Next Article in Journal
The Role of Family Functioning in Over-Adaptation and Subjective Well-Being Among Japan’s Youth: The Moderating Effect of Gender Differences and Rumination
Previous Article in Journal
Just 4U™: Reusable Period Pants Alongside an Ovulatory Menstrual Health Literacy Program
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Youth
Volume 4
Issue 4
10.3390/youth4040112
youth-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Untangling Regional Disparities: HIV and STI Testing Patterns Among Youth Experiencing Homelessness in Seven U.S. Cities

by
Alex Ochs
1,*,
Anamika Barman-Adhikari
1,
Hsun-Ta Hsu
2,
Robin Petering
3,
Jama Shelton
4,
Sarah Narendorf
5,
Diane Santa Maria
6,
Kimberly Bender
1 and
Kristin Ferguson
7
1
Graduate School of Social Work, University of Denver, Denver, CO 80208, USA
2
School of Social Work, University of North Carolina, Chapel Hill, NC 27514, USA
3
Young People to the Front, Los Angeles, CA 90001, USA
4
Silberman School of Social Work, City University of New York, New York, NY 10017, USA
5
Silver School of Social Work, New York University, New York, NY 10003, USA
6
Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
7
School of Social Work, Arizona State University, Phoenix, AZ 85004, USA
*
Author to whom correspondence should be addressed.
Youth 2024, 4(4), 1774-1786; https://doi.org/10.3390/youth4040112
Submission received: 3 September 2024 / Revised: 3 December 2024 / Accepted: 6 December 2024 / Published: 11 December 2024
Versions Notes

Abstract

:
Youth experiencing homelessness (YEH) face elevated risks of HIV and STIs compared to their housed counterparts. HIV and STI testing services are pivotal for prevention and early detection. Investigating utilization rates and associated factors among YEH provides critical insights for intervention efforts in major U.S. regions. This study analyzed secondary data from the Homeless Youth Risk and Resilience Survey (HYRRS) conducted between 2016 and 2017. Participants were recruited in seven major cities: Los Angeles, San Jose, Phoenix, St. Louis, Denver, Houston, and New York City (n = 1426). Notably, YEH in Denver, Houston, Phoenix, San Jose, and St. Louis were significantly less likely to use HIV testing services than those in Los Angeles. YEH reporting early sexual activity were less likely to undergo HIV testing, while having online sex partners increased the likelihood of HIV testing. Moreover, YEH in New York City were more likely to receive STI testing, while Phoenix and San Jose had lower testing rates. Disparities in testing rates highlight questions about equitable resource allocation, accentuating the need for enhanced educational and community outreach efforts to address barriers across diverse urban settings.

1. HIV and STIs Among YEH

Youth experiencing homelessness (YEH) in the United States are at a particularly high risk of contracting human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) compared to their housed peers [1,2]. While it is challenging to determine the actual prevalence of HIV and STI infections among YEH as they are a hard-to-reach population due to their transience in and out of homelessness and distrust in health and social service systems [3], studies have estimated HIV prevalence among YEH to be 2–12 times higher than their housed peers [4,5,6]. STI prevalence rates among this group range from 2.1% to 52.5% [2,7,8,9,10].
Although the incidence of HIV in the U.S. has declined over recent years, STI rates have increased among youth and young adults [11,12]. In 2023, almost half of reported cases of STIs were among youth aged 15–24 years [11]. Disturbingly, YEH are estimated to bear a disproportionate burden of STDs [2]. Furthermore, men who have sex with men, persons from racialized groups, and LGBTQ individuals are not only disproportionately affected by STDs in the United States but are also overrepresented among YEH [2,11,13,14,15,16,17]. This underscores the critical need for targeted interventions and support within these communities. Urgent action is imperative to address this escalating public health crisis.

1.1. Risk Factors Associated with HIV and STIs Among YEH

Risk factors that increase exposure to HIV and STIs among YEH include inconsistent condom use, having multiple sex partners, early sexual debut, and sexual intercourse while under the influence of substances [4,18,19,20]. Further, YEH often engage in higher sexual risk behaviors (i.e., survival sex) to obtain food, shelter, and money [21,22]. In contrast, stably housed youth largely engage in lower-risk behaviors, highlighting the protective role of housing stability in reducing sexual risk [23,24]. For example, YEH are more likely to have an earlier sexual debut than their stably housed peers [25], are more likely to have multiple sex partners, have condomless sex, and use substances during sex [3,26]. Additional characteristics that increase risk of HIV and STI exposure and acquisition among YEH include identifying as a sexual and/or gender minority [27,28,29], involvement in foster care [30,31] while youth, in general, who report involvement in the juvenile justice system have higher rates of HIV and STI risk behaviors [32,33]. Moreover, YEH experience discrimination and are stigmatized due to their housing status, race, and sexuality, which put them at an increased risk of negative health outcomes [34,35]. For example, in a study of LGBTQ+ YEH, participants acknowledged feeling unsafe in shelters and social and health service systems due to experiences of homophobia and transphobia [21]. This compelling convergence of risk factors emphasizes the urgent need for effective interventions and support to mitigate HIV and STI risks among YEH and to address the structural and systemic-level barriers to engaging in and utilizing sexual health services.

