Substance use and risky sexual behavior among homeless and runaway youth

Abstract

Purpose-To (a) characterize human immunodeficiency virus (HIV)-related risk behaviors of homeless youth; (b) determine whether substance use is associated with risky sexual behavior in this population; and, if so, (c) explore explanations for this relationship.Methods-A purposive sample of 327 homeless youth (ages 14-21 years) in Washington, DC, were surveyed in 1995 and 1996. Survey items were adapted from items used in a national study of adult substance use and sexual behavior and measured global (lifetime) and event-specific (most recent sexual encounter) behaviors.Results-Sexual activity with many partners, "survival" sex, and substance use were common. However, needle use was rare, and consistent condom use was evident in half the sample. Nearly all correlations between global measures of substance use and risky sex were statistically significant, but only a few of the event-specific correlations were significant. Marijuana use during the most recent sexual encounter was associated with nonuse of condoms, but this relationship disappeared in the multivariate model. However, crack use during the last encounter was associated with condom use; this relationship remained significant in the multivariate model. Lack of motivation to use condoms, longer histories of sexual activity and homelessness, symptoms of drug dependency, not discussing HIV risks with partner, and being female were also associated with nonuse of condoms.Conclusions-Homeless youth do use condoms, even within the context of substance use and casual sex. Results suggest that prevention and targeted intervention efforts have had some positive effect on this population, but young homeless women are in need of targeted prevention. Finally, additional research is needed to investigate the observed relationship between crack use and condom use in this sample. KeywordsDrug use; Alcohol use; High-risk sexual behavior; HIV; AIDS; Homeless youth; Adolescents; Condom use; Event-level relationships; Gender differences Since the discovery of human immunodeficiency virus (HIV) 15 years ago, effective prevention remains the greatest hope for arresting its spread. To this end, research has focused on identifying the specific populations for targeting interventions, as well as the behavioral, situational, and cultural factors that influence sexual behaviors and may be amenable to intervention.© Society for Adolescent Medicine, 1998 Address reprint requests to: Dr. Susan L. Bailey, Department of Psychiatry, Pittsburgh Adolescent Alcohol Research Center, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213. NIH Public AccessAuthor Manuscript J Adolesc Health. Author manuscript; available in PMC 2010 June 9. Published in final edited form as:J Adolesc Health. 1998 December ; 23(6): 378-388. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe use of alcohol or drugs in conjunction with sex is commonly believed to lead to sexual risk taking, but empirical studies of the associations between substance use and high-r...

Homeless Women: Who is Really at Risk for Unintended Pregnancy?

“…The reasons for these findings are unclear. They contrast with findings from the general population and among homeless youth, where having multiple sexual partners has been shown to be associated with greater risktaking behaviors, including contraceptive nonuse [19,20]. This discrepancy may be because homeless women who are married or living with partners and those in monogamous relationships may be less averse to becoming pregnant than those who have multiple partners and no committed relationship.…”

“…The homeless women in this study reported high rates of contraceptive nonuse or rare use despite their risk for unintended pregnancy [19][20][21]. One-third of sexually-active homeless women at risk for unintended pregnancy were not using contraception, or did so only rarely; one in four (27%) were not using any form of contraception at all, compared to 5% in the general population [8].…”

Alcohol, drugs, and condom use among drug offenders: An event-based analysis

“…Using data from a national survey, Schafer, Blanchard & Fals-Stewart (1994) found that people who used any drug (not including alcohol) at the most recent sexual encounter with a new sexual partner were less likely to use condoms than were non-users. Street youth who used marijuana in a recent sexual encounter were less likely to use condoms, but those who used crack were more likely to use condoms (Bailey, Camlin, and Ennett, 1998). Marijuana use with sex was also associated with decreased condom use at a recent sexual encounter among adolescents in detention (Kingree and Betz, 2003;Kingree, Braithwaite, and Woodring, 2000;Kingree and Phan, 2002) and among MSM (Clutterbuck et al, 2001), but was unrelated to condom use among young heterosexual adults (Brodbeck, Matter, and Moggi, 2006).…”

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

“…[3][4][5] Additionally, the time spent on the street exposes them to drug users, sexual predators and other high-risk individuals who may exploit them and endanger their physical health. 6,7 Also, homeless youth have extremely low rates of condom usage and numerous sexual partners, 6,[8][9][10][11][12] which increases their risk for contracting STI. Self-reported rates of STI among homeless youth range from ~20% to 37%.…”