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HIV and Drug Use Prevention Needs Among Homeless Youth in the U.S.
HIV and Drug Use Prevention Needs Among Homeless Youth in the U.S.

Homeless youth are a diverse population of adolescents and young adults who experience negative health outcomes, including drug use, drug overdose, infectious diseases such as HIV and tuberculosis, and victimization. Currently, it is estimated that 2 million youth are homeless in the United States. One subgroup of homeless youth that may be at especially high risk for negative health outcomes are migratory homeless youth, also known as “travelers.”  Research estimates that travelers comprise about 20% of the homeless youth population. 

With the support from a PSU faculty grant, and later from a R03-type grant from NIH, we have led a team of investigators and partners from youth-serving agencies in the Portland metropolitan area to begin filling the knowledge gap by examining HIV/drug risk-related experiences of migratory homeless youth in the U.S. Guided by a mental models approach we: 1) established an expert panel to identify the available intervention and prevention needs of this population; 2) conducted in-depth interviews and focus groups to explore HIV/drug use among homeless youth, and examined how homeless youth and social/health service providers make decisions about utilizing/providing outreach and engagement prevention services. Youth interviews also explored the circumstances that led to migration or transience, and elicited geographic information to begin to map migration routes that lead to Portland.

Preliminary results have been disseminated at the community events, and at the annual meeting of the Society for Social Work Research in 2017. Some of the results include: Alcohol, heroine, and marijuana were reported as the most used substances. Several participants reported transitions from casual substance users to addicts and “getting stuck in one place” as they became dependent on a local drug dealer. Regarding HIV risks, participants reported that risky behaviors are abundant and (i.e., unprotected sex; needle sharing) often resulted in pregnancy, sexually transmitted infections (STI), and HIV. Most participants knew other youth with a history of STIs. Knowledge of available prevention services was limited. Access to healthcare was limited as participants reported that they “doctor” themselves or others on the road, using small medical kits or over-the-counter medicines.

This work contributes to our knowledge of a subpopulation that is poorly understood by the social service community.  Current prevention services that are available and effective for traditional homeless youth populations may not be effectively reaching and engaging travelers. Portland for example, has a multitude of services, yet travelers underuse them. This migratory youth have different needs than traditional homeless youth. Due to their migratory circumstances, multilevel, multi-city, combination prevention strategies are urgently needed for this population. In addition to behavioral risk-reduction interventions, travelers need immediate and ongoing access to clean needles, condoms, and other survival services. We are currently writing an R34 NIH grant to pilot test an intervention based the results of this study.