Homeless youths' HIV risk behaviors with strangers: Investigating the importance of social networks

Homelessness Among Sexual Minority Youth

OBJECTIVES

This study examines the prevalence and types of homelessness experienced by sexual minority and heterosexual youth. Then, we examine whether state-level nondiscrimination policies and/or public attitudes on sexual diversity are associated with reduced homelessness among sexual minority youth. Finally, we investigate the differences in health risk behaviors at the intersections of sexual minority and homelessness status.

METHODS

We conducted a secondary data analysis using a large population-based sample from 21 states collected in the 2017 and 2019 Youth Risk Behavior Surveys. Self-reported data were obtained from sexual minority (n = 28 405) and heterosexual (n = 136 232) youth through a survey administered in high schools. We assessed the prevalence of homelessness and the types of homelessness. Sexual minority-stratified bivariate and multivariable analyses assessed associations between homelessness, state-level policy and cultural environments, and health-risk behaviors.

RESULTS

Sexual minority youth were significantly more likely (12%) to be homeless compared with heterosexual youth (4.1%). Greater acceptance of sexual diversity at the state-level was associated with reduced homelessness among both sexual minority and heterosexual youth. Finally, homeless sexual minority youth experienced a broad array of health risk behaviors in excess of both nonhomeless sexual minority youth and homeless heterosexual youth.

CONCLUSIONS

Sexual minority high school students were more likely to experience homelessness than their heterosexual peers. Public attitudes and greater acceptance of sexual diversity were associated with lower levels of sexual minority homelessness. More research and public health programs are needed to prevent and address homelessness among sexual minority youth.

Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent

The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.

Lesbian, gay and bisexual homelessness in Australia: Risk and resilience factors to consider in policy and practice

Lesbian, gay and bisexual (LGB) people are more likely than heterosexual people to experience homelessness. The study aimed to compare risk and resilience factors commonly associated with homelessness according to sexual identity to inform more LGB-inclusive and targeted policy and service provision in this area. The study involved analysis of data from two Australian surveys: the General Social Survey 2014 (n = 17,401) and the Journeys Home study (n = 1,659). Chi-squared analyses of the survey data compared LGB with heterosexual respondents. Bisexual respondents had a significantly earlier average age of first homelessness, and were more likely to have repeated episodes of homelessness than lesbian, gay or heterosexual respondents. Risk factors that were higher among bisexual people included family violence, conflict and rejection and substance use issues. LGB respondents were twice as likely to have experienced discrimination as heterosexual respondents, more likely to have experienced violence and have mental health problems. Conversely, resilience factors for LGB respondents included being more likely to access friends for support in times of crisis, and to be involved in civic or political groups. We suggest that LGB people at risk of homelessness need effective responses based on their risk and resilience factors, including targeted peer support and mainstream services that affirm and acknowledge their diverse sexual identities. Australian policies should encourage improved LGB data collection and specific service responses. Primary prevention approaches include educating families of origin about LGB identities and assertive outreach to prevent housing loss.

Sexual Health Communication Among Young Black Women and Their Social Network Members

OBJECTIVE

Young Black women (YBW) are at high risk of HIV infection. Although sexual health communication in social networks has been shown to help prevent HIV among high-risk populations, sexual health communication between YBW and their social network members (SNMs) has been insufficiently studied.

METHOD

Egocentric social-network-level and individual-level data were collected from 78 YBW ages 18-25 to examine their sexual health communication. Multilevel multivariable logistic regression models assessed the association among individual sexual risk behaviors, SNM characteristics, and sexual health communication.

RESULTS

Participants nominated an average of 14 SNMs (N = 1,068). Friends were most frequently nominated (55%). YBW communicated to 55% of their SNMs about sex, to 32% regarding condom use, and to 21% regarding HIV testing. If SNMs provided emotional support, YBW were 4 times more likely to talk with them about sex and HIV testing and 2 times more likely to talk about condom use.

CONCLUSIONS

These results indicate that before developing or adopting HIV interventions geared toward YBW, we need to assess how and with whom YBW are communicating about sexual health to better inform those interventions.

