Research Roundup: What Makes Homeless Youth More Likely to Get STIs? More Likely to Get Tested?

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A young woman in a hoodie leaning against a wall.

Research has shown that many homeless youth trade sex for food or shelter, and many have experienced sexual abuse and abuse substances – all risk factors for contracting HIV and other sexually transmitted infections.

So researchers interested in promoting the health and well-being of homeless youth are asking what makes homeless young people more or less likely to get infected? And what makes them more or less likely to get tested for HIV and STIs?

Attitudes About Sex

Researchers Kimberly Tyler and Lisa Melander, from the University of Nebraska-Lincoln and Kansas State University, examined homeless youth's perceptions of their peers’ sexual behaviors and their views on safe sex practices. The two researchers combined qualitative and quantitative methods, interviewing 19 young people ages 13 to 24, and surveying 249 youth in shelters and on the streets from January 2008 to March 2009 in three Midwestern cities.

The researchers found that despite high rates of risky sexual behavior and substance use among the young people studied, most youth reported avoiding sexual contact with drug users and those they perceived to have a history of risky sexual behaviors. But those precautions did not necessarily translate to consistent condom use. Homeless youth were more likely to use condoms with partners who were not forthcoming about their sexual histories. Still, most of the young people used condoms inconsistently and reported no safe-sex norms in their peer groups.

“Peer-led initiatives through street outreach may be an effective way to alter social norms as pro-social peers have been found to reduce HIV risk behaviors,” Tyler and Melander say.

Influence of Friends and Acquaintances

Annie M. Valente and Colette L. Auerswald from Family Medicine Residency of Idaho and the University of California, Berkeley, were interested in how the differences in homeless girls’ and boys’ social networks – such as their friends’ gender and behaviors – might make them more or less likely to practice safe sex and avoid STIs. 

Their study of 258 homeless 15- to 24-year-olds from San Francisco street venues and transitional programs found that homeless young women used condoms less often and had higher rates of STIs than did young men. Young women also had more friends of the opposite sex and more unstably-housed contacts. In the study, youth with more friends of their own gender and more contact with people who live in a stable home were less likely to have an STI.

Valente and Auerswald write that “efforts to reconnect homeless young men and women with mainstream society and to support same-gender friendships may be effective tools in our efforts to improve their health by increasing their social capital.”

Getting Tested

Allison Ober and others from the RAND Corporation, a nonprofit think tank with headquarters in Santa Monica, CA, wanted to find out what makes homeless youth more or less likely to get tested for HIV and other STIs. Among a sample of 305 sexually active homeless 13- to 24-year-olds in Los Angeles, the researchers found that the youth most likely to have been tested in the past three months fell into several categories:

  • Youth who identified as gay
  • Latino young people
  • Injection drug users
  • Patrons of drop-in centers

Youth with more symptoms of depression than other youth were marginally more likely to have been tested.

The authors found that visiting a drop-in center often facilitated young people’s access to STI testing, especially for homeless youth using injection drugs. In other words, when testing is readily available to young people, they are very likely to take advantage of the service.

Read the Articles

Individual and Social Network Sexual Behavior Norms of Homeless Youth at High Risk for HIV Infection” (abstract). Children & Youth Services Review Vol. 34 No. 12, December 2012.

Gender Differences in Sexual Risk and Sexually Transmitted Infections Correlate With Gender Differences in Social Networks Among San Francisco Homeless Youth” (abstract). Journal of Adolescent Health Vol. 53 No. 4, October 2013.

 “If You Provide the Test, They Will Take it: Factors Associated With HIV/STI Testing In a Representative Sample of Homeless Youth in Los Angeles.” AIDS Education and Prevention Vol. 24 No. 4, August 2012.

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