Abstract: An Egocentric Social Network Analysis of Sexual Health Norms on HIV and STI Testing Among Youth Experiencing Homelessness (Society for Social Work and Research 30th Annual Conference Anniversary)

Schedule:

Saturday, January 17, 2026

Independence BR A, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Alex Ochs, MSS, LCSW, Doctoral Candidate, University of Denver, Denver, CO

Anamika Barman-Adhikari, PhD, Associate Professor, University of Denver, Denver, CO

Hsun-Ta Hsu, PhD, Associate Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Robin Petering, PhD, Founder, Senior Researcher, Lens Co, Los Angeles, CA

Jama Shelton, PhD, Associate Professor, City University of New York, New York, NY

Sarah Narendorf, PhD, Associate Professor, New York University, New York, NY

Diane Santa Maria, DrPH, Associate Professor, University of Texas Health Science Center at Houston, Houston, TX

Kimberly Bender, PhD, Professor, University of Denver, CO

Kristin Ferguson, PhD, Professor, School of Social Work, Arizona Housing Analytics Collaborative, Arizona State University, AZ

Background and Purpose: Youth experiencing homelessness (YEH) are embedded within complex social networks that can significantly shape their health behaviors. Social norms and support exchanged within these networks may serve as key facilitators of positive sexual health outcomes, including HIV and STI testing. While prior research has established elevated rates of HIV and STIs among YEH, fewer studies have examined how specific types of network members influence testing behaviors. This study aims to fill that gap by exploring how sexual health norms and support across five relationship types—such as peers, partners, and staff—are associated with recent HIV and STI testing among YEH across seven U.S. cities.

Methods: This egocentric social network study was a secondary data analysis of the Homeless Youth Risk and Resilience Survey (HYRRS), a cross-sectional survey conducted by the Research, Education, and Advocacy Co-Lab for Youth Stability and Thriving (REALYST) between 2016 and 2017. The sample included 1,426 youth experiencing homelessness across seven U.S. cities, with an average age of 20.89 years (SD = 2.08). Participants identified up to five social network members (“alters”) and reported on each alter’s relationship type, sexual health norms, and support. Recent HIV testing (n = 710; 51.82%) and STI testing (n = 663; 48.57%) were the primary outcomes. Multivariate logistic regression models were used to examine associations between network-level sexual health norms across five relationship types and youth’s recent HIV and STI testing behaviors.

Results: Across multivariate models, several network sexual health norms were significantly associated with recent HIV and STI testing among youth experiencing homelessness. Disclosure of HIV status by family members (OR = 1.61, 95% CI [1.01, 2.55]) and home-based peers (OR = 3.38, 95% CI [1.53, 7.47]) was associated with higher odds of HIV testing. Among street-based peers, talking about HIV/STI testing (OR = 1.99, 95% CI [1.02, 3.91]) and discussions about safe sex (OR = 2.04, 95% CI [1.02, 4.07]) were linked to higher odds of HIV and STI testing, respectively. Intimate partner norms were generally not statistically significant, although disclosing STI results was marginally associated with increased STI testing (OR = 1.84, 95% CI [1.00, 3.37]). Agency staff influence on HIV testing emerged through HIV disclosure norms (OR = 2.49, 95% CI [1.18, 5.24]). Female and transgender/nonbinary participants consistently had greater odds of testing.

Conclusions: This study underscores the critical role of social network norms—particularly around HIV/STI status disclosure and sexual health conversations—in promoting recent HIV and STI testing among youth experiencing homelessness. Family members, home-based peers, and street-based peers significantly influenced testing behaviors, while agency staff also played a meaningful role through supportive disclosure norms. Gender identity and race further shaped these outcomes, suggesting the need for culturally responsive and inclusive strategies. Interventions that engage supportive network members and leverage positive social norms may be especially effective in increasing HIV/STI testing and reducing health disparities among this vulnerable population.