Personal and Social Network Correlates of Survival Sex Involvement Among Gender and Sexual Minority Young Adults Experiencing Homelessness: A Seven City Study

Background and Purpose: Gender and sexual minority (GSM) young adults are disproportionately impacted by homelessness, which is a major facilitator of survival sex involvement (i.e., exchange sex for money, drugs, housing, and food). Compared to non-GSM young adults experiencing homelessness (YAEH), GSM YAEH are especially vulnerable to survival sex. Despite the significant and oftentimes long-term adverse health and mental health impacts of survival sex (e.g., HIV, STIs and suicidality), research on survival sex among GSM YAEH remains scarce. Informed by the socio-ecological framework, this study aims to explore personal and social environmental correlates of survival sex (i.e., social network) among GSM YAEH to inform future survival sex reduction intervention development and delivery targeting this vulnerable population.

Methods: This study used a subset of the Homeless Youth Risk and Resilience Survey data collected originally from 1,384 YAEH aged between 18 to 24 in seven major cities across the U.S. For the purpose of the study, we only included YAEH who self-identified as a sexual or gender minority (i.e., gay, lesbian, bisexual, questioning, transgender, or gender nonconforming; N=425). Bivariate and multivariate logistic regression analyses were conducted to identify personal correlates (e.g., homeless experiences, trauma exposure, and mental health history) and social network correlates (i.e., network composition, such as number of relatives in the network) of survival sex involvement.

Results:

Over 33 percent GSM YAEH engaged in survival sex during homelessness. Personal characteristics, such as homelessness due to running away from home (OR=1.8; 95% CI=1.0, 3.1), longer duration of homelessness (OR=1.7; 95% CI=1.0, 2.8), street victimization history (OR=3.0; 95% CI=1.2, 7.5), and lifetime diagnosis of mental illness (OR=2.1; 95% CI=1.1, 3.9) were associated with elevated survival sex risk. Social network composition, including having more street peers (OR=1.2; 95% CI=1.1, 1.5) and more romantic partners (OR=1.6; 95% CI=1.1,2.1) in their close network were associated with increased risk of GSM YAEH’s survival sex involvement.

Conclusions and Implications: Consistent with previous literature, this study found that GSM YAEH was at significant higher risk of survival sex involvement as compared to their Non-GSM peers (33% vs. 13%; χ2=75.13). In addition to adverse physical and mental health consequences, street-based survival sex is known to be especially dangerous, particularly for young adults with marginalized identities. Our findings highlight the imperative need for survival sex risk reduction interventions tailored to GSM YAEH. More specifically, such interventions should address GSM YAEH’s trauma exposure growing up (e.g., family rejection or conflicts) and during homeless (e.g., street victimizations) by employing trauma-informed principles. Network-based survival sex risk reduction interventions should be cautious of potential social ties (e.g., street peers and romantic partners), though they could be sources of vital supports, they may increase GSM YAEH’s risk for engaging in survival sex. This study failed to identify protective roles among social network compositions. Future research should further examine GSM YAEH’s social networks in detail to identify network ties that do mitigate GSM YAHE’s survival sex risks.