Abstract
The aim of this study was to determine whether there are meaningful subgroups with different types of sexual risk behaviors among youth experiencing homelessness and examine the associations between potential classes and other risk variables. A latent class analysis was used to identify classes of youth according to sexual risk behaviors and sexual assault. A two-class solution was found to be the best fit for the data–Lower and Higher Risk groups. The Higher Risk class had significantly higher levels of synthetic marijuana and alcohol use, mental health diagnoses, and were more likely to have been tested for HIV than the Lower Risk group. Youth were more likely to be in the Higher Risk group if they were cisgender female or lesbian, gay, bisexual, or questioning (LGBQ). Nearly all youth (10/11) who reported having HIV infection were in the Higher Risk group. The Lower Risk group were sexually active but had lower rates of risk behaviors and sexual assault. Youth who were not sexually active had the lowest rates of marijuana and alcohol use as well as HIV testing. Health and social service providers should be aware of the added risks for stress, mental distress, mental health diagnoses, and substance use among youth who also report higher risk sexual behaviors and treat as needed.
Highlights
Youth experiencing homelessness (YEH), ages 14–24 years old, are 6–12 times more likely to become infected with human immunodeficiency virus (HIV) than their housed peers, [1, 2] with HIV prevalence estimates as high as 12% [3]
We examined the fit of four models assessing three fit indices -the Standardized Bayesian Information Criteria (SBIC), the Bayesian Information Criteria (BIC), and the Akaike Information Criteria (AIC) to select the optimal number of classes
The findings support the need for healthcare and social services providers to create youth-friendly and affirming environments that consider gender identity, sexual orientation, and level of sexual risk in programs targeting sexual health, mental health, and substance use to meet the needs of these meaningful groupings of YEH
Summary
Youth experiencing homelessness (YEH), ages 14–24 years old, are 6–12 times more likely to become infected with human immunodeficiency virus (HIV) than their housed peers, [1, 2] with HIV prevalence estimates as high as 12% [3]. AYA population (chlamydia: 1.7–3.2%; gonorrhea: 0.3–0.6%) [4, 5] and engage in more sexual risk behaviors than stably housed youth [6, 7]. YEH initiate sex earlier (the median age of sexual debut is 13 years old) [8], are more likely to have multiple partners, to use substances during sex, and are less likely to use a condom [9, 10]. Trading sex is a survival behavior among YEH that puts them at high risk for HIV/STIs [13]. Many YEH who trade sex do so most frequently for money (82%), a place to stay (48%), or substances (22%) [8, 17, 18]
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