Have You Heard?: Development of a Social Network Peer Leader HIV Prevention Intervention for Homeless Youth

Background: Homeless youth experience elevated rates of HIV compared to their housed counterparts, resulting from co-occurring risks related and street-engaged lifestyles. Peer-based, network driven interventions have been suggested for this population but never fully developed and tested. Have You Heard (HYH) is a peer leader training intervention, developed as part of a pilot study, utilizing Artificial Intelligence technologies to identify key individuals in a homeless youth network for the purpose of efficient information dissemination. HYH was developed based on existing peer leader HIV prevention interventions (e.g. Kelly’s POL and Latkin’s SHEILD).

Methods: The process of intervention development included empirically driven considerations specific to Homeless Youth, such as reduction in intervention length, flexible follow-up and ‘booster’ sessions (i.e. social-media, phone and in-person), and inclusion of discussion related to street-engaged life (trauma and sexual violence, harm reduction). Aspects of sexual anatomy and physiology were included in discussion to bolster what may otherwise be an incomplete sexual education among participants. As a result of community identified needs and advances in recent medical technology, discussions of Hepatitis C and PrEP were included in the intervention. The intervention also addressed different learning styles by including a variety of learning activities such as group discussion, journaling and reflection, role playing and experiential activities.

Results: At baseline 117 youth were enrolled, and 85 youth were retained at 1-month follow-up assessment. The impact of the intervention led to an increase in HIV testing behaviors within the broader network sample.  Of the non-peer leaders, 67% had a recent HIV test at baseline and 76% had a recent HIV test at 1 month (chi-square=1.33, p=0.249). Participating in the intervention as a peer leader had a greater effect on HIV testing behaviors. At baseline, 68% of the peer leader had a recent HIV test. At 1-month follow up 94.7% of the peer leaders had a recent HIV test (chi square= 4.38 p=.036). Additionally, peer-leaders reported finding the intervention training to be empowering, enjoyable and relevant.

Discussion: Considering the challenges when implementing health and prevention interventions within homeless and other at-risk youth populations, results from this pilot study show success in a peer-leader based intervention model. Overall, the intervention had an impact on HIV prevention behaviors in the larger social network. The individuals that were engaged in the actual peer-leader training appeared to experience an additional positive youth development impact. The authors believe this was the result of the trainings focus on personal empowerment, communication skill building and encouragement to hold the seat of a leader within their peer group. Future research will assess this potential effect of the intervention at further detail as well as the larger HIV prevention impact in the target networks. Lessons learned, challenges and future refinement of the HYH intervention will be discussed in detail within the presentation.