Gender Differences in Sexual Risk and Sexually Transmitted Infections Correlate With Gender Differences in Social Networks Among San Francisco Homeless Youth

doi:10.1016/j.jadohealth.2013.05.016

Journal of Adolescent Health

Volume 53, Issue 4, October 2013, Pages 486-491

https://doi.org/10.1016/j.jadohealth.2013.05.016 Get rights and content

Abstract

Purpose

To explore whether gender differences in sexual risk and sexually transmitted infections (STIs) among homeless youth may be explained in part by gender differences in their social networks.

Methods

Our sample includes 258 youth (64% male) recruited in San Francisco from street venues and transitional programs. Participants completed an audio computer-administered self-interview survey regarding their housing status and risk behaviors and an interviewer-administered survey regarding their social networks, and were tested for STIs (chlamydia and gonorrhea). We examined relationships between sexual risk and STI rates and social network characteristics by gender.

Results

Condom use was lower in young women than in young men, whereas young women were more likely to have an injection drug user (IDU) sex partner and to be diagnosed with an STI. Homeless young men were more likely to have stably housed contacts and same-sex friendships in their social networks than were young women. Stably housed network contacts were associated with increased condom use and decreased STI prevalence in young men. Same-sex friends were associated with increased condom use in young women. No young woman with a family member in her network had an IDU sex partner. Having a network member who had been recently incarcerated was associated with having an IDU sex partner for young women.

Conclusions

Homeless young women's networks may place them at greater risk for STIs than young men. Increasing mainstream contacts and same-gender friendships may protect all homeless youth from STIs. Interventions addressing homeless young women's social networks may decrease their gender-disparate STI risk.

Section snippets

Study population and recruitment

Data were collected as part of the Street Youth in Social Environments study, a longitudinal study of the relationship among street culture, social networks, and STI/HIV risk in homeless youth in San Francisco (National Institute for Child Health and Development K23 HD01490; P.I.: C. Auerswald). At the time of our baseline survey in 2004, it was estimated that there were around 1,600 homeless youth at any given time in San Francisco [28].

The study of marginalized, hard-to-reach populations

Sample demographics

Our sample was 64% male. The median male age was 21 years (range, 15–24 years) and median female age was 20 years (range, 15–24 years). Youth were 54.5% white and 45.49% non-white. Table 1 provides a detailed breakdown by race, gender, and neighborhood. A total of 42% of males and 35% of females reported a history of ever engaging in same-sex sexual activity. There were no significant differences by gender in the sample demographics.

Sexual risk and sexually transmitted infections by gender

Table 2 displays frequencies of sexual risk outcomes by

Discussion

Our findings suggest that gender differences in social networks may partially explain gender differences in STI risk for RHY in San Francisco. Young homeless women in our study have greater sexual health risk than do young homeless men, including lower condom use, higher likelihood of sex with IDUs, and a trend toward higher rates of STIs. Young homeless men in our study are more likely than young homeless women to have stably housed contacts and same-sex friends, and are less likely to have

Acknowledgments

We thank the Street Youth in Social Environments research team, including Eiko Sugano, Miriam Raffiq, Eddie Cruz, Brooke Lober, Rondia Crawford, Jennifer Hecht, Renol Ratchford, and Ben Hickler. We are grateful to Steven Q. Muth for assistance with and advising on social network analyses. We are also grateful to John Kornak of the UCSF Center for Translational Sciences Institute for providing statistical consultation, to Alexandra Minnis and Jonathon Ellen for their advice and comments, and to

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Moreover, women experiencing homelessness appear to lack literacy and perception regarding the transmission of STIs, with only a small proportion of them using condoms (15.2%) and the great majority having multiple partners (54.3%) [222,223]. Between genders, women living without a roof appear to be at a greater risk for STIs compared to the men, irrespective of their age, and despite their more frequent screening opportunities [217,221,224–226]. Due to the synergy of crowded living conditions, lack of hygiene and medical care, those experiencing homelessness are often exposed to ectoparasites [211].
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Rates of HIV infection among homeless youth range from about 3–25% across U.S. studies (Medlow, Klineberg, & Steinbeck, 2014), and pregnancy is also more common among homeless than stably housed youth (Begun, 2015; Tucker & Sussell et al., 2012). Although condom use can be an effective means of protection, 40–70% of homeless youth report engaging in unprotected sexual intercourse (Tucker & Ryan et al., 2012; Valente & Auerswald, 2013). AOD use is associated with increased sexual activity and risky sex among homeless youth (Gleghorn, Marx, Vittinghoff, & Katz, 1998; Tucker & Hu et al., 2012), as it is for young people more generally.
Homeless young adults ages 18–25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age = 21.8 years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3 month and past 30 day alcohol use (ps ≤ 0.05), motivation to change drug use (ps < 0.05), and condom use self-efficacy (p = 0.05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p < 0.05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes.
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However, these proportion variables were skewed as well. Typically, in the social network literature, the way skewness has been handled is to recode proportion into categorical variables (Barrington et al., 2009; Davey-Rothwell & Latkin, 2007; Latkin et al., 2010; Tucker et al., 2012; Tyler, 2013; Valente & Auerswald, 2013). The median is used to create a threshold for measures that are not uniformly distributed (Wang, Fan, & Willson, 1996).
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.
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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.
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Original articleGender Differences in Sexual Risk and Sexually Transmitted Infections Correlate With Gender Differences in Social Networks Among San Francisco Homeless Youth

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study population and recruitment

Sample demographics

Sexual risk and sexually transmitted infections by gender

Discussion

Acknowledgments

Soc Sci Med

J Adolesc Health

J Adolesc Health

J Adolesc

Soc Sci Res

J Adolesc

J Adolesc Health

Soc Sci Med

J Adolesc Health

J Adolesc Health

Soc Sci Med

Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth

Health Place

Residential trajectory and HIV high-risk behaviors among Montreal street youth—A reciprocal relationship

J Urban Health

The health of street youth: A Canadian perspective

Can J Public Health

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

Sex Health

Predictors of sexually transmitted infection testing among sexually active homeless youth

AIDS Behav

Housing stability over two years and HIV risk among newly homeless youth

AIDS Behav

Individual and environmental protective factors for risky sexual behavior among homeless youth: An exploration of gender differences

AIDS Behav

The everyday violence of hepatitis C among young women who inject drugs in San Francisco

Hum Organ

Pro-social and problematic social network influences on HIV/AIDS risk behaviours among newly homeless youth in Los Angeles

AIDS Care

Original article
Gender Differences in Sexual Risk and Sexually Transmitted Infections Correlate With Gender Differences in Social Networks Among San Francisco Homeless Youth