Correlates and Rates of HIV and STI Testing Service Utilization Among Homeless Youth across Seven U.S. Cities

Background and Purpose: Youth experiencing homelessness (YEH) experience high rates of HIV and STIs compared to their housed peers. HIV and STI testing services play a key role in the prevention and early detection of HIV and other sexually transmitted diseases. Existing data on testing rates among YEH is limited; however, these data suggest over 50% of YEH have ever tested for HIV or STIs. While there have been some studies focused on HIV and STI testing among YEH, most of these have focused on one region or one city. This limited scope hampers our understanding of the broader trends and variations in testing behaviors among this population across diverse geographical contexts, which could offer vital insights to enhance intervention initiatives in significant regions across the United States. The current study seeks to address this gap by comparing HIV and STI testing rates and correlates among seven U.S. cities. Using Anderson’s behavioral model of health services use, this study identified variables as potential predisposing and enabling factors to HIV and STI testing among YEH.

Methods: This study was a secondary data analysis of the Homeless Youth Risk and Resilience Survey (HYRRS) conducted by the Research, Education, and Advocacy Co-Lab for Youth Stability and Thriving (REALYST) national research collaborative between 2016 and 2017. The seven cities where participants were recruited included Los Angeles, San Jose, Phoenix, St. Louis, Denver, Houston, and New York City. This cross-sectional survey was administered to 1,426 youth were homeless at the time of data collection. 58.5% of participants are cisgender males, and the average age was 20.88 years (SD=2.08). Most participants (37.5%) identified as Black or African American, and the majority had at least a high school education (69.1%).

Results: Results from multivariate logistic regression analyses found YEH in Denver (OR=0.63, p<.05), Houston (OR=0.62, p<.05), Phoenix (OR=0.36, p<.001), San Jose (OR=0.26, p<.001, and St. Louis (OR=0.50, p<.01) were significantly less likely than YEH in Los Angeles to receive an HIV test. Additionally, YEH who reported being sexually active prior to the age of 16 (OR=0.65, p<.01) were less likely to utilize HIV testing services while those who had online sex partners (OR=1.34, p<.05) were more likely to receive an HIV test. With respect to STI testing service use, YEH in NYC (OR=1.71, p<.05) were significantly more likely to get tested the YEH in Los Angeles while participants in Phoenix (OR=0.48, p<.01) and San Jose (OR=0.42, p<.001) were significantly less likely to receive an STI test.

Conclusions: Results of this study demonstrate significant differences in the rates of HIV and STI testing services use across seven major U.S. cities. These findings highlight key questions about whether the allocation of U.S. public health resources is truly equitable. Moreover, these findings demonstrate that there may be barriers to accessing critical HIV and STI testing services in different cities. This underscores the urgency of enhancing educational initiatives and community-engaged outreach efforts, especially in cities where a lower proportion of young adults experiencing homelessness are availing themselves of these vital services.