Long-term and chronic homelessness in homeless women and women with children

The Chronic Homelessness initiative has directed millions of federal dollars to services for single "unaccompanied homeless" individuals, specifically excluding women living with their children. Using a data set with a nationally representative sample of homeless adults, we calculated the prevalence rates and profiles of long-term homelessness in homeless women (n = 849). With the exception of the criterion of being a single "unaccompanied individual," many women, including women with children, met the criteria for chronic homelessness including having a disability of mental health or substance abuse problems. Our findings suggest that the federal definition of chronic homelessness needs to be revised.

Diversity of contexts in drug use among street adolescents

In this study we aimed to investigate through ethnographic methods the different contexts of drug use by street adolescents in Sao Paulo, Brazil. Participant observations and semistructured interviews were performed at 11 major points of adolescent concentration in the streets of the city and in 10 care institutions. The sample was composed of 17 adolescents between 12 and 17 years of age. Data showed diverse patterns of drug use distributed by geographic situation and street circumstances. Observations were grouped into three main contexts: (a) immersion: greater intensity of drug use associated with greater involvement in the street culture; (b) surface: less drug use associated with family closeness; and (c) alternative-migratory: greater involvement with drug trafficking and prostitution associated with less family closeness and street culture. The drug use patterns varied in accordance with the diversity of street situations. Therefore, the peculiarities of each context should be taken into consideration in the development of social/ health policies.

CDC HIV testing guidelines and the rapid and conventional testing practices of homeless youth

The study's aims were to describe rapid and conventional HIV testing practices and referrals/linkages to services posttest among homeless youth in New York City. We also examined variation among service-involved youth, street youth, and "nomads." Respondent-driven sampling was used to recruit 217 homeless youth who participated in structured interviews. Almost all youth were tested in the past year (82%). Most received pretest/posttest counseling (> 77%). Rapid testing was common and conducted in diverse settings. However, youth reported that rates of referral/linkage to services posttest were low (< 44.4%). Service-involved youth were significantly more likely to receive rapid testing, be tested in the past year, and be tested at a high frequency. Street youth and nomads, those at highest risk for poor health outcomes, had less access to testing and may require creative, low-threshold services. Further, a better understanding of barriers to the use of referrals/linkages to services posttest is needed.

Health-seeking challenges among homeless youth

BACKGROUND

Approximately 1.5 to 2 million homeless young persons live on the streets in the United States. With the current economic situation, research is needed on quality of services geared toward homeless young adults.

OBJECTIVES

The objective of this study was to explore homeless young adults' perspectives on barriers and facilitators of health-care-seeking behavior and their perspectives on improving existing programs for homeless persons.

METHODS

This article is a descriptive qualitative study using focus groups, with a purposeful sample of 24 homeless drug-using young adults.

RESULTS

Identified themes were failing access to care based on perceived structural barriers (limited clinic sites, limited hours of operation, priority health conditions, and long wait times) and social barriers (perception of discrimination by uncaring professionals, law enforcement, and society in general).

DISCUSSION

Results provide insight into programmatic and agency resources that facilitate health-seeking behaviors among homeless young adults and include implications for more research with providers of homeless health and social services.

Runaways at risk

The needs of young runaways remain largely hidden from health and social care professionals. Yet up to 10,000 will be away from home for more than four weeks.

