Sexual Health Communication Among Youth Experiencing Homelessness and Their Social Network Members: An Egocentric Network Analysis

Background and Purpose: Youth who experience homelessness are disproportionately impacted by HIV when compared to their stably housed counterparts. There has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication among youth experiencing homelessness (YEH), despite the potential for sexual health communication to be leveraged for HIV prevention. This study examines how sexual health communication among YEH is associated with social network characteristics and individual-level HIV risk factors.

Methods: Cross-sectional survey and social network data from 1,014 YEH aged 14–25 recruited in Los Angeles, California, were utilized to assess individual and network characteristics associated with communication regarding condom use and HIV testing. The study consisted of a social network interview (face-to-face) and a computerized self-administered survey. Measurements examined from the self-administered survey included drug use (i.e., use of meth, cocaine, injection drugs, and heroin during the prior 30 days), sexual behavior variables (i.e., condom use, exchange sex, and testing for HIV in the prior 3 months) and demographics. For the social network interview, YEH were asked to name every person with whom they interacted during the previous month (social network members [SNMs]). Then questions were asked about characteristics (e.g., age, race, gender, relationship) and communication (e.g., condom use and HIV testing) with of each SNM. Multilevel modeling was conducted to understand how individual characteristics (e.g., age, race, drug use, and sexual risk behaviors) and SNM characteristics (e.g., years known, and network relationship type) were associated with the two kinds of sexual health communication (i.e., condom use and HIV testing).

Results: A total of 9,981 social network members (SNMs) were nominated, with youth nominating an average of 9.13 SNMs each. Specifically, 62% YEH listed at least one street-based peer, 38% listed at least one home-based peer, 20% listed at least one relative, 6% listed at least one serious partner, and 4% listed at least one casual partner. YEH with least one serious partner in their networks had almost 12 times the odds of talking about condom use (95% CI = 7.39, 19.18) and 17 times the odds of talking about HIV testing (95% CI = 10.46, 27.88) with their serious partners. YEH were also significantly more likely to speak with their home-based peers about condom use and HIV testing compared to their street-based peers (OR = 3.17; 95% CI = 2.18, 4.61 and OR = 2.77; 95% CI = 1.84, 4.15, respectively). Additionally, YEH with at least one drop-in center staff member in their networks had 4 times the odds of talking about HIV testing (95% CI = 2.08, 7.53).

Conclusion and Implications: Results suggest that social networks are key to understanding sexual health communication; YEH’s engagement in sexual health communication was significantly related to the composition of their networks. This study indicated that training preexisting social network members (e.g., staff members, home-based peers, or partners) as agents of change within naturally occurring social networks of YEH would be a beneficial strategy in the efforts of reduce new HIV incidences.