Can Homeless Teens Learn to Better Protect Themselves From HIV?

A young man standing outdoors.

Reducing High Risk Behaviors Among Street Living Youth: Outcomes of an Integrated Prevention Intervention.” Jasmin Carmona, Natasha Slesnick, Xiamei Guo and Amber Letcher. Children and Youth Services Review, Volume 43 (August 2014).

What it’s about: The authors of this study used a mixture of substance abuse counseling, HIV prevention and emotional therapies to see if a mixed approach to prevention changed homeless young people’s behaviors that put them at risk for HIV. The researchers recruited 270 young people, ages 14 to 20, from shelters in central Ohio, and then randomly assigned them to one of three therapies: community reinforcement approach, motivational enhancement, or case management. The researchers examined whether positive changes came about when they combined these therapies with substance abuse counseling and HIV prevention.

The researchers monitored youth at 3, 6, and 12 months after therapy to see if their behaviors had improved—for example, whether they used condoms more often, had sex with fewer partners, or used drugs less frequently.

Why read it: Homeless youth contract HIV at far higher rates than their non-homeless peers—between two and ten times as often, according to previous studies. Past clinical efforts to reduce high-risk behaviors associated with HIV, such as risky sex and drug use, among homeless youth have been unsuccessful, the authors say. This study looks at an integrative approach as a possible way to reduce homeless young people's risk of getting HIV.

Biggest takeaways from the research: The interventions in this study led to improvement in the short term. At the 6-month mark, most participants reported using condoms more frequently, having improved knowledge about sexual health, and using fewer drugs. But those trends did not hold for the full year. Youth’s overall “HIV risk index” (the chances of the participants’ behavior leading to infection) did not change overall.

The research team hypothesizes that ongoing counseling or “check-ins” could potentially uphold the 6-month gains that their participants showed. But the difficulty of reducing homeless young people’s risk of getting HIV leads the authors to conclude that homelessness itself is the most obstinate risk factor in the equation.

“Evidence shows that among adults, even those receiving risk reduction services, lack of stable housing is a barrier to reducing risky behaviors,” they write, “while improved housing status is associated with a reduction in risk behaviors.” They recommend that future studies measure the impact housing has on young people's HIV risk.

Additional references: Look for more articles on homeless youth and HIV prevention in our research library.

We previously highlighted resources for young HIV-positive women who are pregnant. The director of Metro Teen AIDS in Washington, D.C., also shared some recommendations for helping young people get tested and stay healthy. Past studies have also found a correlation between HIV and intimate-partner violence.

 Publications discussed here do not necessarily reflect the views of the National Clearinghouse on Families & Youth, the Family & Youth Services Bureau or the Administration for Children & Families.

9-5 pm Eastern