1.2. Correlates of HIV and STI Testing Among YEH

Existing data on testing rates vary significantly among YEH. A study of testing rates among a large national sample of youth in the U.S. found that 24% were tested for chlamydia and gonorrhea and 21% were tested for HIV within the last year [36]. YEH who were HIV-positive had a 34% lower odds of being screened for chlamydia and gonorrhea than housed youth with HIV [37]. This differs from several dated studies that demonstrate that over 50% of YEH have tested for HIV or STIs, which is higher than their housed peers [8,9,10]. Yet, apart from a few exceptions [8,9,10,37], there is limited literature on HIV and STI testing rates among YEH in the U.S. Addressing this gap is crucial as HIV and STI testing serve as vital entry points for prevention, treatment, and linkage to care among YEH [38,39].
Prior research demonstrates that engaging in sexual risk behaviors has mixed results concerning HIV/STI testing among YEH. In one study, YEH who understood their vulnerability due to sexual activity, transactional sex, or prior STIs were more likely to get tested [40]. However, the same study found that the number of sexual partners or inconsistent condom use was not necessarily linked to higher testing rates [40]. Similarly, a study of YEH in Los Angeles found that HIV and STI testing was not associated with engaging in sexual risk behaviors [41]. On the contrary, a sample of YEH from the Youth Risk Behavior Survey study found YEH were more likely to be sexually active and participate in high-risk sexual behavior than their housed counterparts [42]. These same YEH were also more likely to report having received an HIV or STI test than their housed peers [42]. The higher likelihood of YEH to utilize HIV and STI testing services is in contrast to a body of literature that suggests YEH are underutilizing healthcare services due to many factors including poor coordination of services [43,44]. This integrated body of research suggests a crucial link between perceived risk and health behaviors. Specifically, it indicates that YEH are more likely to get tested for HIV and STIs when they perceive a higher risk associated with behaviors such as unsafe sex.
Barriers to healthcare are particularly prevalent for YEH [45,46,47,48]. For example, YEH who stay in shelter environments may not receive adequate sexual health information because many shelters, particularly those administered by institutions with more conservative values or belief systems, may discourage staff from discussing sex and sexuality, reproductive options, or providing safe sex supplies such as condoms [46,48]. However, other studies show that health centers and drop-in facilities offering essential necessities like food, hygiene products, and clothing can become crucial gateways to HIV and STI testing [41,44,49]. This approach not only addresses basic needs but also creates an environment where testing feels more comfortable and accessible.
Although there is a dearth of research on gender differences and HIV and STI testing behavior among YEH, gender disparities in testing rates are evident even among housed youth. Studies show that females are more likely to get tested for STIs than males [50]. For males specifically, factors like earlier sexual debut, multiple partners, recent condomless sex, and substance use are associated with higher testing rates [50]. This suggests a potential link between perceived risk and testing behavior for males. Moreover, a study on college students (n = 1294) found that over half reported ever being tested for STIs, with females again being more likely to receive a test [51]. This reinforces the need to address gender-based disparities in testing across all age groups. Although these two studies do not focus on YEH, they provide important considerations for testing use behavior among the youth population for which to compare to YEH.

1.3. Current Study

The existing literature has primarily focused on demographic and sexual risk behavior characteristics concerning HIV and STI testing among youth and young adult populations, including YEH [27,30,40,42]. While they provide us with important information about rates and patterns of HIV and STI testing rates among YEH, these studies are either outdated or focus on specific geographical regions within the United States.
Obtaining information on HIV and STI testing is crucial given the dynamic nature of public health challenges. Specifically, reported prevalence rates are potentially biased due to inequitable access to health care, and unless we know how many individuals are testing and determining disparate outcomes based on racialized status, sexual/gender minority status, as well as geographic differences, it is challenging to determine how to develop and implement prevention and intervention programs to address HIV and STI health disparities. Unfortunately, current data from the CDC do not specifically capture, nor report, HIV and STI testing data among vulnerable youth populations, including YEH.
The identification and comparison of HIV and STI testing rates across various geographic regions, particularly for YEH, have been overlooked. It is crucial to compare testing rates in proportion to the population of specific urban centers to gather valuable data for informed educational and intervention efforts. A study examining YEH in three Midwestern cities found that 67% reported testing for HIV [9]. However, a limitation is the absence of rate comparisons among these cities. Additionally, in Los Angeles, 85% of sexually active YEH reported ever being tested for HIV [41], while in Atlanta, 74.6% of YEH reported receiving an HIV test within the last year [40]. Despite a limited number of studies reporting HIV and STI testing rates independently, there is no existing research, to our knowledge, that compares both HIV and STI testing rates across multiple cities in the U.S. among YEH.
This study aims to build upon the current body of literature by investigating factors influencing the utilization of HIV and STI testing services across numerous cities in different regions of the United States. By exploring the intersections of these factors in diverse urban settings, the study aims to provide a more comprehensive understanding of the factors influencing individuals’ decisions to engage with HIV and STI testing services.

2. Methods

2.1. Study Design

This study was a secondary data analysis of cross-sectional data obtained from a national research collaboration known as the Research, Education, and Advocacy Co-Lab for Youth Stability and Thriving (REALYST). The collaborative implemented a standardized study protocol and assessment tool (HYRRS) across various cities, including Los Angeles, San Jose, Phoenix, St. Louis, Denver, Houston, and New York City, during 2016–2017 (n = 1426). Approval for the study procedures was obtained from the Institutional Review Boards (IRBs) at the academic institutions of the authors.

2.2. Recruitment and Data Collection

Individuals were enlisted from agencies that provide services to YEH, including drop-in centers, transitional housing programs, and/or shelters. The eligibility screener was employed to determine if participants fell within the age range of 18–26 and were either homeless or experiencing unstable housing conditions. The age range of participants was determine based on the provision of services provided among the community partners where recruitment was conducted. After confirming eligibility and obtaining consent, participants underwent the Rapid Estimate of Adult Literacy in Medicine short form (REALM-SF) screener [52]. Those scoring higher than 3 were encouraged to independently complete the self-administered survey on tablets, with study staff available for assistance if needed. The survey typically took about 45 min to finish. YEH participants who completed the survey received $10–20 gift cards for a local store as a token of appreciation. Participant compensation was dependent on the budget for each recruitment location and was IRB approved.

2.3. Measures

2.3.1. Dependent Variables

Recent HIV Testing: Participants were asked if they have been tested for HIV/AIDS within the last 3 months. A response of “Yes” (1) indicates that the participant has undergone HIV/AIDS testing within the past 3 months, while a response of “No” (0) indicates that the participant has not been tested within this timeframe.
Recent STI Testing: Participants were asked if they have been tested for STIs or STDs, such as chlamydia, gonorrhea, syphilis, or genital warts, within the last 3 months. A response of “Yes” (1) indicates that the participant has undergone STI/STD testing within this timeframe, while a response of “No” (0) indicates that the participant has not been tested within the past 3 months.

2.3.2. Independent Variables

Sociodemographic characteristics. Sociodemographic characteristics included age, gender [i.e., male, female, transgender/non-binary], sexual orientation (heterosexual or lesbian, gay, bisexual, or queer [sexual minority]), race/ethnicity [i.e., White, Black, Latinx, multiracial, other], education [i.e., less than high school, high school degree or GED, higher education degree, or currently in school], history of foster care involvement (yes = 1/no = 0), and history of juvenile justice involvement (yes = 1/no = 0).
Substance use behaviors. Substance use behavior variables were adapted from the Youth Risk Behavior Surveillance Survey (YRBSS) [53]. We assessed for hard drug use (i.e., cocaine, crack, heroin, meth; yes = 1/no = 0) and injection drug use (yes = 1/no = 0) during the last 30 days. We also assessed for heavy drinking, which was defined as having five or more drinks of alcohol for one or more days during the past 30 days (yes = 1/no = 0).
Sexual risk behaviors. Sexual risk behaviors we assessed for included being sexually active before the age of 16, survival sex, condomless sex during the last three months, sexual intercourse under the influences of substance during the last three months, and multiple sexual partners (i.e., two or more sexual partners) during the last three months. Sexual risk behavior variables were adapted from the YRBSS.

