Investigating the Influence of Social Support Networks on Sexual Risk Behavior Among Couch-Surfing Youth

Background and Purpose: Youth experiencing homelessness (YEH) are significantly more likely to engage in sexual risk behavior relative to their stably housed peers. Yet few studies have investigated these behaviors among those moving from one temporary housing arrangement to another (or “couch-surfing”)—a highly prevalent but understudied and underserved subset of YEH. Additionally, while the influence of social networks on risk behavior among YEH is well documented, the role of social support and its potential interplay with couch-surfing among YEH is less understood. The current study aims to help address this gap in the knowledge base by examining associations between couch-surfing, sources of social support, and specific sexual health behaviors.

Methods: Survey data were collected from YEH accessing drop-in center services in Los Angeles, CA, between September 2016 and October 2018. 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 = 461) represented sexually active YEH between the ages and 18 and 25, and was primarily comprised of males (63% male; 25% female; 12% transgender or gender-expansive) and youth of color (32% Black; 21% White; 16% Latinx; 32% Multiracial or another race); a sizable minority identified as a sexual minority (47% LGBQ+). Egocentric network analysis was used to examine associations between living situation, social support, and sexual behaviors and to test the potential moderating effect of social support on the relationship between living situation and sexual risk behavior.

Results: Couch-surfing YEH reported the highest rates of recent transactional sex (65.2%), the lowest rates of condomless anal sex (14.0%), and the highest rates of ever being prescribed PrEP (27.3%). Relative to YEH in shelter programs, couch-surfing YEH were over four times as likely to engage in transactional sex (OR = 4.83, 95% CI = 1.42–16.53); unsheltered youth were over three times as likely (OR = 3.48, 95% CI = 1.44–8.41). Latinx youth were also significantly more likely to engage in recent transactional sex relative to their White peers (OR = 3.63, 95% CI = 1.08–12.20). While social support was individually associated with several sexual behaviors, its effect was ultimately eclipsed by living situation in the final model.

Conclusions and Implications: Findings signal opportunities to inform sexual health interventions for YEH based on their living situation and underscore the pronounced vulnerability of couch-surfing YEH to engaging in transactional sex. Service providers need to be able to recognize and respond to young people whose couch-surfing may be dependent upon some form of transactional sex, as these youth are at increased risk for sexually transmitted infections as well as sexual victimization. Engaging couch-surfing youth in assessing their level of risk and helping to identify potential resources to reduce their risk are vital to promoting their sexual health as well as their overall safety and well-being.