Predictors of HIV testing among runaway and homeless adolescents

Discrimination, resilience, and HIV testing frequency among black women seeking services from STD clinics

RATIONALE

In the United States, Black women are disproportionately affected by HIV, accounting for most new HIV infections diagnosed among women. Socio-structural barriers to HIV testing include stigma and discrimination but may be mitigated by resilience.

OBJECTIVE

We aimed to examine the effect of discrimination and resilience on HIV testing behaviors among Black women.

METHODS

Between 2016 and 2018, we conducted The ESSENCE Project, a retrospective cohort study on the role of physiological and environmental factors on the association between sexual assault and HIV risk among Black women in Baltimore, Maryland, USA. Black women aged 18-44 were recruited from public health STD clinics and completed an audio-computer-assisted self-interview survey. Hierarchical multiple negative binomial regression models were used to examine the associations of everyday discrimination (subtle and overt) and resilience on HIV testing frequency; resilience and its subscales (relational maintenance, personal fortitude, positive coping, independence and insight) were also examined as moderators.

RESULTS

Among 236 Black women reporting HIV testing history, the median number of lifetime HIV tests was 4 (IQR = 2, 6). Mean everyday discrimination was 2.3 (SD = 1.2). Mean resilience was 5.3 (SD = 0.8). Everyday discrimination and its subscales (overt and subtle) were negatively associated with lifetime HIV testing frequency, while overall resilience was not associated with lifetime HIV testing frequency. Accounting for demographics, overall resilience moderated the association of subtle discrimination and lifetime HIV testing frequency. For the resilience subscales, more specifically: (1) associations of subtle discrimination and HIV testing frequency were significant at the lowest relational maintenance and lowest positive coping resilience; and (2) the association of subtle discrimination and HIV testing frequency was significant at the highest resilience for all four subscales.

CONCLUSIONS

These findings highlight the need for provider- and community-level interventions addressing the deleterious effects of everyday discrimination and more specifically subtle everyday discrimination to encourage HIV testing.

Substance use, violence experiences, and mental health issues: are these health risks associated with HIV testing among sexually experienced U.S. high school students?

HIV testing is a critical strategy for prevention of HIV yet testing among sexually experienced adolescents is sub-optimal. The purpose of this study is to examine associations between risk behaviors and experiences related to substance use, violence, and mental health and suicide and receipt of testing. We analyzed cross-sectional data from the 2017 national Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students in grades 9-12. Analyses were limited to sexually experienced participants (n = 5192). Measures included nine indicators related to substance use, violence, and mental health and suicide. Unadjusted and adjusted prevalence ratios were calculated for each indicator to examine associations with testing. Adjusted models controlled for same-sex sexual behavior, sexual risk, and demographic characteristics. Prevalence of HIV testing was 17.2%. In adjusted models, forced sexual intercourse, injection drug use, other illicit drug use, and persistent feelings of sadness or hopelessness were associated with a higher likelihood of testing. Prevalence of HIV testing in this sexually experienced sample was low. Some behaviors and experiences that may be indicative of HIV risk, including sexual dating violence and prescription opioid misuse, were not associated with testing.

HIV testing among youth in a high-risk city: prevalence, predictors, and gender differences

While HIV is prevalent among adolescents and young adults, testing levels remain low and little is known about gender differences in HIV testing. The objectives of this study were to describe the prevalence of past-year HIV testing and evaluate associations between HIV testing and individual- and partner-level factors by gender among heterosexually experienced youth (15-24 years) in Baltimore, Maryland (N = 352). Past-year HIV testing was prevalent (60.1%) and differed by gender (69.4% among women vs. 49.6% among men, p = 0.005). For women, African-American race (AOR 3.09) and recent older partner by ≤2 years (AOR 4.04) were significantly associated with testing. Among men, only African-American race was associated with testing (OR 4.23), with no patterns identified based on risk behavior or perceived partner risk. HIV testing among adolescent and young adults was prevalent in this highly affected urban area. Findings emphasize the value of a gender lens, and provide direction for optimizing engagement in HIV testing.

Rapid point-of-care HIV testing in youth: a systematic review

PURPOSE

This review examines the literature surrounding acceptability of, and preference for, rapid point-of-care (POC) human immunodeficiency virus (HIV) testing in youth, documents notification rates when youth were offered rapid POC testing, and identifies the sociodemographic factors associated with testing.