The challenge of understanding mortality changes among street youth

According to a cohort study conducted in Montréal, Québec from 1995 to 2000, the mortality rate among street youth was 921/100,000 person-years. Several new community initiatives aiming to increase access to housing and to social and health services for the homeless were implemented in the city between 2000 and 2003. This study aims to update the mortality rate estimate for the period 2001-2006 and to examine factors that could explain a difference between rates, if any. A second cohort study was conducted between 2001 and 2006. The Cohort 2 mortality rate was computed and compared with the Cohort 1 rate. Several analyses were then carried out: (1) mortality rates in the general population were compared with street youth rates using standardized mortality ratios (SMR); (2) Cohorts 1 and 2 distributions of risk factors for mortality were examined, and their effects were assessed using multivariate proportional hazards regression analyses carried out on a combined Cohorts 1 and 2 dataset. Mortality rate among street youth decreased by 79% while it declined by only 19% in the general population; the SMR for Cohort 1 was higher than for Cohort 2 (11.6 versus 3.0). Multivariate proportional hazards regression analyses yielded estimates that were close to the model's estimates based on Cohort 1 data only, and participation in Cohort 1 was an independent predictor of mortality, with an adjusted hazard ratio of 9.0. The mortality decline cannot be completely explained by a similar decrease among the general population or by a difference in distribution of risk factors for mortality between the two cohorts. Field workers suggested that the decrease in heroin consumption they had observed in the streets might have contributed to the mortality decline. We then performed additional analyses which showed that even though the proportion of street youth currently using heroin decreased significantly between 1995 and 2005, the association between heroin use and mortality was not significant (adjusted hazard ratio of 0.9; 95% CI, 0.4 to 2.3). It seems that various factors could have contributed to the decline in mortality rates among street youth, one plausible factor being the implementation of new services for the homeless. This study underscores the importance of monitoring risky behaviors among vulnerable populations to ensure that morbidity and mortality data among these populations is correctly interpreted. Setting up a system to monitor the drug market could improve the quality of information collected.

Sexual risk behaviour of street youths in south west Nigeria

OBJECTIVES

Previous studies have mainly focused on sexual behaviour of in-school Nigerian youths with little attention to those on the street. This survey was conducted to determine the sexual risk behaviours of young people on the streets of Ibadan, Nigeria.

METHODOLOGY

A cross sectional survey was conducted among youths aged 15-24 years in the major markets, motor parks and commercial areas in two local government areas in Ibadan. Participants in the study areas were identified in groups based on their occupational activity and all consenting young people were interviewed. A semi-structured questionnaire was used to obtain information on sexual behaviours, condom use and history of sexually transmitted infections. Data was managed using SPSS version 11.

RESULTS

Most (68.8%) were males, 79.0%, were sexually experienced, the median age at sexual debut for males was 15 years and 16 years for females. More females (53.9%) compared to (34.5%) males reported that their first partners were five or more years older, p < 0.01. Condom use during the first sexual intercourse was reported by only 32.2%. Sex with a commercial sex worker or exchange of sex for money was reported by 18.2% (20.6% of males versus 12.2% of females, p = 0.01). Factors significantly associated with history of transactional sex were; male gender; older age (20-24 years); being out of school and regular alcohol use. Multiple sexual partnering was reported by 58.2%, the significant predictors were male gender; early age at sexual debut; regular alcohol use and history of transactional sex. Inconsistent condom use was reported by 44.8%, the predictors were female gender; regular alcohol use and history of transactional sex in the previous year.

CONCLUSION

Majority of these young people on the streets are sexually active and many engage in high risk sexual behaviours. Development of appropriate sexual and reproductive health interventions is recommended.

Exploring family environment characteristics and multiple abuse experiences among homeless youth

This qualitative study used data from the Social Enterprise Intervention (SEI) pilot study, a comprehensive vocational training program with integrated clinical services for homeless youth. In-depth interviews were conducted with 28 homeless youth participating in the SEI study to explore their perceptions of family environment characteristics and abuse experiences. The constant comparative method was used to analyze transcripts from in-depth interviews with the youth participants. Emergent themes related to family characteristics include home instability, abandonment, and caregiver substance abuse. Abuse-related subthemes include intrafamilial abuse, caregiver abuse, rejection, and deprecation by caregivers. Grounded theory is used to interpret findings and develop working hypotheses to guide future studies of multitype maltreatment among homeless youth.