2.4. Data Analyses

Stata 17.0 was used to calculate descriptive statistics (percentages, means, and standard deviations) to describe sociodemographic characteristics and substance use and sexual risk behaviors of YEH in our sample. Bivariate correlation analyses were conducted on all main variables. Multivariate logistic regression analyses were run on variables that were statistically significant as a result of bivariate analyses [54]. Additionally, we conducted cross-tabulations between HIV and STI testing, and the seven cities YEH completed the survey to determine rates of HIV and STI testing.

3. Results

3.1. Descriptive Statistics

As seen in Table 1, the mean age of participants was 20.88 (SD = 2.08). More than half of the participants identified as heterosexual (n = 985; 71.3%) and cisgender males (n = 828; 58.5%). Concerning race/ethnicity, 37.5% identified as Black (n = 518), and the majority had at least a high school education or higher education degree (n = 952; 69.1%). 38.5% (n = 531) of YEH participants had a history of foster care involvement, and similarly, 36% (n = 497) had a history of juvenile justice system involvement. Regarding substance use behaviors, 34% (n = 474) of YEH participated in heavy drinking, approximately 40.6% (n = 560) engaged in illicit drug use, and approximately 8.6% (n = 121) reported injection drug use. In terms of sexual risk behaviors, nearly a quarter (n = 269; 24.4%) of participants engaged in survival sex, 57.6% (n = 634) reported condomless sex, 57.4% (n = 634) were sexually active before the age of 16, 43.6% (n = 479) had sexual intercourse under the influence of substances, and 54.4% (n = 600) had sex with someone they met online. In terms of the outcome variables, 48.6% of YEH participants reported having received an STI test recently, while 51.8% reported having received an HIV test recently. Table 2 reports rates of HIV and STI rates across the seven cities where participants were surveyed. YEH in New York City reported the highest rates of HIV (75.2%) and STI (71.9%) testing in the last three months while YEH in Phoenix and San Jose reported the lowest rates of testing, respectively.

3.2. Bivariate Statistics

Bivariate correlations among variables were conducted prior to multivariate analysis and can be found in Table 3.

3.3. Multivariate Statistics

Following bivariate analyses, multiple regression analyses (Table 4 were run to examine correlations between the two dependent variables (HIV and STI testing) and relevant independent variables that resulted in significant outcomes during bivariate analyses [54]. YEH in Denver (OR = 0.63, p < 0.05), Houston (OR = 0.62, p < 0.05), Phoenix (OR = 0.36, p < 0.001), San Jose (OR = 0.26, p < 0.001), and St. Louis (OR = 0.50, p < 0.01) were significantly less likely than YEH in Los Angeles to utilize HIV testing services. Additionally, YEH who reported being sexually active prior to the age of 16 (OR = 0.65; p < 0.01) were less likely to utilize HIV testing services, while those who had online sex partners (OR = 1.34, p < 0.05) were more likely to receive an HIV test. With respect to STI testing service use, YEH in New York City (OR = 1.71, p < 0.05) were more likely to get tested than YEH in Los Angeles, while participants in Phoenix (OR = 0.48, p < 0.01) and San Jose (OR = 0.42, p < 0.001) were less likely to receive an STI test. Further, YEH who had online sex partners (OR = 1.54, p < 0.01) were more likely to receive an STI test.

4. Discussion

Several key findings emerged from this study related to patterns of HIV and STI testing service use among YEH. Of particular importance, approximately half of the YEH included in our sample received an STI test (48.6%) and HIV test (51.8%) within the past six months of data being collected. These testing rates are high compared to other studies using nationally representative samples of youth in the U.S., which found that only 22% of high school students and 33% of young adults (18–24 years old) had tested for HIV in one study of housed youth [55] and 9.3% among a sample of high school students in 2017 in another study [56]. Similarly, another study of adolescents and young adults (15–25 years old) in the U.S. found that only 11.5% of participants had received an STI test in the past year [57]. The current study’s finding that approximately half of YEH received an HIV or STI test within the past three months compared with the testing rates of their housed peers perhaps suggests YEH are willing to avail themselves of these services where they are readily available and accessible. For example, a study in Los Angeles found that the presence and use of a drop-in centers for YEH mediated the association of injection drug use with HIV and STI testing [41]. Moreover, a study in New York City found that YEH who were connected and engaged in services were more likely to engage in continuous testing behavior [8], suggesting that youth who were able to access services and then stay engaged are likely to understand the importance of consistent health monitoring and preventive behaviors.
Further, YEH may be aware of their elevated risk or exposure to HIV and STI, thus illustrating higher rates of testing compared to previous studies of HIV and STI testing behavior among housed youth. It is also important to note that our HIV and STI testing variables assessed for whether or not YEH had been tested in the past 3 months. For persons demonstrating elevated risk for HIV and/or STIs, the CDC recommends testing every three to six months [58]. For YEH who are aware of their increased risk and/or those who are connected to care, they may be more likely to test at higher frequencies, which our findings may suggest.
The present study also revealed notable variations in HIV and STI testing rates among YEH across different U.S. cities. Specifically, New York City and Los Angeles exhibited the highest rates of HIV and STI testing among YEH in the sample, respectively. The current study significantly contributes to the HIV and STI prevention literature by addressing a gap in geographical coverage. Existing research on HIV and STI testing among YEH has primarily focused on specific cities or regions, limiting the broader understanding of testing rates [9,40,41,59]. Investigating geographic locations is crucial for identifying healthcare access disparities and developing targeted prevention programs and services for at-risk youth, including YEH.
The study’s findings align with the Andersen Behavioral Model [60,61], which suggests location significantly impacts access to healthcare. Our research reinforces this notion as cities with higher testing rates (Los Angeles and New York City) also have a greater number of organizations specifically serving YEH. An online search of organizations that specifically advertise services to YEH elicited valuable insights regarding the availability of such services. (The search phrase for this online survey of services was “homeless youth AND shelters OR services in [city]”.) For example, an online search of organizations that serve YEH in Los Angeles and New York City produced more than ten agencies in each city, many of which were youth homeless shelters or drop-in centers which provide access or linkage to vital sexual health resources. In comparison, an online search in Denver, Colorado produced only one agency which provides services specifically to YEH. Similarly, an online search in St. Louis, Missouri and San Jose, California elicited approximately five organizations each. The stark difference in service availability highlights crucial implications for the accessibility of HIV and STI testing services for YEH and suggests disparities in services specifically for this population, potentially exacerbating health inequities [62]. Expanding service accessibility may reduce health inequities among YEH by improving their access to timely care for preventable and treatable conditions, such as STIs [2,63].
Next, YEH who had online sex partners were significantly more likely to test for HIV and STIs than their peers who did not report having sex with partners from online sources. A previous study of YEH in Los Angeles found that nearly a quarter of their sample used websites or dating apps to search for sexual partners to fulfill basic survival needs (e.g., shelter, food, money; [22]), which can potentially result in higher HIV risk behaviors, such as condomless sex and multiple sex partners [42,64]. Further, locating sex partners from online venues may facilitate anonymous encounters, which often leads to limited information regarding partners’ sexual health history, and potentially resulting in increased instances of engaging in unprotected sex. This may be especially true for young people using online platforms or apps that prioritize quick connections [65]. Importantly, these finding demonstrates that YEH may be aware of the increased risk of engaging in sex with persons from online venues and recognize the need to use HIV and STI testing as a result of participating in this behavior. Moreover, this finding has crucial implications for web-based prevention and interventions as the use of the internet and smartphone applications among YEH is only increasing over time [66,67].
Finally, the YEH in our sample who had sex prior to the age of 16 were less likely to receive an HIV test. Although there is a dearth of research examining the relationship between early sexual debut and HIV testing behavior, existing studies have found that YEH who had an early sexual debut were more likely to have multiple sexual partners, to use substances during sex, and engage in condomless sex [3,4,26]. Thus, this conflation of risk factors suggests a need for augmented community and individual-level sexual health education and linkage to prevention and treatment services at earlier points in youths’ lives.