METHODS

The reviewers searched the scholarly literature indexed in MEDLINE, Embase, CINAHL, and PsycInfo using a set of keywords related to youth and rapid POC HIV testing. A total of 14 articles were included in the review.

RESULTS

Four themes were identified: (1) Youth will accept rapid POC testing, particularly if offered; (2) youth prefer rapid POC testing to traditional testing; (3) youth receive their rapid POC HIV test results; and (4) older youth and those with HIV risk factors or a concurrent genitourinary diagnosis are more likely to accept rapid POC HIV testing when it is offered.

CONCLUSIONS

Evidence shows that youth accept and prefer rapid POC HIV tests when offered. The routine use of rapid POC HIV tests in emergency departments and adolescent primary care clinics should be considered because of higher uptake in these environments. Youth receive their rapid POC test results more frequently and sooner than traditional test results. However, further work is needed to develop HIV testing programs that target younger adolescents.

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

Homeless youth are at high risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STI), yet those at greatest risk may never have been tested for HIV or STI. In a probability sample of sexually active homeless youth in Los Angeles (n = 305), this study identifies factors associated with HIV/STI testing status. Most youth (85%) had ever been tested and 47% had been tested in the past 3 months. Recent testing was significantly more likely among youth who self-identified as gay, were Hispanic, injected drugs, and used drop-in centers, and marginally more likely among youth with more depressive symptoms. Drop-in center use mediated the association of injection drug use with HIV/STI testing. HIV/STI testing was unrelated to sexual risk behavior. Drop-in centers can play an important role in facilitating testing, including among injection drug users, but more outreach is needed to encourage testing in other at-risk subgroups.

Correlates of service utilization among homeless youth

Though few studies exist on service utilization among homeless youth in the U.S., services are important because without them, many of these young people may resort to delinquent strategies in order to meet their daily survival needs. The current study examines frequency and correlates of service utilization (i.e., shelters, food programs, street outreach, counseling, STI and HIV testing) among a sample of 249 homeless youth ages 14 to 21. Multivariate analysis revealed significant differences in service usage by sex, age, and sexual orientation. Experiencing family physical and/or sexual abuse, being kicked out of the family home, spending more nights per week sleeping on the street, and having ever stayed in a group home facility were significant correlates of homeless youths' service usage.

Adolescents’ agreement to test for HIV when different testing methods are offered

Offering rapid HIV testing improves rates of testing in adults, but little is known about whether offering adolescents a choice of testing methods increases rates of testing. The aims of the study were to determine rates of HIV testing in adolescents when different testing methods were offered and explore factors associated with agreement to be tested for HIV. Participants ( n= 200, sexually experienced 13–22 year olds) were recruited from an urban adolescent clinic, completed a 99-item theory-based survey and were offered their choice of venipuncture, rapid fingerstick or rapid oral fluid HIV testing. Approximately half (49.5%) agreed to HIV testing. Male gender, parental completion of high school, intention to test for HIV if offered by clinician and higher perceived likelihood of current HIV infection were independently associated with agreement to test. Combining new strategies, such as opt-out testing, with routine testing may be needed to improve rates of adolescent HIV testing.

Acceptability and feasibility of rapid HIV testing in an adolescent clinic setting: youth testing attitudes, knowledge, and behaviors

PURPOSE

To assess youths' attitudes, knowledge, and behaviors regarding rapid HIV testing (RHT) and measure acceptability and feasibility of RHT in an adolescent clinic setting.

METHODS

A 2007-2008 project introduced free RHT at an urban, hospital-based adolescent and young adult clinic in Boston, MA. Patients and HIV testing clients were offered either free nonrapid tests or fingerstick RHT. An anonymous questionnaire assessed youths' testing attitudes, knowledge, and behaviors (N = 127). Ordinal logistic regression model was used to determine associations with youth demographic characteristics and testing experience.

RESULTS

Most participants valued rapid results. A minority desired confidentiality from parents and insurance providers. Older youth were more likely to know about testing methods (OR: 1.25; CI: 1.04-1.51) and plan for follow-up (OR: 1.43; CI: 1.14-1.81). Age, gender, and race were unrelated to testing facilitators such as rapidity, confidentiality, and cost, although younger clients were more likely to prefer noninvasive methods. Individuals with previous testing experience were more likely to say that they would contribute to expenses and value rapidity over cost.

