who inject drugs] in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries,” the report read.

Meanwhile, nearly all participants reported drinking less water than is medically recommended for proper hydration, although a smaller percentage — about 11 percent — said they had insufficient access to drinking water from 2020 to 2021.

“Even in Southern California — one of the wealthiest parts of the world — people who use drugs often go without access to water, showers and toilets,” said Alheli Calderón Villarreal, the study’s lead author. Villarreal conducted the research as part of her doctoral dissertation for the UCSD-SDSU Joint Doctoral Program in Public Health.

“The lack of these basic services also places people who use drugs at risk of serious, but preventable, illnesses, and poses risks to society at large,” she continued.

For those who use injectable drugs, this includes the development of injuries ranging from abscesses or vascular damage that, if it is not treated properly with safe water, could lead to possibly life-threatening infections.

Irregular access to public restrooms or clean water can also give way to outbreaks of infectious diseases like hepatitis A. Last year, San Diego County saw an uptick in hepatitis A cases in the unhoused population, killing two people and prompting a public health advisory.

Four consecutive grand jury reports, including one issued while the hepatitis A cases were spiking last year, have reached similar findings as the recent UCSD and SDSU study: The city of San Diego, in particular, does not have enough clean, public bathrooms.

It recommended the city develop plans to maintain its existing facilities, as well as create new ones for unhoused and housed residents to use.

In an October meeting, San Diego City Councilmembers acknowledged it was a big issue, but expressed belief that efforts to expand its portfolio of shelters would be a better use of city resources since the existing public restrooms are most often used by homeless residents.

According to the study, participants who use injectable drugs but had housing between 2020 and 2021 faced less difficulty attaining clean water sources.

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Unsheltered participants were three times more likely to report being unable to access clean water sources for cleansing wounds, and two times more likely to say they did not have clean water to prepare drugs for injection.

These respondents were also twice as likely to say they were unable to access basic drinking water, bathing opportunities and sanitation.

The researchers recommend leaders in both Tijuana and San Diego should continue working to reach the long-term goal of providing safe and secure places for people to live with access to safe water and sanitation.

They added that the two cities should look towards expanding mobile hygiene services and public restrooms in the meantime — whether that is extending hours of operation for existing facilities, creating more public restrooms or increasing the number of providers offering water, sanitation and hygiene opportunities.

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