Using the 'protective environment' framework to analyse children's protection needs in Darfur

A major humanitarian concern during the continuing crisis in Darfur, Sudan, has been the protection of children, although there has been little in the way of comprehensive analysis to guide intervention. Founded on a situational analysis conducted between October 2005 and March 2006, this paper documents the significant threats to children's well-being directly linked to the political conflict. It demonstrates the role of non-conflict factors in exacerbating these dangers and in promoting additional protection violations, and it uses the 'protective environment' framework (UNICEF Sudan, 2006a) to identify systematic features of the current environment that put children at risk. This framework is shown to provide a coherent basis for assessment and planning, prompting broad, multidisciplinary analysis, concentrating on preventive and protective action, and fostering a systemic approach (rather than placing an undue focus on the discrete needs of 'vulnerable groups'). Constraints on its present utility in emergency settings are also noted.

Physically violent mothers are a reason for young people's leaving home

In a qualitative study, 302 homeless young people (aged 12 to 20 years) were asked to discuss their reasons for leaving home. Some 103 youth cited physical violence by a parent or stepparent, and of these, 39 cited their mother's or stepmother's violence as the reason for leaving home. Females were more likely than males to report being the target of violence by their mother; however, the converse was true for stepmothers. Several discrete reasons for maternal violence were identified, including maternal personal characteristics and behaviors, issues associated with blended families, or young people's own behavior. In some cases, young people reported violence by both parents. Their attributions of maternal violence centered on a single dimension of the mother/stepmother or her relationship with a partner. They rarely discussed the contribution that they had made to the conflict or acknowledged the social context that may have been a catalyst for violence.

[Street children in Bukavu, Democratic Republic of the Congo: causes for leaving home]

The purpose of this report is to describe the results of a survey conducted in 2004 among a cohort of 310 street children in Bukavu DR Congo to determine sociodemographic features and the reasons that led them to leave the homes of their parents. The causes were school dropout due either to the inability of the parents to pay or refusal to study, death or separation of parents, family dispute, feelings of injustice or discrimination within the family, and a desire for freedom. Street life depersonalizes children, subjects them to the law of the strongest, and exposes them to drugs and prostitution.

A support intervention to promote health and coping among homeless youths

Homeless youths are often vulnerable to limited support resources and loneliness. Peers are a potent source of social support. A support intervention for homeless youths was designed to optimize peer influence and was pilot tested. The intervention was based on an initial assessment of support needs and intervention preferences from the perspective of 36 homeless youths and 27 service providers. Based on the results, a 20-week pilot intervention program was designed, consisting of 4 support groups, optional one-on-one support, group recreational activities, and meals. Support was provided by professional and peer mentors, including formerly homeless youths. A total of 56 homeless youths aged 16 to 24 took part. Participants completed pre-, mid-, and post-test quantitative measures and qualitative interviews. In spite of challenges due primarily to attrition, the youths reported enhanced health behaviours, improved mental well-being, decreased loneliness, expanded social network, increased coping skills, enhanced self-efficacy, and diminished use of drugs and alcohol. Further research could focus on replication at other sites with a larger sample.

[Taking charge of street children in the Democratic Republic of the Congo: an ethical alternative]

The goal of this study carried out on street children and care providers was to determine the opinions of the staff of these institutions--foster homes--and their degree of satisfaction. Out of twenty homes of the zone or healthcare district of Kasavubu in the city of Kinshasa in the Democratic Republic of the Congo (DRC), ten were chosen at random (50%). In them, we selected one hundred street children--the beneficiaries--, ten care providers and ten protocol programs--of guardianship. The players--beneficiaries and providers--answered questions on their perceptions and expectations regarding to following: the range of activities provided, its organization, its quality and their degree of satisfaction of the site and on the development of skills. The results obtained demonstrated the predominance on useful activities ("welfarism") and on charity. The respondents declared they sometimes commit antisocial actions (theft) to access education, which is similar to a form of obtaining independence. The protocols for guardianship are often the conceived by experts. However, in a general way for young respondents, it is relatively difficult for experts alone (assistants and social educators or others) to provide precise and exhaustive data on the needs felt by street children. In view of these results, it is thus ethically acceptable to resort to the ability-based approach in the conception, the setting up and the evaluation of guardianship protocols for street children. What the youth think, the range of activities provided, the conception and the quality of the guardianship protocols is an important stake in the development of the skills. It is highly probable that the emergence of such protocols cannot be undertaken except if street children have a degree of independence in relation to experts and can assert a specific point of view.