CONCLUSION

There was strong support for RHT among youth receiving HIV testing. Offering RHT to youth may facilitate routine testing. Future research should focus on increasing RHT access among diverse populations of youth.

Correlates of HIV testing history among urban youth recruited through venue-based testing in 15 US cities

BACKGROUND

Adolescents and young adults comprise disproportionately high percentages of individuals living with human immunodeficiency virus (HIV) and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 US cities.

METHODS

A total of 20 to 30 sexually active youths, aged 12 to 24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2 to 3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users.

RESULTS

Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high-risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing seems to be more associated with sexually transmitted infection testing services than with primary care.

CONCLUSIONS

More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.

Factors related to past HIV testing among South African non-injection drug users

South Africa has some of the highest estimates of human immunodeficiency virus (HIV) in the world, with a prevalence of 21.5%. Despite this, based on population-level data, 39% of sexually active South Africans have never been tested for HIV. Non-injection drug users (NIDUs) are a high-risk and increasingly prevalent group in South Africa. However, few studies have examined HIV test utilization among high-risk groups such as drug users in South Africa. The study was conducted in Pretoria, South Africa between 2002 and 2006. Of the 382 individuals surveyed, 31% had been tested for HIV in the past. Results indicate that females and older individuals were significantly more likely to have been tested for HIV at some point in the past, while individuals who did not know someone with HIV/AIDS as well as individuals who are unsure of their risk of HIV infection were significantly less likely to have ever accessed testing. Identification of these subgroups has implications for the development of targeted interventions to promote greater HIV testing among at-risk groups in South Africa.

The effect of drug and sexual risk behaviours with social network and non-network members on homeless youths' sexually transmissible infections and HIV testing

BACKGROUND

The study examined whether engaging in drug and sexual risk behaviours with social network and non-network members (strangers) differentially affected the decision to test for sexually transmissible infections (STIs) and HIV.

METHODS

A cross-sectional survey was conducted among 249 homeless youths aged 14-21 years.

RESULTS

Multivariate analyses revealed that females were over three times more likely than males to test for STIs (adjusted odds ratio (AOR) = 3.34; 95% confidence interval (CI) = 1.54-7.25). For every one unit increase in age, there was a 37% increase in the likelihood of having tested for STIs (AOR = 1.37; 95% CI = 1.12-1.68). Youths who had sex after using alcohol and drugs with strangers were approximately 3.5 times more likely to have tested for STIs (AOR = 3.45; 95% CI = 1.38-8.61). For every one unit increase in age, there was a 26% increase in the likelihood of having tested for HIV (AOR = 1.26; 95% CI = 1.05-1.51). Youths who had sex with a stranger after using alcohol or drugs were over three times more likely to test for HIV (AOR = 3.22; 95% CI = 1.42-7.31). No social network variables reached significance for STI or HIV testing.

CONCLUSIONS

Being older and engaging in drug and sexual risk behaviours with strangers are important correlates of STI and HIV testing. Females are more likely than males to be tested for STIs. Engaging in risky behaviours with social network members was not a key factor in deciding whether to be tested.

The effect of early maltreatment, victimization, and partner violence on HIV risk behavior among homeless young adults

PURPOSE

The purpose of our study was to examine the relationship between child maltreatment, physical and sexual victimization, and partner violence victimization with human immunodeficiency virus (HIV) risk behaviors among a sample of homeless young adults from the midwestern United States.

METHODS

Data are from the Homeless Young Adult Project. A total of 199 young adults aged 19-26 years were interviewed over 14 months using a systematic sampling strategy. The final sample included 172 young adults who were homeless or had a history of running away and being homeless.

RESULTS

Results from the path analysis revealed that sexual abuse is directly linked with street sexual victimization which was positively associated with a greater number of HIV risk behaviors. Experiencing more types of physical abuse and neglect were positively correlated with partner violence victimization, which was, in turn, associated with more HIV risk behaviors. Those who suffered from more types of neglect also experienced more forms of sexual and physical victimization.

