HIV and Drug Use Prevention Needs Among Migratory Homeless Youth in the United States

Background and Purpose: Homeless youth are a diverse population of adolescents and young adults who experience negative health outcomes, including drug use, drug overdose, infectious diseases such as HIV and tuberculosis, and victimization. Currently, it is estimated that 2 million youth are homeless in the United States. One subgroup of homeless youth that may be at especially high risk for negative health outcomes are migratory homeless youth, also known as “travelers.”  Research estimates that travelers comprise about 20% of the homeless youth population. Our study examined specific HIV and drug use prevention service needs of migratory homeless youth as well as what factors need to be considered in developing effective interventions for this unique group of young people.

Methods: In 2015, we conducted a qualitative study with migratory homeless youth in Portland, Oregon (USA). We purposively recruited 19 homeless youth, with an average age of 22 years. The sample was diverse with males (n=13), females (n=5) and one transgender participant. Participants were willing to interview and express interest on the topic.

Results: Alcohol, heroine, and marijuana were reported as the most used substances. Several participants reported transitions from casual substance users to addicts and “getting stuck in one place” as they became dependent on a local drug dealer. Regarding HIV risks, participants reported that risky behaviors are abundant and (i.e., unprotected sex; needle sharing) often resulted in pregnancy, sexually transmitted infections (STI), and HIV. Most participants knew other youth with a history of STIs. Knowledge of available prevention services was limited. Access to healthcare was limited as participants reported that they “doctor” themselves or others on the road, using small medical kits or over-the-counter medicines. 

Conclusions and Implications: Current prevention services that are available and effective for traditional homeless youth populations may not be effectively reaching and engaging travelers. Portland has a multitude of services, yet travelers underuse them. These migratory youth have different needs than traditional homeless youth. Due to their migratory circumstances, multilevel, multi-city, combination prevention strategies are urgently needed for this population. In addition to behavioral risk-reduction interventions, travelers need immediate and ongoing access to clean needles, condoms, and other survival services.