High rates of homelessness among a cohort of street-involved youth

Using multivariate logistic regression, we examined the prevalence and correlates of homelessness among youth enrolled in a community-recruited prospective cohort known as the At-Risk Youth Study (ARYS), between September 2005 and October 2006. Of 478 individuals included in this analysis, 132 (27.6%) were female and 120 (25.1%) self-identified as Aboriginal. The median age was 22 (IQR: 20-24). In total, 284 (56.9%) participants reported baseline homelessness, with most living either at no fixed address, on the street, or in a hostel or shelter. Factors associated with homelessness included public injecting, frequent crack use, experienced violence, having less than a high-school education, and not having been in any addiction treatment. Homeless individuals were at-risk for various adverse health outcomes. These findings indicate the need for additional interventions, including residential addiction treatment, to address homelessness and drug use among youth.

Mental health and substance abuse indicators among homeless youth in Denver, Colorado

We report the results of mental health evaluations from 182 homeless youth residing in a Denver, Colorado, shelter. The literature on homeless youth, although developing, is still somewhat limited as it relates to mental health, substance abuse, and trauma. This study was motivated by clinically observed high rates of mental illness, trauma, dangerousness issues, and drug and alcohol abuse. Using archival data from mental health evaluations conducted over two years, variables including gender, age, ethnicity, primary diagnosis, drug of choice, trauma history, suicidal ideation, homicidal ideation, and legal history were assessed. Results discovered significantly higher than expected diagnoses of mental illness and associations between drug of choice and diagnosis, trauma history and suicidal ideation, and trauma history and diagnosis. Results suggest a strong need for co-occurring treatment, trauma-focused therapy, and attention to both mental illness and substance abuse in homeless youth.

Homelessness and the transition from foster care to adulthood

Prior research suggests that homelessness is a significant problem among young people aging out of foster care. However, these studies have not attempted to identify potential risk or protective factors that might affect the likelihood of becoming homeless during the transition to adulthood. This paper uses data from a longitudinal study to examine both the occurrence and predictors of homelessness among a sample of young people from three Midwestern states who recently aged out of foster care.

Building intervention responses for sexually exploited, runaway youth

The health and safety of runaway, sexually exploited youth is a national concern and challenge. This article describes how nursing administrators can support outreach to vulnerable and difficult to serve populations, develop collaborations with community agencies, and promote the delivery of healthcare.

Knowledge of HIV, sexual behavior and correlates of risky sex among street children in Kinshasa, Democratic Republic of Congo

CONTEXT

Homeless children are at risk of getting many diseases, including sexually transmitted infections (STI). The number of street children is on the rise in the Democratic Republic of Congo (DRC), while very little is known about their health problems.

OBJECTIVES

To determine knowledge of HIV (transmission and prevention means), sexual activity, exposure to HIV-prevention services, and to identify correlates of risky sexual behaviour (not having used a condom at first or last sexual encounter and/or having multiple sexual partners over a 12-month period) among street children in Kinshasa.