Limitations

This study and the conclusions drawn from it are not without some limitations. Although the number of YEH who participated in this study were similar across the seven cities (approximately 200 YEH sampled from each city), illustrating significant differences in geographically based HIV and STI testing rates, the lack of randomization in this sample may introduce bias in the findings. Moreover, the cross-sectional study design makes it challenging to generate assumptions or conclusions about long-term patterns of HIV and STI testing behavior among YEH, particularly in light of the recent COVID-19 pandemic, which is likely to have exacerbated prevalence rates and reduced access to health care [68]. Further investigation would benefit from longitudinal study designs that track YEH HIV and STI testing behavior over an extended period of time. Finally, data for this study were collected from 2016–2017, potentially limiting the validity of the findings to the present day due to the evolving nature of policy and practice responses to youth homelessness. Although dated, these findings are important because they provide information on a significant public health issue (i.e., HIV and STI testing among YEH) across multiple urban contexts.
Regardless of the limitations, findings from this study demonstrate the importance of developing critical sexual health prevention and intervention strategies to augment HIV and STI prevention services in urban centers where HIV and STI testing rates are lower compared to the proportion of the population in these respective urban settings. In particular, these results indicate the importance of additional education and promotion of HIV and STI testing among YEH who engage in high-risk sexual behaviors. Moreover, considering the differences in testing rates among the cities in this study and the relatively high rates of testing of YEH compared to their housed peers [8,9,10], our findings demonstrate YEH are very likely to avail themselves of these crucial health services as long as these services are accessible.
Future research on HIV and STI testing service use among YEH would benefit from a more intentional investigation into the various structural- and systemic-level factors that may act as barriers and/or facilitators of testing behavior. This area of inquiry will be especially important to understand the unique needs of YEH who identify as members of sexual and gender minorities and/or are from racialized communities.

Author Contributions

All authors on this paper meet the four criteria for authorship as identified by the International Committee of Medical Journal Editors (ICMJE); all authors have contributed to the conception and design of the study, drafted or have been involved in revising this manuscript, reviewed the final version of this manuscript before submission, and agree to be accountable for all aspects of the work. Specific contributions are as follows: Conceptualization & Methodology: A.O., A.B.-A., H.-T.H., R.P., J.S., S.N., D.S.M., K.B. and K.F.; Formal Analysis: A.O. and A.B.-A.; Writing—original draft: A.O. and A.B.-A.; Writing/Revising: H.-T.H., R.P., J.S., S.N., D.S.M., K.B. and K.F. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the Greater Houston Community Foundation Funders Together to End Homelessness, National Institute of Mental Health (F31MH108446), and Arizona State University Institute for Social Science Research. Funding sources had no role in the collection, analysis or interpretation of data, the writing of the manuscript, or the decision to submit the article for publication.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by University of Denver Institutional Review Board Approval (Code: 913077 Approval Date: 6 August 2016).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

