Friendships Reduce Risky Sexual Behaviors in Homeless Youth

Homeless young women may be at greater risk for sexually transmitted infections (STIs) than homeless young men because of the structure of their social groups and friendships, according to new research from UC San Francisco. The findings underscore how the social networks of homeless youth can be highly influential, affecting their participation in risky and protective behaviors.

The study examined the relationship between STI rates and the characteristics of the social networks of 258 homeless young people ages 15 to 24 in San Francisco. The youth were surveyed about their housing status, risky behaviors and social networks. They also were tested for Chlamydia and gonorrhea.

The researchers found that the homeless young women had lower condom use and a higher likelihood of sex with intravenous drug users than the homeless young men. The women also showed a trend toward higher rates of sexually transmitted infections.

"We thought that homeless young women may be at higher risk in part because of whom they had access to in their network," said lead author Annie Valente, MD, who conducted the research while a medical student at UCSF. "Social networks are proving to be a very important indicator for other health outcomes, including obesity and cigarette smoking."

Study participants were homeless for two nights or more during the previous six months. Each participant took a computer-based survey, and created a table reflecting their social networks from the previous three months. They listed people to whom they felt close, sex partners, injection partners, and people with whom they had shared resources.

The study, which will be published in the Journal of Adolescent Health and is now online, also found:

- homeless young men were more likely than their female counterparts to have contacts with stable housing and same-sex friends.
- when young men had stably housed contacts in their network, they were more likely to use condoms.
- female participants were more likely to use condoms when they were able to name a friend of the same gender.

"The presence of same-sex friendships and contacts living in stable homes seems to increase condom use," said senior author Colette Auerswald, MD, a UCSF associate adjunct professor of pediatrics and director of the Masters in Medical Science program for the UC Berkeley-UCSF Joint Medical Program. She was based at the UCSF Division of Adolescent Medicine of the UCSF Benioff Children's Hospital at the time of the study. "Young homeless men seem to name these social network contacts more frequently than do young homeless women. It will be important in future investigations to ask why this happens."

The presence of family in the social networks of the young women played an important role in their risk of having sexual partners who are intravenous drug users (IDU). None of the females who listed a family member in their network had an IDU sex partner, whereas 26.4 percent of the women who did not list a family member had an IDU sex partner.

"This study shows the importance of reconnecting homeless young men and women to mainstream society," said Valente. "It also emphasizes how same-gender friendships and family ties may be effective tools in our efforts to improve the health of homeless youth."

The data collected were part of the Street Youth in Social Environments study, a longitudinal NIH-funded study conducted by Auerswald examining the relationships among street culture, social networks and STI/HIV risk in homeless youth in San Francisco.

This study builds on research that used the same sample of homeless youth in San Francisco to investigate the impact of social networks on shelter use among homeless youth. Published in the June issue of the Journal of Adolescent Health, the researchers found that street youth whose social networks included people who used shelters, increased the odds of their own shelter use over time.

"Together these studies suggest the value of designing social network-based interventions to improve the health of our city's marginally housed youth," said Auerswald.