CONCLUSIONS

These findings have implications for service providers. Clinicians who serve homeless youth should recognize the potential effect that experiencing a variety of forms of victimization may have on health risk behaviors.

Using a web-based survey to assess correlates of intention towards HIV testing among never-been-tested but sexually experienced college students

The purpose of this study is to identify influential psychosocial factors predicting testing intention among college students who have never been tested but are sexually experienced. A web-based survey was conducted during the spring semester in 2003 in a major Southeastern university (N = 440). Results showed only 7.7% of the students expressed intention despite having been sexually experienced. Multiple logistic regression models showed that the combined five psychosocial factors examined (perceived pros, cons, risk, self-efficacy and availability/accessibility related to testing) significantly predicted testing intention (p < 0.001). Two factors, perceived pros (OR = 1.641) and perceived risk (OR = 1.357), showed significant coefficients. The reduced model with only these two predictors showed increased correct classification of students in terms of their testing intention (from 91.8 to 93.4%). Results suggested that educational and prevention programmes aimed at encouraging testing should address these important testing-related psychosocial constructs to maximize programme impacts. Future studies need to further investigate the role of other factors in affecting testing intention or related behaviours among other sub-groups of students.

Correlates of HIV/STD testing and willingness to test among rural-to-urban migrants in China

This study investigates socio-demographic, behavioral, psychological, and structural factors associated with self-reported HIV/STD testing and willingness to test among 1,938 Chinese migrants. Overall, 6% and 14% of participants had ever been tested for HIV and STD, respectively. The results of multivariate analyses indicate that working at entertainment sectors, engaging in commercial sex, and utilization of health care were positively associated with both HIV and STD testing. Younger age, selling blood, perceived peer sexual risk involvement, and satisfaction with life were associated with HIV testing only. Female gender, early sexual debut, multiple sexual partners, and perceived vulnerability to HIV/STD were associated with STD testing only. Male gender, having premarital sex, perceived higher severity of and vulnerability to HIV/STD, and utilization of health care were associated with willingness to be tested for both HIV and STD. Interventions designed to raise the perception of vulnerability to HIV/STD and to improve access to and utilization of health care may be effective in encouraging more HIV testing in this vulnerable population.

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.

Social network characteristics and risky sexual and drug related behaviors among homeless young adults

Although research finds high rates of risky sexual and drug related behavior among homeless young people, little research had examined how the characteristics of their social networks encourage or constrain risky behaviors. Based on a sample of 145 homeless young adults in the Midwestern United States, results revealed that having used alcohol with at least one of their network members and the presence of more conflict was associated with engaging in a greater number of sexual risk taking behaviors. Correlates of engaging in a greater number of substance use related behaviors included having older peers within the network, having used illicit drugs with at least one network member, and the presence of more conflict. The presence of a family member in one's network, however, was associated with fewer sexual and drug related risk behaviors. Overall, the social network characteristics of youth explained significant, additional variance beyond that of youth's own characteristics and their early family histories.

Barriers and facilitators to adolescent HIV testing

This study examined the barriers and facilitators of HIV counseling, testing, and referral service (HIV CTR) acceptance among 278 youth aged 12-24 years old. Participants completed a questionnaire before health education sessions with trained counselors. Information was collected on individual characteristics, HIV testing acceptance, risk behaviors, reasons for having never been tested, and what would make it easier to get tested for HIV. Ninety percent of the respondents were minority and 52% were female with an average age of 15 years. High-risk minority youth who had never received HIV CTR listed low perception of risk and never having been offered a test as reasons for not having been tested. Increased availability of oral and rapid testing methods as well as free testing services were listed as facilitating their acceptance of HIV testing. Older youth aged 18-24 years reported that HIV tests in which results can be received rapidly and confidentially would encourage them to obtain HIV testing services. Early identification approaches should be tailored to increase the access to and acceptance of HIV-testing services among the adolescent and young adult populations.

Sexual health of homeless youth: prevalence and correlates of sexually transmissible infections

BACKGROUND

The study examined risk factors for having ever contracted sexually transmissible infections (STI) among a high-risk sample in midwestern USA.

METHODS

A cross sectional survey was conducted among 428 homeless youth aged 16-19 years. Assessed correlates included child maltreatment, street exposure, sexual histories, street experiences and substance use.

