Permanent supportive housing (PSH) has been recognized by the U.S. federal government as the ''clear solution'' to chronic homelessness. Whether and how access to PSH affects HIV risk is unclear. This mixed methods pilot study uses a convergent parallel design in order to better understand social relationships and HIV risk during the transition from homelessness to PSH. Findings suggest that (a) Sexual activity and HIV risk behaviors increase with housing, (b) Social network size and composition appear to change as individuals transition into PSH, and (c) There is tension between moving forward and leaving behind the past once a person has housing. This study demonstrates that PSH constitutes a specific risk environment that has not been previously investigated.

Permanent supportive housing (PSH) has been recognized as central to the goal of ending chronic homelessness. This qualitative study considers the positive and negative expectations of 31 men and women in the Skid Row area of Los Angeles who are beginning the transition from homelessness to PSH through a Housing First approach. This study uses in-depth, qualitative interviews and an inductive approach informed by sensitizing concepts derived from the literature and thematic analysis of case summaries, interview transcripts, and interviewer feedback and observation. Three themes emerged from the data: (a) nowhere to go but up, (b) some things stay the same, and (c) neighborhood matters. These findings indicate that PSH is regarded as a fresh start and universally positive experience, and that the role of neighborhood highlights a tension in the pursuit of recovery from homeless between removing people from their neighborhoods versus keeping them close to their previous and familiar environments. Implications for social work practice include that maximizing a successful transition will require understanding and managing people's expectations and reality.

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Sexual concurrency poses significant HIV/STI transmission risk. The correlates of concurrency have not been examined among homeless men. A representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row area of Los Angeles reported on their mental health, substance use, and social network characteristics. Nearly 40% of men reported concurrency with one of their four most recent sex partners. Results indicated that HIV seropositivity (OR = 4.39, CI: 1.10, 17.46; p = 0.04), PTSD (OR = 2.29, CI: 1.05, 5.01; p = 0.04), hard drug use (OR = 2.45, CI: 1.07, 5.58; p = 0.03), and the perception that network alters engage in risky sex (OR = 3.72, CI: 1.49, 9.30; p = 0.01) were associated with increased odds of concurrency. Programs aimed at reducing HIV/STI transmission in this vulnerable population must take into account the roles that behavioral health and social networks may play in sexual concurrency.

Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.

Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.

Most studies examining peer influence on drug-use among youth experiencing homelessness (YEH) have relied on perceptions of peer use rather than measuring peers' self-reported use, an approach that can inflate estimates of peer substance use behavior. Sociometric network data provide an optimal mechanism to compare perceptual data to actual self-reports from peers. Method: Using an event-based approach, we recruited a sample of YEH (N 5 241), ages 13-25 years, between October 2011 and February 2012 from 2 drop-in centers-1 in Hollywood, CA, and 1 in Santa Monica, CA. We used multilevel multiple membership modeling to investigate participant-level, network-level, and relationshiplevel factors associated with the accuracy of respondent perceptions. Results: The accuracy of respondent perceptions of peer substance use was high (70%-90% depending on the substance). The individual-and network-level factors associated with accuracy or inaccuracy varied by substance. Conclusions: Interventions designed to reduce the risk of substance use among YEH may benefit from using a social norms approach that emphasizes changing norms at a community/group level rather than at an individual level.

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