Current Age, Age at First Sex, Age at First Homelessness, and HIV Risk Perceptions Predict Sexual Risk Behaviors among Sexually Active Homeless Adults

Housing Insecurity and Other Syndemic Factors Experienced by Black and Latina Cisgender Women in Austin, Texas: A Qualitative Study

Austin, Texas emerged as one of the fastest-growing cities in the U.S. over the past decade. Urban transformation has exacerbated inequities and reduced ethnic/racial diversity among communities. This qualitative study focused on housing insecurity and other syndemic factors among Black and Latina cisgender women (BLCW). Data collection from 18 BLCW using in-depth interviews guided by syndemic theory was conducted three times over three months between 2018 and 2019. Four housing insecurity categories emerged: (a) very unstable, (b) unstable, (c) stable substandard, and (d) stable costly. Participants who experienced more stable housing, particularly more stable housing across interviews, reported fewer instances of intimate partner violence (IPV), less substance use, and a reduced risk of acquiring HIV. Results identified the importance of exploring housing insecurity with other syndemic factors among BLCW along with determining structural- and multi-level interventions to improve housing circumstances and other syndemic factors. Future research should explore these factors in other geographic locations, among other intersectional communities, and among larger sample sizes and consider using a mixed methods approach.

Vulnerability to HIV Infection Among International Immigrants in China: Cross-sectional Web-Based Survey

BACKGROUND

The rising number of migrants worldwide, including in China given its recent rapid economic development, poses a challenge for the public health system to prevent infectious diseases, including sexually transmitted infections (STIs) caused by risky sexual behaviors.

OBJECTIVE

The aim of this study was to explore the risky sexual behaviors of international immigrants living in China to provide evidence for establishment of a localized public health service system.

METHODS

Risky sexual behaviors were divided into multiple sexual partners and unprotected sexual behaviors. Basic characteristics, sexual knowledge, and behaviors of international immigrants were summarized with descriptive statistics. Multivariate logistic regression analyses were used to identify factors associated with risky sexual behaviors, and the associations of demographic characteristics and risk behaviors with HIV testing and intention to test for HIV.

RESULTS

In total, 1433 international immigrants were included in the study, 61.76% (n=885) of whom had never heard of STIs, and the mean HIV knowledge score was 5.42 (SD 2.138). Overall, 8.23% (118/1433) of the participants had been diagnosed with an STI. Among the 1433 international immigrants, 292 indicated that they never use a condom for homosexual sex, followed by sex with a stable partner (n=252), commercial sex (n=236), group sex (n=175), and casual sex (n=137). In addition, 119 of the international immigrants had more than three sex partners. Individuals aged 31-40 years were more likely to have multiple sexual partners (adjusted odds ratio [AOR] 2.364, 95% CI 1.149-4.862). Married participants were more likely to have unprotected sexual behaviors (AOR 3.096, 95% CI -1.705 to 5.620), whereas Asians were less likely to have multiple sexual partners (AOR 0.446, 95% CI 0.328-0.607) and unprotected sexual behaviors (AOR 0.328, 95% CI 0.219-0.492). Women were more likely to have taken an HIV test than men (AOR 1.413, 95% CI 1.085-1.841). Those who were married (AOR 0.577, 95% CI 0.372-0.894), with an annual disposable income >150,000 yuan (~US $22,000; AOR 0.661, 95% CI 0.439-0.995), considered it impossible to become infected with HIV (AOR 0.564, 95% CI 0.327-0.972), and of Asian ethnicity (AOR 0.330, 95% CI 0.261-0.417) were less likely to have an HIV test. People who had multiple sexual partners were more likely to have taken an HIV test (AOR 2.041, 95% CI 1.442-2.890) and had greater intention to test for HIV (AOR 1.651, 95% CI 1.208-2.258).

CONCLUSIONS

International immigrants in China exhibit risky sexual behaviors, especially those aged over 30 years. In addition, the level of HIV-related knowledge is generally low. Therefore, health interventions such as targeted, tailored programming including education and testing are urgently needed to prevent new HIV infections and transmission among international immigrants and the local population.

Understanding the Health and Health-Related Social Needs of Youth Experiencing Homelessness: A Photovoice Study

PURPOSE

Homelessness is a major public health problem facing millions of youths across the United States (U.S.), with lesbian gay, bisexual, transgender, questioning (LGBTQ+) youths and youths of color being disproportionately at higher risk. This study obtains an understanding of the health and health-related social needs of youths experiencing homelessness during the coronavirus disease (COVID-19) pandemic.

METHODS

A total of 14 youths between the ages of 14 and 24 who (a) lived, worked, or attended school in New Britain, Connecticut (CT) and (b) had at least one experience of homelessness or housing insecurity worked with the research team to conduct a needs assessment regarding youth homelessness. Using photovoice, a community-based participatory research method, participants created photo narratives to share their stories and recommendations for community change. The main goals of photovoice are to enable participants to (1) record and represent their everyday realities; (2) promote critical dialogue and knowledge about person and community strengths and concerns; and (3) reach policy makers.

RESULTS

Most of the participants identified as youths of color, and half of the participants identified as members of the LGBTQ+ community. Three major themes that appeared in the youths' narratives include the following: mental health and substance use challenges, trouble accessing basic human needs, and lack of a social support system.

CONCLUSION

This study uplifts and empowers a vulnerable population to increase visibility around a major public health challenge from their own lived experiences. Despite the challenges that were voiced, many participants shared a sense of hope and resiliency. The major themes endorsed by the youths has the potential of informing practitioners and policy makers of how to better address the needs of youths experiencing homelessness, particularly those most at risk.

Health and Health Service Needs: Comparison of Older and Younger Women with Criminal-Legal Involvement in Three Cities

Objectives: We profiled the health and health services needs of a sample of older adult women (age 50+) with criminal-legal system (CLS) involvement and compared them with younger women (age 18-49), also CLS-involved. Methods: Using survey data collected from January to June 2020 from adult women with CLS involvement in three US cities, we profiled and compared the older adult women with younger women on behavioral and structural risk factors, health conditions, and health services access and use. Results: One-third (157/510) were age 50+. We found significant differences (p < .05) in health conditions and health services use: older women had more chronic conditions (e.g., hypertension and stroke) and more multimorbidity and reported more use of personalized care (e.g., private doctor, medical home, and health insurance). Discussion: Although older women with CLS involvement reported good access to health services compared with younger women, their chronic health conditions, multimorbidity, and functional declines merit attention.

Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness

Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness among homeless adults living in homeless shelters and/or receiving services from homeless-serving agencies. Homeless participants (N = 919; 67.3% men) were recruited within two independent studies from Dallas and Oklahoma. Covariate-adjusted logistic regressions were used to measure associations between homelessness onset and mental illness as a reason for current homelessness, history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity. Overall, 29.5% of the sample reported youth-onset homelessness and 24.4% reported mental illness as the reason for current homelessness. Results indicated that mental illness as a reason for current homelessness (AOR = 1.62, 95% CI = 1.12–2.34), history of specific mental illnesses (Bipolar disorder–AOR = 1.75, 95% CI = 1.24–2.45, and Schizophrenia/schizoaffective disorder–AOR = 1.83, 95% CI = 1.22–2.74), history of severe mental illness (AOR = 1.48, 95% CI = 1.04–2.10), and severe mental illness comorbidities (AOR = 1.30, 95% CI: 1.11–1.52) were each associated with increased odds of youth-onset homelessness. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.

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.