Impact of Homelessness On Vulnerability to HIV Among Young Latino MSM: Youth and Provider Perspectives

Background and Purpose: Latino MSM are disproportionately affected by HIV/AIDS. Among Latino MSM, homeless youth may be especially vulnerable as research has observed high rates of victimization, poor mental health, substance use, and survival sex. Although structural inequalities have emerged as key drivers of the HIV/AIDS epidemic, these factors have been underexplored with Latino youth who are homeless and gay. The present study sought to better understand the contextual factors that shape vulnerability to HIV/AIDS from the perspectives of both homeless gay youth and the providers who serve them. In doing so, the study addresses an important gap, as little is known about how structural factors manifest at different ecological levels (i.e., individual, interpersonal, community, and societal) and how Latino MSM and service providers work together to offset the risks posed by structural inequalities.

Methods: Focus groups were conducted with 18 homeless Latino MSM aged 18 – 25 years old and 15 service providers at an LGBT-serving agency. Focus groups with Latino MSM examined risk factors for homelessness, the link between homelessness and health, sources of support and resilience, and youth’s future life goals. Provider focus groups explored risk factors for homelessness, the link between homelessness and health, and the context of service provision. Focus groups were conducted in English and recorded on digital voice recorders. A written transcript was produced for each focus group and then uploaded into Dedoose for qualitative data analysis. Three independent coders conducted a content analysis of each transcript to identify, categorize, and code themes from the data.

Results: Family rejection was identified as a primary risk factor for homelessness. Negative family responses were discussed as an individual problem, as well as a symptom of societal discrimination. Once disconnected from their family of origin, young men were vulnerable to HIV through several pathways; common narratives involved victimization, substance use, and survival sex. Providers also identified the lack of housing and employment as drivers of vulnerability to HIV. Despite their histories of homelessness, most youth were optimistic about attaining housing and achieving their life goals. Social support was important for youth and providers described the context in which they built caring relationships with young men. Beyond support, young men identified services that could help them become stably housed and reduce their vulnerability to HIV/AIDS. These included: access to long-term transitional housing, educational, vocational, and financial training, and meaningful economic opportunities.

Implications: Current HIV/AIDS prevention programs often focus on reducing individual risk behaviors. Our results suggest that the structural factors that shape the contexts in which young men live warrant additional attention. First, homeless youth need educational and economic services that can help them to become stably housed. Future research should explore how to integrate such services into HIV-prevention programs and which types of services are most successful. Second, additional work is needed to combat stigma/discrimination and to support the families of gay youth. Although more distally related to HIV infection, our results suggest that they are precursors to homelessness among young Latino MSM.