References

  1. Lindberg, L.D.; Bell, D.L.; Kantor, L.M. The sexual and reproductive health of adolescents and young adults during the COVID-19 pandemic. Perspect. Sex. Reprod. Health 2020, 52, 75–79. [Google Scholar] [CrossRef]
  2. Caccamo, A.; Kachur, R.; Williams, S.P. Narrative review: Sexually transmitted diseases and homeless youth—What do we know about sexual transmitted disease risk and prevalence? Sex. Transm. Dis. 2017, 44, 466–476. [Google Scholar] [CrossRef] [PubMed]
  3. Edidin, J.P.; Ganim, Z.; Hunter, S.J.; Karnik, N.S. The mental and physical health of homeless youth: A literature review. Child Psychiatry Hum. Dev. 2012, 43, 354–375. [Google Scholar] [CrossRef] [PubMed]
  4. Hsu, H.-T.; Fulginiti, A.; Rice, E.; Rhoades, H.; Winetrobe, H.; Danforth, L. But everyone is doing it (sort of)! Perceived sexual risks in the social environment and the impact on homeless youth engagement in concurrent sexual relationships. AIDS Behav. 2018, 22, 3508–3518. [Google Scholar] [CrossRef]
  5. Carmona, J.; Slesnick, N.; Guo, X.; Letcher, A. Reducing high risk behaviors among street living youth: Outcomes of an integrated prevention intervention. Child. Youth Serv. Rev. 2014, 43, 118–123. [Google Scholar] [CrossRef]
  6. Ferguson, K.M.; Bender, K.; Thompson, S.; Xie, B.; Pollio, D. Correlates of street survival behaviors in homeless young adults in four U.S. cities. Am. J. Orthopsychiatry 2011, 81, 401–409. [Google Scholar] [CrossRef] [PubMed]
  7. Williams, S.P.; Bryant, K.L. Sexually transmitted infection prevalence among homeless adults in the United States: A systematic literature review. Sex. Transm. Dis. 2018, 45, 494–504. [Google Scholar] [CrossRef] [PubMed]
  8. Gwadz, M.V.; Cleland, C.M.; Quiles, R.; Nish, D.; Welch, J.; Michaels, L.S.; Gonzalez, J.L.; Ritchie, A.S.; Leonard, N.R. CDC HIV testing guidelines and the rapid and conventional testing practices of homeless youth. AIDS Educ. Prev. 2010, 22, 312–327. [Google Scholar] [CrossRef]
  9. Tyler, K.; Melander, L. The effect of drug and sexual risk behaviours with social network and non-network members on homeless youths’ sexually transmissible infections and HIV testing. Sex. Health 2010, 7, 434–440. [Google Scholar] [CrossRef]
  10. Young, S.D.; Rice, E. Online social networking technologies, HIV knowledge, and sexual risk and testing behaviors among homeless youth. AIDS Behav. 2011, 15, 253–260. [Google Scholar] [CrossRef]
  11. Centers for Disease Control and Prevention. Sexually Transmitted Infections (STIs): Annual Surveillance Summary. 2023. Available online: https://www.cdc.gov/sti-statistics/annual/summary.html#:~:text=As%20in%20past%20years%2C%20there,were%20men%20diagnosed%20with%20HIV (accessed on 1 December 2024).
  12. Shannon, C.L.; Klausner, J.D. The growing epidemic of sexually transmitted infections in adolescents: A neglected population. Curr. Opin. Pediatr. 2018, 30, 137–143. [Google Scholar] [CrossRef] [PubMed]
  13. Giannouchos, T.V.; Crouch, E.; Merrell, M.A.; Brown, M.J.; Harrison, S.E.; Pearson, W.S. Racial, ethnic, and rural/urban disparities in HIV and sexually transmitted infections in South Carolina. J. Community Health 2023, 48, 152–159. [Google Scholar] [CrossRef] [PubMed]
  14. Deal, C.; Doshi, R.D.; Gonzales, G. Gender minority youth experiencing homelessness and corresponding health disparities. J. Adolesc. Health 2023, 72, 763–769. [Google Scholar] [CrossRef]
  15. Ormiston, C.K. LGBTQ youth homelessness: Why we need to protect our LGBTQ youth. LGBT Health 2022, 9, 217–221. [Google Scholar] [CrossRef]
  16. Petry, J.; Hill, C.; Milburn, N.; Rice, E. Who is couch-surfing and who is on the streets? Disparities among racial and sexual minority youth in experiences of homelessness. J. Adolesc. Health 2022, 70, 734–750. [Google Scholar] [CrossRef] [PubMed]
  17. Fusaro, V.A.; Levy, H.G.; Shaefer, H.L. Racial and ethnic disparities in the lifetime prevalence of homelessness in the United States. Demography 2018, 55, 2119–2128. [Google Scholar] [CrossRef]
  18. Mastro, T.D.; Cunningham, J.; Medrano, T.; van Dam, J. Youth and HIV: The intersection of homelessness, orphaned status, injection drug use and sexual risk. AIDS 2012, 26, 111–113. [Google Scholar] [CrossRef] [PubMed]
  19. Barman-Adhikari, A.; Hsu, H.-T.; Begun, S.; Perez Portillo, A.; Rice, E. Condomless sex among homeless youth: The role of multidimensional social norms and gender. AIDS Behav. 2017, 21, 688–702. [Google Scholar] [CrossRef]
  20. Smith-Grant, J.; Kilmer, G.; Brener, G.; Robin, L.; Underwood, J.M. Risk behaviors and experiences among youth experiencing homelessness—Youth Risk Behavior Survey, 23 U.S. states and 11 local school districts, 2019. J. Community Health 2022, 47, 324–333. [Google Scholar] [CrossRef]
  21. Alessi, E.J.; Greenfield, B.; Manning, D.; Dank, M. Victimization and resilience among sexual and gender minority homeless youth engaging in survival sex. J. Interpers. Violence 2021, 36, 11236–11259. [Google Scholar] [CrossRef]
  22. Srivastava, A.; Rusow, J.A.; Holguin, M.; Semborski, S.; Onasch-Vera, L.; Wilson, N.; Rice, E. Exchange and survival sex, dating apps, gender identity, and sexual orientation among homeless youth in Los Angeles. J. Prim. Prev. 2019, 40, 561–568. [Google Scholar] [CrossRef]
  23. Parsons, J.T.; Lelutiu-Weinberger, C.; Botsko, M.; Golub, S.A. Predictors of day-level sexual risk for young gay and bisexual men. AIDS Behav. 2013, 17, 1465–1477. [Google Scholar] [CrossRef] [PubMed]
  24. Dermen, K.H.; Thomas, S.N. Randomized controlled trial of brief interventions to reduce college students’ drinking and risky sex. Psychol. Addict. Behav. 2011, 25, 583–594. [Google Scholar] [CrossRef] [PubMed]
  25. Beech, B.M.; Myers, L.; Beech, D.J.; Kernick, N.S. Human immunodeficiency syndrome and hepatitis B and C infections among homeless adolescents. Semin. Pediatr. Infect. Dis. 2003, 14, 12–19. [Google Scholar] [CrossRef] [PubMed]
  26. Thompson, S.J.; Pillai, V.K. Determinants of runaway episodes among adolescents using crisis shelter services. Int. J. Soc. Welf. 2006, 15, 142–149. [Google Scholar] [CrossRef]
  27. Santa Maria, D.; Daundasekara, S.S.; Hernandez, D.C.; Zhang, W.; Narendorf, S.C. Sexual risk classes among youth experiencing homelessness: Relation to childhood adversities, current mental symptoms, substance use, and HIV testing. PLoS ONE 2020, 15, e0227331. [Google Scholar] [CrossRef]
  28. Reisner, S.L.; Jadwin-Cakmak, L.; Sava, L.; Liu, S.; Harper, G.W. Situated vulnerabilities, sexual risk, and sexually transmitted infections’ diagnoses in a sample of transgender youth in the United States. AIDS Patient Care STDs 2019, 33, 120–130. [Google Scholar] [CrossRef]
  29. Shannon, C.L.; Keizur, E.; Fehrenbacher, A.; Ramos, W.; Koussa, M.; Fournier, J.; Lee, S.J.; Patel, D.; Akabike, W.N.; Abdalian, S.E.; et al. Sexually transmitted infection positivity among adolescents with or at high-risk for human immunodeficiency virus infection in Los Angeles and New Orleans. Sex. Transm. Dis. 2019, 46, 737–742. [Google Scholar] [CrossRef]
  30. Yoshioka-Maxwell, A.; Rice, E. Exploring the relationship between foster care experiences and HIV risk behaviors among a sample of homeless former foster youth. AIDS Behav. 2019, 23, 792–801. [Google Scholar] [CrossRef]
