We examined the interconnectedness of stigma experiences in families living with HIV, from the perspective of multiple family members. Semi-structured interviews were conducted with 33 families (33 parents with HIV, 27 children under age 18, 19 adult children, and 15 caregivers). Parents were drawn from the HIV Cost and Services Utilization Study, a representative sample of people in care for HIV in US. All of the families recounted experiences with stigma, including 100% of mothers, 88% of fathers, 52% of children, 79% of adult children, and 60% of caregivers. About 97% of families described discrimination fears, 79% of families experienced actual discrimination, and 10% of uninfected family members experienced stigma from association with the parent with HIV. Interpersonal discrimination seemed to stem from fears of contagion. Findings indicate a need for interventions to reduce HIV stigma in the general public and to help families cope with stigma.

BACKGROUND This study examines whether residential neighborhood characteristics influence the initiation of marijuana use and binge drinking, and if these neighborhood factors heighten or dampen peer influences on substance use. METHODS Predictors of marijuana (N = 6,516) and binge drinking (N = 6,630) initiation over a one-year period were identified using data from the National Longitudinal Study of Adolescent Health. Participants were ages 12–19 years at baseline. The main predictor variables were neighborhood characteristics, using both objective (proportion of households below the poverty line and female-headed, unemployment rate, residential stability) and subjective (perceived cohesion and safety) measures. Binge drinking was defined as 5 or more drinks in a row. RESULTS Initiation occurred for 12.9% of adolescents in the case of marijuana and 16.4% for binge drinking. Marijuana initiation was more likely among adolescents who lived in neighborhoods with a higher unemployment rate, and binge drinking initiation was more likely among those who perceived greater safety in their neighborhood, after adjusting for other neighborhood characteristics, demographics, friend characteristics, and behavioral and family risk factors. There was no evidence that neighborhood context moderates the associations of peer factors on initiation. CONCLUSIONS Select neighborhood characteristics appear relevant to the initiation of marijuana use and binge drinking, although the mechanisms appear to be distinct for each substance. If these results are found to be robust, future research will help better understand how neighborhood context influences the initiation of adolescent substance use in order to inform prevention efforts.

This study used an event-based approach to understand condom use in a probability sample of 309 homeless youth recruited from service and street sites in Los Angeles County. Condom use was significantly less likely when hard drug use preceded sex, the relationship was serious, the partners talked about “pulling out”, or sex occurred in a non-private place (and marginally less likely when heavier drinking preceded sex, or the partnership was monogamous or abusive). Condom use was significantly more likely when the youth held positive condom attitudes or were concerned about pregnancy, the partners talked about condom use, and the partners met up by chance. This study extends previous work by simultaneously examining a broad range of individual, relationship, and contexual factors that may play a role in condom use. Results identify a number of actionable targets for programs aimed at reducing HIV/STI transmission and pregnancy risk among homeless youth.

CONTEXT Pregnancy rates are substantially higher among homeless youth than in the general population of youth, yet little is known about homeless adolescents’ and young adults’ pregnancy-related attitudes and behaviors. METHODS Pregnancy-related attitudes and behaviors were examined among two samples of sexually active homeless 13–24-year-olds in Los Angeles County. Data from 37 semistructured interviews conducted in March–April 2011 were analyzed using standard qualitative methods. Data from a structured survey with 277 respondents, conducted between October 2008 and August 2009, were analyzed primarily using regression modeling. RESULTS More than half of interview respondents held ambivalent attitudes toward pregnancy, and ambivalent youth reported less contraceptive use than others. The interviews identified several potential influences on pregnancy attitudes: barriers associated with homelessness, readiness to settle down, desire to achieve goals, belief that a child would create something positive in life, and family and partners. In the survey, having positive attitudes toward pregnancy was positively associated with duration of homelessness (odds ratio, 1.6), contact with relatives (1.1) and relationship commitment (1.8); it was negatively associated with frequency of drinking (0.9). Relationship commitment was positively associated with nonuse of an effective contraceptive method at last sex (1.5). CONCLUSIONS Effective and accessible pregnancy prevention and family planning programs for homeless youth are needed. Youths’ ambivalence toward pregnancy and feelings of relationship commitment warrant attention as possible areas for programs to address.

The goal of this exploratory study was to examine the composition of homeless women’s personal networks in order to better understand the social context of risk behavior in this vulnerable population. Twenty-eight homeless women residing in temporary shelters in Los Angeles County provided detailed information about their extended personal networks. Women named 25 people with whom they had contact during the past year, and then were asked a series of questions about each one of these named network members. Results indicate that the personal networks of homeless women are larger and more diverse than suggested by previous research. About one-third of women’s relationships were with high-risk individuals (i.e., people perceived to drink heavily, use drugs, or engage in risky sex). However, most women also reported having relationships that could be characterized as both “low risk” (e.g., involving individuals perceived as not drinking heavily, using drugs, or engaging in risky sex) and “high quality” (e.g., long-term, emotionally close, or supportive), although these relationships tended to be rather tenuous. Our results suggest a need to assist homeless women in strengthening these existing low-risk/high-quality relationships, and extending the diversity of their networks, in order to increase women’s exposure to positive role models and access to tangible support and other needed resources.