RESULTS

Multivariate analyses revealed that males were 86% less likely to have had STI compared with females (adjusted odds ratio [AOR] = 0.14; 95% confidence interval [CI] = 0.06-0.31). Blacks were almost four times more likely (AOR = 3.71; 95% CI = 1.80-7.63) and other races were over two times more likely (AOR = 2.25; 95% CI = 1.08-4.67) to have had STI compared with whites. For every one unit increase in the number of times youth ran away, there was a 3% increase in the likelihood of ever having had an STI (AOR = 1.03; 95% CI = 1.01-1.06). For every one unit increase in frequency of condom use there was a 61% decrease in the likelihood of an STI (AOR = 1.39; 95% CI = 1.10-1.76). Finally, youth who traded sex were approximately 2.5 times more likely to have had STI compared with youth who did not trade sex (AOR = 2.36; 95% CI = 1.04-5.34). None of the remaining correlates approached multivariate significance.

CONCLUSIONS

The amount of time youth spend on the street, their sexual practices, and their subsistence strategies are important correlates of STI and females and non-whites are particularly vulnerable among this high-risk population.

Newly homeless youth STD testing patterns over time

PURPOSE

To use the Behavioral Model for Vulnerable Populations to examine the predisposing and need characteristics of newly homeless youth that are associated with sexually transmitted disease (STD) testing over time.

METHODS

A longitudinal cohort of newly homeless youth from Los Angeles County (n = 261; ages 12-20 years) were followed for 24 months. Youth were interviewed at baseline, 3, 6, 12, 18, and 24 months, and asked about their background, housing situation, emotional distress (using the Brief-Symptom Inventory), substance use, sexual risk behaviors, and their STD testing rates. We modeled our longitudinal data using logistic random effects models.

RESULTS

Characteristics of homeless youth that were associated with STD testing in our multivariate model included time in study (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1-1.6), age at baseline (OR 1.2, 95% CI 1.1-1.4), being African-American (OR 2.7, 95% CI 1.4-5.3), being from a mixed race/ethnic group (OR 2.8, 95% CI 1.3-5.8), self-identifying as a gay/bisexual male (OR 2.9, 95% CI 1.2-6.9), self-identifying as a heterosexual female (OR 2.2, 95% CI 1.3-3.7), using amphetamines (OR 1.7, 95% CI 1.1-2.6), and history of having gotten someone/becoming pregnant (OR 2.3, 95% CI 1.4-3.9). Youth who lived in an apartment were less likely to have received an STD test than youth who lived in other types of housing (OR .4, 95% CI .2-.9). Sexual risk behaviors such as inconsistent condom use (OR 1.0, 95% CI .6-1.4) and number of sexual partners over past 3 months (OR 1.1, 95% CI 1.0-1.1) were not predictive of STD testing over time.

CONCLUSIONS

A need exists for interventions to target young newly homeless youth who engage in high-risk sexual behaviors to increase their STD testing rates and thereby decrease their risk for HIV infection.

Predictors of sexually transmitted infection testing among sexually active homeless youth

We examined the association between sexual risk behaviors and sexually transmitted infection (STI) testing in a sample of homeless youth. Of 261 youth interviewed, 50% had been sexually active in the past 3 months. Gender variation in sexual behaviors and risk were found. Boys were more likely than girls to engage in anal sex (46% vs. 15%), to have 3 or more sexual partners (46% vs. 17%) and to engage in anonymous sex (38% vs. 21%). Girls were less likely to use condoms consistently and more likely to engage in sex with a partner suspected of having an STI (20% vs. 4%). In the past 3 months, the STI testing rates were similar for boys and girls (46%). However, girls were more likely to have positive STI results (46% vs. 9%). In a multivariate logistic regression analysis, the only variable that was an independent predictor of STI testing was having either gotten someone or having become pregnant in the past 3 months. High-risk sexual behaviors did not predict STI testing in our sample. Outreach programs are needed that target sexually active homeless youth for early STI testing and treatment.

Personal strengths of homeless adolescents living in a high-risk environment

Health-risk behaviors and associated adverse health outcomes in homeless adolescents are well documented. Strengths of these youth that contribute to their health and well-being are seldom acknowledged. The purpose of this secondary analysis of qualitative data was to identify strengths that protect homeless youth. Two types of strengths emerged: resources and self-improvement. Resources served as the foundation for survival whereas self-improvement served as a process that enabled youth to consider a more healthy future. By recognizing the many strengths of homeless youth, nurses may develop community-based programs to help this population reenter society.