  31. Brook, J.; Rifenbark, G.G.; Boulton, A.; Little, T.D.; McDonald, T.P. Risk and protective factors for drug use among youth living in foster care. Child Adolesc. Soc. Work J. 2015, 32, 155–165. [Google Scholar] [CrossRef]
  32. Udell, W.; Donenberg, G.; Emerson, E. Parents matter in HIV-risk among probation youth. J. Fam. Psychol. 2011, 25, 785–789. [Google Scholar] [CrossRef] [PubMed]
  33. Haney-Caron, E.; Brown, L.K.; Tolou-Shams, M. Brief report: HIV testing and risk among justice-involved youth. AIDS Behav. 2021, 25, 1405–1410. [Google Scholar] [CrossRef] [PubMed]
  34. Budescu, M.; Torino, G.C.; Sisselman-Borgia, A. Multiple discriminatory threats and well-being among youth experiencing homelessness. Stigma Health, 2024; advance online publication. [Google Scholar] [CrossRef]
  35. Karamouzian, S.J.; Dong, H.; Gilbert, M.; Kerr, T.; DeBeck, K. Perceived devaluation and STI testing uptake among a cohort of street-involved youth in a Canadian setting. Arch. Sex. Behav. 2017, 46, 2165–2172. [Google Scholar] [CrossRef]
  36. Thompson, E.L.; Griner, S.B.; Galvin, A.M.; Lowery, A.D.; Lewis, M.A. Correlates of STI testing among US young adults: Opportunities for prevention. Prev. Sci. 2021, 22, 216–226. [Google Scholar] [CrossRef]
  37. Clemenzi-Allen, A.A.; Hartogensis, W.; Cohen, S.E.; Gandhi, M.; Geng, E.; Chritopoulos, K. Evaluating the impact of housing status on gonorrhea and chlamydia screening in an HIV primary care setting. Sex. Transm. Dis. 2019, 46, 153–158. [Google Scholar] [CrossRef]
  38. Ahonkhai, A.A.; Rebeiro, P.F.; Jenkins, C.A.; Rickles, M.; Cook, M.; Conserve, D.F.; Pierce, L.J.; Shepherd, B.E.; Brantley, M.; Wester, C. Individual, community, and structural factors associated with linkage to HIV care among people diagnosed with HIV in Tennessee. PLoS ONE 2022, 17, e0264508. [Google Scholar] [CrossRef]
  39. Kurth, A.E.; Lally, M.A.; Choko, A.T.; Inwani, I.W.; Fortenberry, J.D. HIV testing and linkage to services for youth. J. Int. AIDS Soc. 2015, 18 (Suppl. S1), 19433. [Google Scholar] [CrossRef]
  40. Myles, R.L.; Best, J.; Bautista, G.; Wright, E.R.; LaBoy, A.; Demissie, Z.; Dean, H.D. Factors associated with HIV testing among Atlanta’s homeless youth. AIDS Educ. Prev. 2020, 32, 325–336. [Google Scholar] [CrossRef]
  41. Ober, A.J.; Martino, S.C.; Ewing, B.; Tucker, J.S. If you provide the test, they will take it: Factors associated with HIV/STI testing in a representative sample of homeless youth in Los Angeles. AIDS Educ. Prev. 2012, 24, 350–362. [Google Scholar] [CrossRef]
  42. Halverson, M.; Hatchimonji, D.R.; Treglia, D.; Flatley, C.A.; Herbers, J.E.; Cutuli, J.J. Risky sexual behavior and STI testing among teens experiencing homelessness. Child. Youth Serv. Rev. 2022, 139, 106538. [Google Scholar] [CrossRef]
  43. Prock, K.A.; Kennedy, A.C. Characteristics, experiences, and service utilization patterns of homeless youth in a transition living program: Differences by LGBQ identity. Child. Youth Serv. Rev. 2020, 116, 105176. [Google Scholar] [CrossRef]
  44. Slesnick, N.; Dashora, P.; Letcher, A.; Erdem, G.; Serovich, J. A review of services and interventions for runaway and homeless youth: Moving forward. Child. Youth Serv. Rev. 2009, 31, 732–742. [Google Scholar] [CrossRef] [PubMed]
  45. Gallardo, K.R.; Santa Maria, D.; Narendorf, S.; Markham, C.M.; Swartz, M.D.; Batiste, C.M. Access to healthcare among youth experiencing homelessness: Perspectives from healthcare and social service providers. Child. Youth Serv. Rev. 2020, 115, 105094. [Google Scholar] [CrossRef]
  46. Grennan, T.; Edward, J.; Chown, S. Sexually transmitted infections sexual healthcare of homeless street-involved youth. In Clinical Care for Homeless and Runaway, and Refugee Youth: Intervention Approaches, Education and Research Directions; Walf, C., Charles, G., Eds.; Springer Nature: Cham, Switzerland, 2020. [Google Scholar] [CrossRef]
  47. Chelvakumar, G.; Ford, N.; Kapa, H.M.; Lange HL, H.; McRee, A.L.; Bonny, A.E. Healthcare barriers and utilization among adolescents and young adults accessing services for homeless and runaway youth. J. Community Health 2017, 42, 437–443. [Google Scholar] [CrossRef]
  48. Coolhart, D.; Brown, M.T. The need for safe spaces: Exploring the experiences of homeless LGBTQ youth in shelters. Child. Youth Serv. Rev. 2017, 82, 230–238. [Google Scholar] [CrossRef]
  49. Pedersen, E.R.; Tucker, J.S.; Kovalchik, S.A. Facilitators and barriers of drop-in center use among homeless youth. J. Adolesc. Health 2016, 59, 144–153. [Google Scholar] [CrossRef] [PubMed]
  50. Liddon, N.; Pampati, S.; Dunville, R.; Kilmer, G.; Steiner, R.J. Annual STI testing among sexually active adolescents. Pediatrics 2022, 149, e2021051893. [Google Scholar] [CrossRef]
  51. Martin-Smith, H.A.; Okpo, E.A.; Bull, E.R. Exploring psychosocial predictors of STI testing in university students. BMC Public Health 2018, 18, 664. [Google Scholar] [CrossRef]
  52. Murphy, P.W.; Davis, T.C.; Long, S.W.; Jackson, R.H.; Decker, B.C. Rapid estimate of adult literacy in medicine (REALM): A quick reading test for patients. J. Read. 1993, 37, 124–130. [Google Scholar]
  53. Eaton, D.K.; Kann, L.; Kinchen, S.; Shanklin, S.; Flint, K.H.; Hawkins, J.; Harris, W.A.; Lowry, R.; McManus, T.; Chyen, D.; et al. Youth risk behavior surveillance—United States, 2011. In Morbidity and Mortality Weekly Report, Surveillance Summaries (Washington D.C.: 2002); Centers for Disease Control and Prevention: Atlanta, GA, USA, 2012; Volume 61, pp. 1–162. [Google Scholar]
  54. Hosmer, D.W., Jr.; Lemeshow, S.; Sturdivant, R.X. Applied Logistic Regression; John Wiley & Sons: Hoboken, NJ, USA, 2013. [Google Scholar]
  55. Van Handel, M.; Kann, L.; O’Malley Olsen, E.; Dietz, P. HIV testing among US high school students and young adults. Pediatrics 2016, 137, e20152700. [Google Scholar] [CrossRef] [PubMed]
  56. Kann, L.; McManus, T.; Harris, W.A.; Shanklin, S.L.; Flint, K.H.; Queen, B.; Ethier, K.A. Youth Risk Behavior Surveillance–United States, 2017. In MMWR Surveillance Summaries; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2018; Volume 67, pp. 1–114. Available online: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf (accessed on 24 March 2024).
  57. Cuffe, K.M.; Newton-Levinson, A.; Gift, T.L.; McFarlane, M.; Leichliter, J.S. Sexually transmitted infection testing among adolescents and young adults in the United States. J. Adolesc. Health 2016, 58, 512–519. [Google Scholar] [CrossRef] [PubMed]
  58. Centers for Disease Control and Prevention. Getting Tested for STIs. 2024. Available online: https://www.cdc.gov/sti/testing/index.html (accessed on 25 November 2024).
  59. Keizur, E.M.; Goldbeck, C.; Vavala, G.; Romero, A.; Ocasio, M.; Fournier, J.; Lee, S.J.; Abdalian, S.E.; Rotheram, M.J.; Klausner, J.D.; et al. Safety and effectiveness of same-day Chlamydia trachomatis and neisseria gonorrhoeae screening and treatment among gay, bisexual, transgender, and homeless youth in Los Angeles, California and New Orleans, Louisiana. Sex. Transm. Dis. 2020, 47, 19–23. [Google Scholar] [CrossRef] [PubMed]
  60. Andersen, R.M. Revisiting the behavioral model and access to medical care: Does it matter? J. Health Soc. Behav. 1995, 36, 1–10. [Google Scholar] [CrossRef] [PubMed]