Factors Associated With HIV Testing Among Atlanta's Homeless Youth

Homeless youth experience increased risk of contracting HIV, making HIV testing imperative in this population. We analyzed factors associated with HIV testing among homeless youth in Atlanta, Georgia using data from the 2015 Atlanta Youth Count and Needs Assessment. The analysis included 693 homeless youth aged 14-25 years, of whom 88.4% reported ever being tested for HIV, and 74.6% reported being tested within the previous year. Prevalence of ever testing for HIV was significantly higher among youth who reported risk factors for HIV (sexually active, transactional sex, or ever having an STI). Higher prevalence of testing within the last year was significantly associated with experiencing physical abuse or transactional sex. However, reporting ≥ 4 sexual partners or not using condoms were not associated with higher testing. Although testing prevalence among homeless youth was high, homeless youth engaging in certain high risk behaviors could benefit from further promotion of HIV testing.

Exchange and Survival Sex, Dating Apps, Gender Identity, and Sexual Orientation Among Homeless Youth in Los Angeles

We estimated the association between gender and sexual identities, and engagement in exchange and survival sex and seeking these partners via dating apps or websites, within a sample of homeless youth. In 2017, 253 homeless youth were interviewed from three different drop-in centers in Los Angeles. Multivariable regression analyses assessed associations between gender/sexual identity, and exchange and survival sex, adjusting for demographic characteristics. Sexual minority (43.6%) and gender minority (12.1%) youth reported elevated rates of exchange sex compared to cisgender heterosexual youth. Twenty-three percent of youth who engaged in survival or exchange sex used dating apps or websites to find partners. Exchange sex was associated with having recent HIV positive sex partners. Reporting an HIV positive partner and a relatively high number of sexual partners were significant predictors of engaging in survival sex. Programs and interventions for homeless youth should address engagement with technology and exchange and survival sex, and should respond to the unique needs of sexual and gender minority homeless youth.

Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness

Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.

Homelessness among youth who identify as LGBTQ+: A systematic review

AIMS AND OBJECTIVES

To explore homelessness among lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ+) youth and to identify their support and care requirements.

BACKGROUND

LGBTQ+ youth face many health and societal challenges including issues related to homelessness.

DESIGN

A systematic review of qualitative, quantitative and mixed methods studies.

METHODS

A search of relevant electronic databases was carried out and included the dates August 2008-August 2018 and limited to academic journals and peer-reviewed empirical studies written in English. Included studies specifically addressed the homeless experiences of youth aged 13-24 years old who identified as LGBTQ+. The PRISMA checklist was used in the review. A quality assessment instrument was used to review all of the selected papers and narrative methods utilised in the synthesis of the research evidence.

RESULTS

The search resulted in 319 papers, and after applying distinct inclusion criteria, a total of 14 papers were considered suitable for the systematic review. Following analysis, the four main themes identified were stigma, discrimination and exclusion; mental health issues and substance use; sexual risks and vulnerability; and interventions and supports.

CONCLUSION

LGBTQ+ homeless youth is a major public health concern that has significant consequences for a young person's physical and psychosocial well-being.

RELEVANCE TO CLINICAL PRACTICE

Practitioners need to be aware of the specific health and support requirements of LGBTQ+ youth in relation to homelessness. Inclusive and holistic care plans should exist that are fully responsive to the distinct needs of this group guided by definitive policies and sound clinical research. The implications for future nursing practice are presented and discussed.

The Complexity of Family Reactions to Identity among Homeless and College Lesbian, Gay, Bisexual, Transgender, and Queer Young Adults

Familial responses to lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people's identities range on a spectrum from rejection to acceptance and these reactions strongly impact family relationships and young adult well-being. Less is known, however, about how family members' reactions may differ based on young people's contexts of socioeconomic status. Through a qualitative, life course analysis of in-depth interview data from 46 LGBTQ college students and LGBTQ homeless young adults, our study highlights the diverse, contextual nuances of young people's "linked lives" within their families. We find that the context of socioeconomic status influenced how a young person managed family rejection. Conversely, processes of familial acceptance were also connected to life course transitions that worked in some cases to enhance LGBTQ young adults' family relationships. Finally, the intricacy of familial reactions to a young person's LGBTQ identity transcended socioeconomic contexts as many respondents shared similar experiences of rejection and acceptance. These findings have implications for understanding how young people manage family relationships across different contexts of socioeconomic status and how these experiences can shape their life course trajectories. Results from this study can inform LGBTQ youth service providers by tailoring intervention programs that account for contextual social diversity.