Factors associated with HIV testing among HIV-positive and HIV-negative high-risk adolescents: the REACH Study. Reaching for Excellence in Adolescent Care and Health

OBJECTIVE

To describe human immunodeficiency virus (HIV) testing patterns among high-risk, uninfected adolescents and HIV-infected adolescents, and factors associated with testing.

METHODS

HIV-infected adolescents (N = 246) and high-risk, uninfected adolescents (N = 141) at 15 sites nationwide were asked about the number of times they were tested for HIV, the type of agency at which testing occurred, and reasons for testing.

RESULTS

The majority of participants reported being influenced to obtain testing by health care providers (53.1% of the HIV-infected group and 66.1% of the HIV-uninfected group, respectively). Female participants were somewhat more likely to have used a confidential or anonymous site for the most recent test, compared with male participants (73.5% and 67.5%, respectively). Among the HIV-infected group, feeling sick was the only factor associated with number of tests. Among the HIV-uninfected group, having more male partners, marijuana use in the past 3 months, white race, and having had same-gender partners in their lifetime (males only) were associated with number of tests. Multivariate analyses identified 2 significant models. Modeling the probability of having been tested 3 or more times, black participants were less likely to be tested than white participants (odds ratio [OR] = 0.4), and participants who felt sick were more likely to be tested than those who did not (OR = 1.7). Modeling the probability that the last test would be positive, black participants were more likely than white participants to test positive (OR = 2.3); those who were tested because they thought they might have gotten HIV from sex (OR = 3.0) or they felt sick (OR = 3.9) were more likely to test positive; participants who were tested because a health care professional recommended it were actually less likely (OR = 0.5) to test positive.

CONCLUSIONS

Overall, these findings highlight the importance of making HIV testing more routinely available to sexually active adolescents. More work needs to be done to normalize HIV testing among adolescents, and more innovative approaches need to be implemented on a wide scale.

Relationships of sexual abuse, connectedness, and loneliness to perceived well-being in homeless youth

ISSUES AND PURPOSE

To describe respondents' perceptions of connectedness, loneliness, and well-being; and to explore relationships among these variables.

DESIGN AND METHOD

Survey data from 96 participants, focus group interviews with 32 participants, and 10 individual interviews were analyzed.

RESULTS

Sixty percent of the sample reported sexual abuse, which was significantly related to loneliness and inversely related to connectedness and perceived well-being. Subjects felt lonely and disconnected. They perceived their well-being in terms of current health status.

PRACTICE IMPLICATIONS

High rates of sexual abuse, lack of connectedness, and loneliness may help to explain poor perceived well-being in homeless youth.

Telephone vs. face-to-face notification of HIV results in high-risk youth

PURPOSE

To increase the number of high-risk and homeless youth who receive human immunodeficiency virus (HIV) test results and posttest counseling.

METHODS

Oral HIV testing and counseling were offered to high-risk and homeless youth at sites at which youth congregate throughout Portland, Oregon. Subjects were randomized to receive test results and posttest counseling either in a face-to-face manner or with the option of telephone notification. Self-reported demographic and risk-behavior information was collected prior to HIV testing. The differences in the proportion of youth who received their test results were analyzed according to the notification method and demographic characteristics using SPSS.

RESULTS

Among the 351 youth who were tested, 48% followed up to receive test results and posttest counseling. Adolescents most likely to receive their results were female, older (19-24 years), and white and those who reported high-risk behaviors. Those given the option of telephone notification were significantly more likely to receive their results than those required to have face-to-face notification (odds ratio = 2.301, 95% confidence interval of 1.499, 3.534). This was true regardless of age, race, history of previous HIV testing, or presence of high-risk behaviors. Two youths tested positive for HIV corroborating previous reports of low HIV prevalence in this population. Both were assigned to the face-to-face notification group and, therefore, no HIV positive results were given by telephone.

CONCLUSIONS

The option of telephone notification significantly increased the proportion of youth who received posttest counseling and results following community-based testing.