  61. Andersen, R.M. National health surveys and the behavioral model of health services use. Med. Care 2008, 46, 647–653. [Google Scholar] [CrossRef]
  62. Santa Maria, D.M.; Fernandez-Sanchez, H.; Nyamathi, A.; Lightfoot, M.; Quadri, Y.; Paul, M.; Torres Jones, J. Lessons learned from conducting a community-based, nurse-led HIV prevention trial with youth experiencing homelessness: Pivots and pitfalls. Public Health Nurs. 2024, 41, 806–814. [Google Scholar] [CrossRef]
  63. Auerswald, C.L.; Sugano, E.; Ellen, J.M.; Klausner, J.D. Street-based STD testing and treatment of homeless youth are feasible, acceptable, and effective. J. Adolesc. Health 2006, 38, 208–212. [Google Scholar] [CrossRef]
  64. Piche, J.; Kaylegian, J.; Smith, D.; Hunter, S.J. The relationship between self-reported executive functioning and risk-taking behavior in urban homeless youth. Behav. Sci. 2018, 8, 6. [Google Scholar] [CrossRef]
  65. Beymer, M.R.; Weiss, R.E.; Bolan, R.K.; Rudy, E.T.; Bourque, L.B.; Rodriguez, J.P.; Morisky, D.E. Sex on demand: Geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles County. Sex. Transm. Infect. 2014, 90, 567–572. [Google Scholar] [CrossRef]
  66. Barman-Adhikari, A.; Rice, E.; Bender, K.; Lengnick-Hall, R.; Yoshioka-Maxwell, A.; Rhoades, H. Social networking technology use and engagement in HIV-related risk and protective behaviors among homeless youth. J. Health Commun. 2016, 21, 809–817. [Google Scholar] [CrossRef]
  67. Rice, E.; Monro, W.; Barman-Adhikari, A.; Young, S.D. Internet use, social networking, and HIV/AIDS risk for homeless adolescents. J. Adolesc. Health 2010, 47, 610–613. [Google Scholar] [CrossRef] [PubMed]
  68. Herbers, J.E.; Hayes, K.R.; Cutuli, J.J. Adaptive systems for student resilience in the context of COVID-19. Sch. Psychol. 2021, 36, 422–426. [Google Scholar] [CrossRef] [PubMed]
Table 1. Participant Characteristics.
Table 1. Participant Characteristics.
Mean (SD)n (%)
Outcomes
        Recent STI Test 663 (48.57)
        Recent HIV Test 710 (51.82)
Demographics
Study Sites
        Los Angeles 210 (15.20)
        Phoenix 206 (14.91)
        Denver 199 (14.40)
        St Louis 192 (13.89)
        Houston 200 (14.47)
        New York 193 (13.97)
        San Jose 182 (13.17)
Age (in years)20.88 (2.08)
Gender
        Male 828 (58.47)
        Female 482 (34.04)
        Trans and Nonbinary 106 (7.49)
Sexual Orientation
        Heterosexual 985 (71.27)
        LGB 332 (23.30)
        Questioning/Something else 75 (5.43)
Race/Ethnicity
        White 266 (19.25)
        Black 518 (37.48)
        Latinx 233 (16.86)
        American Indian 44 (3.18)
        Asian/Pacific Islander 21 (1.52)
        Multiracial 222 (16.06)
        Other 78 (5.64)
Education
        Less than H.S. 425 (30.86)
        H.S. Diploma or GED 717 (52.07)
        Higher Education 235 (17.07)
        Currently In School 265 (18.77)
Involvement in Foster Care System 531 (38.45)
Involvement in Juvenile Justice System 497 (36.04)
Risk Engagement
Substance Use Behaviors
        Heavy Drinking 474 (34.00)
        Illicit Drug Use 560 (40.61)
        Injection Drug Use 121 (8.64)
Sexual Risk Behaviors
        Survival Sex 269 (24.39)
        Condomless Sex 634 (57.58)
        Sexually Active before 16 634 (57.38)
        Sexual Intercourse under Influence of Substances 479 (43.55)
        Sex with Someone met Online 600 (54.35)
n = 1426
Table 2. HIV and STI Testing Rates.
Table 2. HIV and STI Testing Rates.
HIV TestingSTI Testing
Cityn (%)n (%)
Los Angeles115 (63.54%)99 (55.62%)
Denver87 (50.88%)81 (47.37%)
Houston86 (54.43%)83 (52.53%)
New York City109 (75.17%)105 (71.92%)
Phoenix 64 (39.51%)59 (36.88%)
San Jose54 (35.76%)54 (36%)
St. Louis80 (49.08%)80 (49.38%)
Table 3. Bivariate Statistics.
Table 3. Bivariate Statistics.
HIV TestingSTI Testing
OR95% CIOR95% CI
Demographics
Study Sites (ref = Los Angeles)
        Denver0.59 *0.39, 0.910.720.47, 1.09
        Houston0.690.44, 1.060.880.57, 1.19
        New York City1.74 *1.07, 2.822.04 **1.28, 3.26
        Phoenix0.37 ***0.24, 0.580.47 **0.30, 0.72
        San Jose0.31 ***0.20, 0.500.45 ***0.29, 0.70
        St. Louis0.55 **0.36, 0.850.780.51, 1.19
Age0.94 *0.89, 1.000.92 **0.87, 0.97
Sex Assigned at Birth (ref = male)1.43 **1.12, 1.821.53 **1.20, 1.96
Gender (ref = Male)
        Female1.54 **1.20, 1.971.57 ***1.22, 2.02
        Trans/Non-binary2.13 **1.33, 3.431.540.98, 2.44
Sexual Orientation (ref = Heterosexual)
        Sexual minority1.41 **1.10, 1.821.270.98, 1.64
Race/Ethnicity (ref = White)
        Black1.55 **1.12, 2.151.58 **1.15, 2.20
        Latinx1.49 *1.01, 2.211.150.78, 1.70
        Multiracial 1.84 **1.25, 2.711.70 **1.16, 2.51
        Other1.82 *1.13, 2.911.340.84, 2.15
Education (ref = Less than H.S.)0.930.72, 1.191.040.81, 1.34
        Currently In School1.240.92, 1.681.39 *1.03, 1.88
Foster Care Involvement1.260.99, 1.601.090.86, 1.39
Juvenile Justice Involvement0.960.76, 1.220.930.73, 1.18
Risk Engagement
Substance Use Behaviors
Hard Drug Use (ref = no)0.880.67, 1.150.70.53, 0.91
Injection Drug Use (ref = no)1.210.79, 1.850.730.48, 1.12
Sexual Risk Behaviors
        Sexually Active before 16 0.71 **0.56, 0.900.80.63, 1.01
        Survival Sex1.080.82, 1.421.070.81, 1.41
        Condomless Sex1.330.96, 1.831.381.00, 1.91
        Sexual Intercourse Under the Influence of Substances1.070.85, 1.360.890.71, 1.13
        Multiple Sexual Partnerships 0.970.72, 1.290.910.68, 1.23
        Online Sex Partner(s)1.49 **1.18, 1.891.58 ***1.25, 2.00
Note. OR = Odds Ratio, CI = 95% Confidence Interval; * p < 0.05, ** p < 0.01, *** p < 0.001.
Table 4. Multivariate Statistics.
Table 4. Multivariate Statistics.
HIV TestingSTI Testing
OR95% CIOR95% CI
Demographics
Study Sites (ref = Los Angeles)
        Denver0.63 *0.40, 0.990.770.50, 1.20
        Houston0.62 *0.39, 0.980.770.49, 1.22
        New York City1.450.86, 2.441.71 *1.03, 2.81
        Phoenix0.36 ***0.23, 0.560.48 **0.31, 0.76
        San Jose0.26 ***0.16, 0.420.42 ***0.26, 0.67
        St. Louis0.50 **0.30, 0.820.640.39, 1.04
Age0.970.91, 1.040.950.88, 1.01
Sex Assigned at Birth (ref = male)0.980.42, 2.271.380.62, 3.09
Gender (ref = Male)
        Female1.610.68, 3.821.130.50, 2.58
        Trans/Non-binary1.550.88, 2.731.110.64, 1.92
Sexual Orientation (ref = Heterosexual)
        Sexual minority1.10.82, 1.461.020.77, 1.35
Race/Ethnicity (ref = White)
        Black1.290.90, 1.861.310.91, 1.88
        Latinx1.370.89, 2.121.040.68, 1.60
        Multiracial 1.460.97, 2.201.40.93, 2.10
        Other1.640.99, 2.711.20.73, 1.96
Currently In SchoolN/AN/A1.110.81, 1.54
Risk Engagement
Sexual Risk Behaviors
        Sexually Active before 16 0.65 **0.50, 0.84
        Online Sex Partner(s)1.34 *1.04, 1.731.54 **1.20, 1.98
Note. OR = Odds Ratio, CI = 95% Confidence Interval; * p < 0.05, ** p < 0.01, *** p < 0.001.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Ochs, A.; Barman-Adhikari, A.; Hsu, H.-T.; Petering, R.; Shelton, J.; Narendorf, S.; Santa Maria, D.; Bender, K.; Ferguson, K. Untangling Regional Disparities: HIV and STI Testing Patterns Among Youth Experiencing Homelessness in Seven U.S. Cities. Youth 2024, 4, 1774-1786. https://doi.org/10.3390/youth4040112

