Sex and Relationships on the Street: How Homeless Men Judge Partner Risk on Skid Row

Brown, Ryan Andrew; Kennedy, David P.; Tucker, Joan S.; Wenzel, Suzanne L.; Golinelli, Daniela; Wertheimer, Samuel; Ryan, Gery W.

doi:10.1007/s10461-011-9965-3

Cited by 25 publications

(52 citation statements)

References 29 publications

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“…Being homeless is a barrier to sexual intimacy due to limited privacy and shelter policies separating men and women (Brown, Kennedy, Tucker, Golinelli, & Wenzel, 2013). Having one’s own place may facilitate sexual intimacy, but condom use to prevent sexually transmitted infections (STIs) may decrease once one receives housing (Brown et al, 2012; Brown et al, 2013; Henwood et al, 2013; Henwood et al, 2015). These findings point to the importance of understanding need for HIV prevention among homeless persons entering PSH so that providers can ensure that such services are available to residents during this critical time of transition.…”

Section: Introductionmentioning

confidence: 99%

Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing

et al. 2016

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Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the health and wellbeing of PSH residents.

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Section: Introductionmentioning

confidence: 99%

Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing

et al. 2016

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“…Furthermore, relationship commitment has been significantly associated with more unprotected sex among homeless men and women and women living in shelters (Kennedy et al, 2010;Kennedy et al, 2013;Tucker, Elliott, Wenzel, & Hambarsoomian, 2007). In qualitative analyses, homeless individuals have stated that the "seriousness" of a relationship contributes to their assessment of their partner's risk regarding STIs such as HIV (Brown et al, 2012;Ryan et al, 2009). Trust of a partner has also been stated as a reason for engaging in unprotected sex (Brown et al, 2012;Cederbaum, Wenzel, Gilbert, & Chereji, 2013;Ryan et al, 2009), and the social costs of condom use may serve as a barrier (Worth, 1989).…”

Section: Chapter 4 Discussionmentioning

confidence: 99%

“…In qualitative analyses, homeless individuals have stated that the "seriousness" of a relationship contributes to their assessment of their partner's risk regarding STIs such as HIV (Brown et al, 2012;Ryan et al, 2009). Trust of a partner has also been stated as a reason for engaging in unprotected sex (Brown et al, 2012;Cederbaum, Wenzel, Gilbert, & Chereji, 2013;Ryan et al, 2009), and the social costs of condom use may serve as a barrier (Worth, 1989). For example, some homeless women have reported that they feel that initiating condom use with steady partners may raise suspicion regarding their faithfulness or fear losing their partner as a result (Cederbaum et al, 2013).…”

Section: Chapter 4 Discussionmentioning

confidence: 99%

“…One or both parties may have concurrent partners (Stein et al, 2007) that are undisclosed and/or may engage in needle-sharing if injecting drugs. STI risk-reduction interventions should address the risks involved in unprotected sex with spouses or in more "serious" relationships where increased trust and relationship commitment may be involved (Brown et al, 2012).…”

Section: Chapter 4 Discussionmentioning

confidence: 99%

“…In addition, sex exchange may also involve violence, which has been reported at increased rates among homeless and unstably housed individuals (Henny, Kidder, Stall, & Wolitski, 2007;Wenzel et al, 2004) and has been found to be associated with unprotected sex (Henny et al, 2007;Kennedy et al, 2010). A lack of housing may also serve as a barrier to privacy, which can make it more difficult to develop and maintain stable relationships (Aidala et al, 2005;Brown et al, 2012;Giannetti & Freyder, 1998). Unsurprisingly, sex with multiple partners (Giannetti & Freyder, 1998) has been reported among homeless individuals and, if unprotected, creates an effective means of STI transmission.…”

Section: Homelessness As a Barrier To Condom Usementioning

confidence: 99%

See 2 more Smart Citations

Housing First and Unprotected Sex: A Structural Intervention

Parpouchi¹,

Moniruzzaman²,

McCandless³

et al. 2016

Journal of Health Care for the Poor and Underserved

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Previous studies have found a high prevalence of sexually transmitted infections and associated risk behaviours among homeless and marginally housed adults. Although individual-level characteristics and their association with risk behaviours have traditionally been a major focus of research, the importance of structural factors, such as housing, that impact these behaviours have received increasing attention. Supported housing interventions like Housing First (HF) have been argued to potentially contribute to reductions in sexual risk behaviours. Using an experimental design, the present study investigated the effect of HF on unprotected sex among homeless adults with mental illness with a treatment as usual (TAU) comparison group. Over the 24 months of followup, no association was found between HF and unprotected sex when compared to TAU.Several other variables were independently associated with unprotected sex. Results indicate that in conjunction with HF, additional interventions are needed to reduce unprotected sex among homeless individuals with mental illness.

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Understanding Heterosexual Condom Use among Homeless Men

et al. 2012

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This study uses an event-based approach to examine individual, relationship, and contextual correlates of heterosexual condom use among homeless men. Structured interviews were conducted with a predominantly African American sample of 305 men recruited from meal lines in the Skid Row area of Los Angeles. Men reported on their most recent heterosexual event involving vaginal or anal intercourse. Adjusting for demographic characteristics only, condom use was more likely when men had higher condom use self-efficacy, greater HIV knowledge, or talked to their partner about condoms prior to sex. Condom use was less likely when men held more negative attitudes towards condoms, the partner was considered to be a primary/serious partner, hard drug use preceded sex, or sex occurred in a public setting. Condom attitudes, self-efficacy, partner type, and communication were the strongest predictors of condom use in a multivariate model that included all of the above-mentioned factors. Associations of unprotected sex with hard drug use prior to sex and having sex in public settings could be accounted for by lower condom self-efficacy and/or less positive condom attitudes among men having sex under these conditions. Results suggest that it may be promising to adapt existing, evidence-based IMB interventions for delivery in non-traditional settings that are frequented by men experiencing homelessness to achieve HIV risk reduction and thus reduce a significant point of disparity for the largely African American population of homeless men.

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Sex and Relationships on the Street: How Homeless Men Judge Partner Risk on Skid Row

Cited by 25 publications

References 29 publications

Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing

Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing

Housing First and Unprotected Sex: A Structural Intervention

Understanding Heterosexual Condom Use among Homeless Men

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