Predictors of Sexually Transmitted Infection Testing Among Sexually Active Homeless Youth

Discussion

Homeless youth are at high risk for STIs. Half of our sample was sexually active in the preceding 3 months and a significant proportion engaged in high-risk sexual behaviors and used substances. Although 46% of sexually active youth in our sample had received an STI test in the past 3 months, youth's high-risk sexual behaviors were not associated with STI testing. This finding supports our hypothesis. A need exists for the development of outreach programs that target sexually active homeless youth for early STI detection and treatment.

The STI rate found in our study (32%) is a higher than in another study of homeless youth (23%; Goodman and Berecochea, 1994). Although this rate is high, it is likely an underestimate of STI rates in sexually active homeless youth. Some STIs can be asymptomatic (e.g. Chlamydia and genital herpes) and unless youth receive laboratory screening, they are unlikely to know they are infected. In addition, a previous study has shown that youth are likely to underreport STIs (Clark et al., 1997). Further, we only assessed STI testing for the prior 3 months; past year STI rates may be higher in this group.

In our study, although sexually active boys and girls had similar rates for STI testing, girls were significantly more likely to have positive STI results than boys. This finding may be explained by the lower use of condoms among sexually active girls compared to boys. Our findings are consistent with a previous study that found sexually active homeless girls were at higher risk for STIs than boys because of inconsistent condom use (Noell et al., 2001). We also found a history of pregnancy or getting someone pregnant to be the only predictor of STI testing. A likely explanation for our findings is that physicians are likely to offer pregnant girls STI testing, as this is a standard of care.

The sampling procedures used in this study were designed to recruit a cohort of homeless youth who had been homeless for less than 6 months. All youth who met criteria for being homeless for less than 6 months were included in our study and we had a low refusal rate. The distinction between newly homeless young people who have been out of home for a short period of time and chronic experienced homeless young people has been overlooked in the research literature (Milburn et al., 2005). Classifying homeless young people by time out of home provides a greater understanding of the heterogeneity of homeless young people. However, there are limitations to this study that need to be mentioned. First, our data are cross-sectional and did not allow for temporal sequencing of risk behaviors and STI testing or the causal relationships of risk behaviors and STI testing. Second, the low prevalence of behaviors, such as survival sex and intravenous drug use, limited our ability to examine high-risk behaviors for HIV that may be either positively or negatively associated with STI testing. Third, all of our data are based on self-reports and therefore may be subject to reporting biases. To minimize bias, risk behaviors were assessed only over the previous 3 months and all sensitive data were collected using Audio-CASI. The use of Audio-CASI has been shown to increase the accuracy of responses obtained in self-administered questionnaires (O'Reilly et al., 1994; Turner et al., 1992, 1995).

Future research that evaluates STI rates and risks among sexually active homeless youth would benefit from physiologic assessments rather than relying on youth's self-report of STIs. In addition, future research should explore individual and institutional factors that facilitate or serve as barriers to STI testing in homeless youth. Some of these barriers may include youth being unaware of the need for STI screening if having sex without condoms and the lack of availability of screening services. In addition, longitudinal studies should examine subgroups of sexually active homeless youth who continue to engage in high-risk sexual behaviors and changes in their STI testing patterns over time.

Our findings indicate STI outreach programs for sexually active homeless youth that offer early STI testing and treatment are needed. Such programs can provide individual as well as societal benefits. Early STI detection and treatment is an effective HIV prevention strategy.

AIDS and Behavior. 2006;10(2):179-184. © 2006 Springer
Springer Science Business Media

Cite this: Predictors of Sexually Transmitted Infection Testing Among Sexually Active Homeless Youth - Medscape - Mar 01, 2006.