Homelessness and drug abuse among young men who have sex with men in New York city: A preliminary epidemiological trajectory

Abstract

The objective of this paper is to profile the role of homelessness in drug and sexual risk in a population of young men who have sex with men (YMSM). Data are from a cross-sectional survey collected between 2001 in New York City (N = 569). With the goal of examining the import of homelessness in increased risk for the onset of drug and sexual risk, we compare and contrast three subgroups: (1) YMSM with no history of homelessness, (2) YMSM with a past history of homelessness but who were not homeless at the time of the interview, and (3) YMSM who were currently homeless. For each group, we describe the prevalence of a broad range of stressful life events (including foster care and runaway episodes, involvement in the criminal justice system, etc.), as well as selected mental health problems (including past suicide attempts, current depression, and selected help-seeking variables). Additionally, we examine the prevalence of selected drug and sexual risk, including exposure to a broad range of illegal substances, current use of illegal drugs, and prevalence of lifetime exposure to sex work. Finally, we use an event history analysis approach (time-event displays and paired t-test analysis) to examine the timing of negative life experiences and homelessness relative to the onset of drug and sexual risk. High levels of background negative life experiences and manifest mental health distress are seen in all three groups. Both a prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk. Onset of these risks occur earlier in both groups that have had an experience of housing instability (e.g., runaway, foster care, etc.) but are delayed or not present among YMSM with no history of housing instability. Few YMSM had used drug prior to becoming homeless. While causal inferences are subject to the limitations of a cross-sectional design, the findings pose an empirical challenge to the prevailing assumption that prior drug use is a dominant causal factor in YMSM becoming homeless. More broadly, the data illustrate the complexity of factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of homelessness and its relationship to the onset of drug and sexual risk among high risk youth populations.

Modeling Minority Stress Effects on Homelessness and Health Disparities among Young Men Who Have Sex with Men

“…Previous research has documented elevated substance use as a coping response to past negative life events and street-survival among both marginally housed YMSM, 10 although our results suggest that ever being kicked out of one's home is a significantly larger predictor of daily marijuana use than past-year homelessness. Substance use among YMSM has also been shown to be associated with experiencing dimensions of minority stress, 27,28 and being kicked out of one's home has been associated with a range of negative health outcomes among sexual minority youth.…”

“…36 Clatts et al examined past stressful experiences in a sample composed of YMSM who were currently homeless, had experienced homelessness but were currently stably housed, and who had never experienced homelessness. 10 All three groups reported high levels of background stressful events, foster care, or involvement in criminal justice systems. Although the majority of homeless and non-homeless youth reported background negative life experiences, and lifetime substance use was pronounced in all three groups, examination of the timing of events across the groups revealed that negative life events occurred prior to the onset of substance use.…”

“…How minority stress varies among sexual minority youth and how it may help explain associations between health outcomes and homelessness among sexual minority youth is not well understood. A small number studies have analyzed the health of homeless sexual minority youth compared to stably housed sexual minority youth, 10,35,36 and each have provided insights into the relationships to background experiences, stressors, homelessness, and health that differentiate risks among sexual minority youth. Each of these studies has assessed stressors experienced among sexual minority youth experiencing homelessness, although types and timing of stressors have differed across studies.…”

“…7,9 Much of the disparities exhibited by youth experiencing homelessness have been attributed to past early and background negative life experiences. [10][11][12][13] Numerous studies using community-based samples of homeless youth have documented that sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, [14][15][16][17][18][19] yet few among these have assessed determinants that help explain the disparities between sexual minority youth and heterosexual youth experiencing homelessness.…”

Health educators’ perceptions of a sexual health intervention for homeless adolescents

“…This finding has been attributed primarily to past experiences such as sexual abuse and early sexual debut as well as current behaviors such as having multiple sex partners, engaging in sex while under the influence of alcohol and other drugs, exchanging sex for survival needs, and engaging in sex with intravenous drug users. [1,2] One of the National health objectives set forth in Healthy People 2010 is to "promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications" [3 p 25].…”