Substance abuse and high-risk needle-related behaviors among homeless youth in Minneapolis: implications for prevention

Homeless and runaway youth face a variety of health risks, including those related to substance abuse and use of unsterile needles. During 1998-1999, we recruited 201 Minneapolis homeless youths aged 15-22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or "couch hopping." There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization.

Impact of parental consent and notification policies on the decisions of adolescents to be tested for HIV

Restrictions have been placed on the ability of adolescents to obtain human immunodeficiency virus (HIV) testing independent of their parents. Although some states have given adolescents the right to consent to HIV testing independently, many states have remained silent on the issue or have compromised these rights by providing for parental consent or notification when adolescents seek testing. This article examines existing policies and explores whether policies that require adolescents to obtain parental consent, or that permit or mandate parental notification, may deter them from obtaining needed HIV testing.

HIV risk behavior and HIV testing: a comparison of rates and associated factors among homeless and runaway adolescents in two cities

This study examined differences in self-reported rates and predictors of HIV testing between homeless and runaway youths in San Diego (N = 1,102) and Los Angeles (N = 1,167). Youths aged 13-23 were recruited from agency and street sites using a stratified probability sampling design. Interviewers administered a structured survey instrument lasting 20 minutes, which assessed youths' involvement in HIV risk-related sexual and drug-use behaviors, contact with outreach workers, and other variables. Significantly more Los Angeles youths (78%) reported testing than did San Diego youths (52%; p < .001). Multivariable analyses controlling for risk behaviors, knowing someone with HIV, and contact with outreach workers indicated that the higher rates of these factors in Los Angeles did not account for the difference in testing rates between the cities. Youths in Los Angeles were still 1.85 times as likely to be tested as San Diego youths (p < .001), possibly a result of differing normative behavior and accessibility of testing services.

Behavioral factors affecting HIV prevention for adolescent and young adult IDUs

Epidemiological and sociobehavioral data regarding HIV-related risk and injection drug use among adolescents and young adults are examined to provide insight and assistance to nurses delivering preventive intervention and community and clinical care. The increase in HIV/AIDS cases among injection drug users (IDUs), adolescents, and African Americans strongly suggests that clinical care providers acquire a better understanding of the sociocultural and behavioral context within which health care is provided. Transition into injection drug use, high-risk injecting and sexual behaviors, sociodemographic differences, and the importance of social networks are discussed. Nurses are encouraged to provide health promotion, disease prevention messages, and health care to IDUs in small nontraditional clinical settings and to seek out the assistance of the IDUs' social network to increase adherence and compliance to complex prevention and therapeutic efforts.

Psychosocial histories, social environment, and HIV risk behaviors of injection and noninjection drug using homeless youths

Injection drug use is a common risk behavior for HIV infection among homeless, runaway and street youths. However, the psychosocial histories and current social environment of these youths are not well understood. The authors recruited 186 homeless, runaway and street youths using systematic street-based sampling methods, and assessed psychosocial histories, current daily activities, and sexual and drug-related risk behaviors using qualitative and quantitative techniques. Youths reported high lifetime rates of injection drug use (45%), recent drug and alcohol use (100%), and current homelessness (84%). Injection drug using youths were more likely than noninjection drug using youths to report traumatic psychosocial histories, including parental substance use and forced institutionalization, use of alcohol and other noninjection drugs, a history of survival sex, and the use of squats or abandoned buildings as shelter. These findings underscore the need for multifaceted service and prevention programs to address the varied needs of these high-risk youths.

A collaborative model for community-based health care screening of homeless adolescents

Because of their survival life-style, homeless youth are at extremely high risk for contracting life-threatening and debilitating diseases, such as acquired immunodeficiency syndrome and hepatitis B, and for engaging in chronic substance abuse; yet health services are often limited and not easily accessed. This article describes an innovative health-screening project for 150 homeless youth between the ages of 11 and 23 years in an urban metroplex. The Homeless Youth Services Project was the initial phase of a multiphase project to investigate the social and health services available to homeless youth. The study project was a collaborative effort between several community agencies that shared the multiple goals of identifying the homeless adolescent population, documenting the rate of human immunodeficiency virus (HIV) seroprevalence and level of risk, and identifying community services and resources. Results of the screening project included the psychosocial and physical risks associated with homeless adolescents as well as the laboratory results of blood and urine screens. Consistent with the literature, the study population had a history of runaway behavior; physical, sexual, and substance abuse; and high rates of HIV seroprevalence and hepatitis B. Implications for advanced practice nurses working with homeless youth are also addressed.

