Youth Experiencing Homelessness and HIV Prevention Communication: A Multi-Level Dyadic Network Analysis

Background and Purpose: Youth experiencing homelessness (YEH) are at increased risk for contracting HIV compared to their stably housed peers. Given the importance of social networks to influencing the sexual risk behavior of YEH, the conversations YEH have with their social network members about sexual health may help promote safer sex practices.

Methods: The current study uses self-reported social network data collected from 731 YEH (age 14 to 26) accessing homeless youth services in Los Angeles, California, between September 2016 and October 2018. Participants were recruited in-person from three major drop-in centers serving YEH and completed a self-administered computerized survey that included items on demographics, recent sexual behaviors, and social network members. The majority of participants were male (65% male; 23% female; 6% transgender; 6% gender-expansive) and were youth of color (32% Black; 15% Latinx, 21% White; 6% another race; 25% Multiracial); a sizable majority identified as lesbian, gay, bisexual, questioning, or another sexual minority (LGBQ+) (43%). Multi-level dyadic network analysis was performed to examine the individual- and network-level characteristics associated with communication about condoms, pre-exposure prophylaxis (PrEP), HIV, and HIV testing.

Results: Relative to their cisgender male counterparts, YEH were significantly more likely to report talking to a social network member about PrEP if the youth identified as transgender (OR=3.65, 95% CI 1.53 to 8.76) or with a gender-diverse identity (OR=3.06, 95% CI 1.22 to 7.68). YEH in general were also more likely to talk to a social network member about PrEP if that network member identified as LGBQ+ (OR=8.45, 95% CI 1.13 to 2.77). YEH also indicated being more likely to talk to a romantic/sexual partner about condom use (OR=5.86, 95% CI 1.25 to 2.33) or HIV testing (OR=1.90, 95% CI 1.08 to 3.35) than to another YEH.

Conclusions and Implications: Understanding how YEH engage in sexual health communication with their social networks is necessary in order to build effective HIV prevention models for this vulnerable population. To decrease the incidence of HIV among YEH, we encourage further exploration into how to improve and expand communication about HIV protective behaviors (e.g., condom use, PrEP use, and HIV testing) in the social networks of YEH in order to promote safer sex behaviors in this population and recommend an emphasis on partner communications. Additionally, special attention to the unique needs and experiences of transgender and gender-diverse YEH regarding PrEP uptake is needed; future research must identify the specific strategies needed to reach these particular young people.