AMA Style

Ochs A, Barman-Adhikari A, Hsu H-T, Petering R, Shelton J, Narendorf S, Santa Maria D, Bender K, Ferguson K. Untangling Regional Disparities: HIV and STI Testing Patterns Among Youth Experiencing Homelessness in Seven U.S. Cities. Youth. 2024; 4(4):1774-1786. https://doi.org/10.3390/youth4040112

Chicago/Turabian Style

Ochs, Alex, Anamika Barman-Adhikari, Hsun-Ta Hsu, Robin Petering, Jama Shelton, Sarah Narendorf, Diane Santa Maria, Kimberly Bender, and Kristin Ferguson. 2024. "Untangling Regional Disparities: HIV and STI Testing Patterns Among Youth Experiencing Homelessness in Seven U.S. Cities" Youth 4, no. 4: 1774-1786. https://doi.org/10.3390/youth4040112

APA Style

Ochs, A., Barman-Adhikari, A., Hsu, H.-T., Petering, R., Shelton, J., Narendorf, S., Santa Maria, D., Bender, K., & Ferguson, K. (2024). Untangling Regional Disparities: HIV and STI Testing Patterns Among Youth Experiencing Homelessness in Seven U.S. Cities. Youth, 4(4), 1774-1786. https://doi.org/10.3390/youth4040112

Article Metrics

Back to TopTop