The impact of parental consent on the HIV testing of minors

OBJECTIVES

This investigation assessed change in use of human immunodeficiency virus (HIV) testing by minors after removal of the parental consent requirement in Connecticut.

METHODS

HIV counseling and testing records for 13- to 17-year-olds who accessed publicly funded testing sites were analyzed.

RESULTS

The number of visits increased by 44% from the 12-month period before the statutory change (n = 656) to the 12-month period thereafter (n = 965). The number of HIV tests increased twofold. Visits and tests of high-risk minors tripled.

CONCLUSIONS

Minors should have the right to consent to HIV testing.

A risk profile of street youth in northern California: implications for gender-specific human immunodeficiency virus prevention

PURPOSE

To assess human immunodeficiency virus (HIV) risk behaviors of street youth and to determine whether risk behaviors differ by gender or housing status.

METHODS

Using systematic street-based sampling in four Northern California cities, we recruited 429 street youth (mean age = 19.2 years). Participants completed a structured interview which was used to assess sexual and drug HIV risk behaviors.

RESULTS

The majority of youth were heterosexual (85%), white (77%), male (68%), and currently without any type of stable housing (75%). Although 60% of the sample had had vaginal sex in the past 30 days, only 44% used a condom the last time they had sex. About one-third (32%) of the sample reported ever injecting drugs, and almost all reported lifetime use of multiple drugs including D-lysergic acid diethylamide (96%), marijuana (90%), alcohol (81%), cocaine (70%), and speed (70%). Compared to males, females were equally likely to use injection and noninjection drugs, but were more likely to be sexually active (P < .001), were more likely to have been diagnosed with a sexually transmitted disease (P = .005), and were less likely to report consistent condom use (P = .003) or intent to use condoms consistently in the future (P = .005). Compared with those with stable housing, youth who were currently without such housing reported higher rates of injection, and other drug use; females without stable housing were less likely to have used condoms the last time they had vaginal intercourse.

CONCLUSION

The high level of HIV risk behavior in this street-based sample of youth, particularly females and youth without stable housing, suggests an urgent need for gender-specific prevention efforts and an increased range of housing options.

Health risks of homeless adolescents. Implications for holistic nursing

Although the exact number of homeless adolescents is unknown, it is estimated that this population may exceed 2 million. Literally living on the streets, homeless youth are at risk for a variety of physical, psychosocial, and spiritual health problems. Many engage in "survival sex," exchanging sexual favors for necessities of food, clothing, and shelter. Such risky sexual behaviors make them vulnerable to sexually transmitted diseases, including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and unintended pregnancies. Many have serious, diagnosable mental health problems, whereas others suffer various consequences of substance abuse. There is a need for comprehensive and holistic health care services, for which the majority of homeless youth have very limited access. Holistic nursing can provide creative interventions for thus vulnerable population.

Relationship of optimism, knowledge, attitudes, and beliefs to use of HIV antibody testing by at-risk female adolescents

This study's purpose was to examine the extent to which optimism, knowledge, attitudes, and beliefs predict use of HIV testing services in a group of at-risk female adolescents. We prospectively interviewed 124 consecutive girls engaging in risky behaviors before regularly scheduled pediatric clinic appointments at a large urban HMO. Subjects completed a self-report questionnaire assessing optimism (Scheier's Life Optimism Test, or LOT), HIV-related knowledge, beliefs, and behaviors before their regular visit. At the visit, they were counseled about risky behaviors and the availability of confidential HIV testing at the clinic. All subjects were next given an opportunity to view an educational video about HIV testing and then decided whether or not to obtain testing. LOT scores were not associated with HIV-related knowledge, perceived risk, self-efficacy, condom expectations, or most risky behaviors, including higher levels of recent unprotected intercourse. LOT scores were higher among those who did not view the video and were also higher among those who did not obtain an HIV test. We conclude that higher optimism is not necessarily associated with HIV protective behaviors among adolescent girls and, depending on the context, may serve as a barrier to HIV prevention in this population.