RESULTS

At the time of the survey, most participants (85.8%, 95% CI = 83.5-88.1) were sexually experienced and 55.8% had their first sexual intercourse when they were already living on the streets. The median age at first sexual activity was 14.3 years for males and 13.5 years for females. Compared to males (median number of sexual partners = 1), females tended to be more involved with multiple sexual partners (median = 12). Condoms were used less at the fist sexual encounter (20.2%; 95% CI = 17.3-23.1) and the pattern of condom use depended on the type of sexual partners (61.1% at last sexual encounter with a paid/paying partner and 23.1% at last sexual encounter with a non-paid/non-paying partner). In males, sleeping in a NGO-provided night shelter (OR = 0.47; 95% CI = 0.27-0.79), and having had the first sexual intercourse while living on the streets (OR = 0.55; 95% CI = 0.35-0.88) were protective of risky sexual behaviour, while a history of drug use (OR = 3.00; 95% CI = 1.46-6.18), and being aged 20 to 24 years (OR = 1.59; 95% 1.00-2.55) increased the likelihood of displaying risky sexual behaviour. In females, not knowing where to get a condom (OR = 0.04; 95% CI = 0.005-0.29), having started sexual activity when living on the streets (OR = 0.10; 95% CI = 0.01-0.73) and not having an income-generating activity (OR = 0.09; 95% CI = 0.01-0.44) were protective of risky sexual behaviour.

CONCLUSION

Street children need to be regarded as a high-risk group for acquiring HIV. The potential benefit of providing homeless youth with night-shelters should be explored more since this could be an opportunity to integrate risk-reduction programmes that take into account all problematic behaviors such as risky sexual behaviour and drug use.

The contextual determinants of sexually transmissible infections among street-involved youth in North America

Young people living on the urban street are at a significantly increased risk of HIV and other sexually transmitted infections (STIs). Much research examining the epidemiological basis for their heightened susceptibility has concentrated on the individual behaviours and characteristics associated with acquiring these infections. However, contextual factors, including the social, structural and environmental forces that influence sexual risk behaviour, are increasingly found to play an important role in shaping the transmission dynamics of HIV and STIs within these marginalised populations. This paper reviews research describing the individual and contextual factors that have been shown to influence street youth sexual behaviour and provides an analysis of the potential impact of such factors on HIV and STI transmission. In order to implement effective sexual health programmes for street-involved young people, innovative programmes are required that take into account the unique social and structural context of youth homelessness. Interventions to reduce the elevated prevalence and incidence of HIV and STIs among this population must explicitly target multi-level factors influencing the transmission dynamics of these diseases.

Health educators' perceptions of a sexual health intervention for homeless adolescents

OBJECTIVE

The purpose of this qualitative descriptive study was to explore the perceptions and experiences of health educators in providing a brief, street-based intervention to homeless adolescents.

METHOD

Qualitative data were collected via e-mail from a purposive sample of 13 male and female health educators who provided the intervention and analyzed using manifest and latent content analysis techniques.

RESULTS

Five categories with two or more subcategories were identified in the data and included how the educators' views changed, how they felt homeless youth were similar to and different from other adolescents, positive aspects and challenges of providing the intervention, and suggestions for future interventionists working with this population.

CONCLUSIONS

The health educators' practice was strengthened over the course of providing the intervention through their positive experiences, changes in their perceptions, some of which were biased, and ability to confront the challenges that accompany working with this vulnerable population.

PRACTICE IMPLICATIONS

Health educators who work with this population should learn about the culture of homeless youth and characteristics of homeless youth that may influence their participation in a sexual health intervention. Moreover, they need to be non-judgmental, practice the intervention, be aware of their biases, and remain flexible.

Risk behaviours for HIV/AIDS infection among men who have sex with men in Cairo, Egypt

A sample of 73 men who have sex with men (MSM) in Cairo, Egypt, were screened for HIV infection and were interviewed to study their risk behaviours for HIV/AIDS. Most (65.8%) had initiated sexual activity before 15 years; 65.8% took both active and passive roles in sexual acts. The frequency of sexual acts was < 1 per week for 73.3% of those aged 25+ years, but > 1 daily for 25.9% of those aged < 25 years. Heterosexual relations were reported by 73.3% of the older age group, while 70.7% of the younger age group were exclusively MSM. Condoms were always used by only 19.2% of the sample.