Condomless Sex Among Homeless Youth: The Role of Multidimensional Social Norms and Gender

Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.

Descriptive and injunctive network norms associated with nonmedical use of prescription drugs among homeless youth

BACKGROUND

Nonmedical use of prescription drugs (NMUPD) among youth and young adults is being increasingly recognized as a significant public health problem. Homeless youth in particular are more likely to engage in NMUPD compared to housed youth. Studies suggest that network norms are strongly associated with a range of substance use behaviors. However, evidence regarding the association between network norms and NMUPD is scarce. We sought to understand whether social network norms of NMUPD are associated with engagement in NMUPD among homeless youth.

METHODS

1046 homeless youth were recruited from three drop-in centers in Los Angeles, CA and were interviewed regarding their individual and social network characteristics. Multivariate logistic regression was employed to evaluate the significance of associations between social norms (descriptive and injunctive) and self-reported NMUPD.

RESULTS

Approximately 25% of youth reported past 30-day NMUPD. However, more youth (32.28%) of youth believed that their network members engage in NMUPD, perhaps suggesting some pluralistic ignorance bias. Both descriptive and injunctive norms were associated with self-reported NMUPD among homeless youth. However, these varied by network type, with presence of NMUPD engaged street-based and home-based peers (descriptive norm) increasing the likelihood of NMUPD, while objections from family-members (injunctive norm) decreasing that likelihood.

CONCLUSIONS

Our findings suggest that, like other substance use behaviors, NMUPD is also influenced by youths' perceptions of the behaviors of their social network members. Therefore, prevention and interventions programs designed to influence NMUPD might benefit from taking a social network norms approach.

Sociometric network structure and its association with methamphetamine use norms among homeless youth

Homeless youths' social networks are consistently linked with their substance use. Social networks influence behavior through several mechanisms, especially social norms. This study used sociometric analyses to understand whether social norms of drug use behaviors are clustered in network structures and whether these perceived norms (descriptive and injunctive) influence youths' drug use behaviors. An event-based approach was used to delineate boundaries of the two sociometric networks of homeless youth, one in Los Angeles, CA (n = 160) and the other in Santa Monica, CA (n = 130). Network characteristics included centrality (i.e., popularity) and cohesiveness (location in dense subnetworks). The primary outcome was recent methamphetamine use. Results revealed that both descriptive and injunctive norms influenced methamphetamine use. Network cohesion was found to be associated with perception of both descriptive and injunctive norms in both networks, however in opposite directions. Network interventions therefore might be effective if designed to capitalize on social influence that naturally occurs in cohesive parts of networks.

Risk Factors for HIV among Zambian Street Youth

The sub-Saharan African region has been disproportionately affected by Human Immunodeficiency Virus (HIV) and Zambia has one of the highest HIV prevalence rates within this region. Moreover, new incidences of HIV infection are increasing most rapidly among those 15 to 24 years of age. Though young people are at high risk for HIV infection, street youth are even more vulnerable given their exposure to high risk behaviors. The current study examines multiple levels of social influence on HIV infection among 250 street youth in Zambia. Results reveal that though the majority of youth understand what behaviors increase their risk for HIV, youth still hold many misconceptions about HIV/AIDS. Additionally, youth who do not have a home to return to and those who report parental drug misuse were significantly more likely to be HIV positive. This study underscores the need for further education among street youth regarding HIV knowledge.

Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth

BACKGROUND

High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection.

OBJECTIVES

The purpose of the current study is to examine how multi-level risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use.

METHODS

A total of 250 street youth in Lusaka, Zambia were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods.

RESULTS

Youth reported high rates of alcohol use. At the multivariate level, peer and individual level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family level factors. Community level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multi-level risk and protective factors for young people's alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth.

Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless

A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions.