Couch-Surfing and Sexual Risk Among Youth Experiencing Homelessness: Insights from a Latent Class Analysis

Background and Purpose: Youth experiencing homelessness (YEH) are at higher risk for sexually transmitted infections compared to stably housed youth. While homelessness and risky peer networks are known to be associated with elevated sexual risk-taking among YEH, further work is needed to disentangle the types of homelessness and sources of social support that may affect risk. This is particularly relevant given the prevalence of “couch-surfing” among YEH and the unique role young people’s support networks play in facilitating these short-lived housing arrangements. This study represents the first investigation into whether profiles of YEH, based on living situation and social support networks, differ significantly in their sexual risk and prevention behaviors.

Methods: Survey data were collected between September 2016 and October 2018 at drop-in centers serving YEH in Los Angeles, CA. Participants were recruited in-person and engaged in a self-administered survey that included items on their most recent living situation, social support networks, and sexual behaviors. The sample of youth included in the present study (n = 556) was primarily comprised of males (67% male; 21% female; 12% transgender or gender-expansive) and youth of color (32% Black; 23% White; 15% Latinx; 31% Multiracial or another race); a sizable minority identified as a sexual minority (43% LGBQ+). Latent class analysis was used to identify YEH profiles based on living situation and social support networks. Latent class regression assessed demographic correlates of class membership and bivariate logistic regressions were conducted to explore associations between classes and sexual behaviors.

Results: Three classes were identified: (1) Family support and heterogeneous homelessness (n = 293; 53%), (2) Very little support and heterogeneous homelessness (n = 139; 25%), and (3) Homeless peer support and no couch-surfing (n = 124; 22%). Youth of color were more likely—and LGBTQ+ youth less likely—to be in Family support and heterogeneous homelessness than Homeless peer support and no couch-surfing. Family support and heterogeneous homelessness youth were less likely to report transactional sex than Very little support and heterogeneous homelessness youth. Additionally, compared to YEH in the Homeless peer support and no couch-surfing class, YEH in each of the other two classes were significantly less likely to report knowledge of PrEP.

Conclusions and Implications: Findings underscore the complex dynamics of youth homelessness and sexual risk, highlighting the heterogeneity of support networks among couch-surfing YEH and their differential impact on sexual behavior. Study findings also emphasize the potential for more culturally-grounded and network-based sexual health interventions geared toward minorized YEH. Understanding the diverse profiles of YEH can also inform broader policy efforts to address the deprioritization of couch-surfing within current homeless services systems and promote the health and well-being of YEH.