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Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth
Authors:Brandon DL Marshall  Thomas Kerr  Jean A Shoveller  Thomas L Patterson  Jane A Buxton  Evan Wood  
Institution:1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul''s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6;2. School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3;3. Department of Medicine, University of British Columbia, St. Paul''s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6;4. Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA;5. San Diego Veteran Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA;6. Department of Epidemiology Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4;1. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada;2. BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada;3. Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;4. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada;5. BC Centre for Disease Control and Prevention, Vancouver, BC, Canada;6. Vancouver Coastal Health, Vancouver, BC, Canada;1. Center for Biomedical Research, Population Council, New York, NY, USA;2. National Institute of Allergy and Infectious Diseases, Bethesda MD, USA;3. Albert Einstein College of Medicine, Bronx, NY, USA;4. Laboratory of Cellular Oncology, National Cancer Institute, Bethesda, MD, USA;5. Obstetrics and Gynecology, University of Washington Seattle, WA, USA;6. NWJ Group, Wayne, PA, USA;7. Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland;1. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK;2. Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA;3. Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;4. Department of Family Medicine, Université de Montréal, Montréal, QC, Canada;5. Centre hospitalier de l''Université de Montreal, Montréal, QC, Canada;6. Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan;7. James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh;8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;9. BC Centre for Excellence in HIV/AIDS and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;10. Burnet Institute, Melbourne, VIC, Australia;11. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia;12. Department of Medicine, University of Melbourne, Melbourne, VIC, Australia;13. Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia;14. Faculty of Medicine, Tbilisi State University, Tbilisi, Georgia;15. National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic;p. Department of Addictology, The First Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic;q. National Institute of Mental Health, Klecany, Czech Republic;r. University Hospital Centre of Québec Research Centre—Laval University, QC, Canada;s. National Institute of Public Health of Québec, QC, Canada;t. Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada;u. International Charitable Foundation Alliance for Public Health, Kiev, Ukraine;v. Department of Epidemiology, University of Kentucky College of Public Health, KY, USA;w. Center on Drug and Alcohol Research, University of Kentucky, KY, USA;x. Public Health Institute, Liverpool John Moores University, Liverpool, UK;y. National Infection Service, Public Health England, London, UK;z. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK;11. Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK;12. Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK;13. Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA;1. Department of Emergency Medicine and Department of Population Health, NYU School of Medicine, Bellevue Hospital Center, New York, New York;2. U.S. Department of Veterans Affairs;3. Department of Psychiatry, University of California, San Francisco, California;4. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut;5. Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York;6. Department of Medicine, University of California, San Francisco, San Francisco, California;1. Family Medicine Residency of Idaho, Boise, Idaho;2. Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California, and UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of California, Berkeley, Berkeley, California
Abstract:The role that environmental factors play in driving HIV and STI transmission risk among street-involved youth has not been well examined. We examined factors associated with number of sex partners using quasi-Poisson regression and consistent condom use using logistic regression among participants enroled in the At Risk Youth Study (ARYS). Among 529 participants, 253 (47.8%) reported multiple partners while only 127 (24.0%) reported consistent condom use in the past 6 months. Homelessness was inversely associated with consistent condom use (adjusted odds ratio aOR]=0.47, p=0.008), while unstable housing was positively associated with greater numbers of sex partners (adjusted incidence rate ratio aIRR]=1.44, p=0.010). These findings indicate the need for interventions which modify environmental factors that drive risk among young street-involved populations.
Keywords:Adolescent  Homeless youth  Sexual behaviour  Substance use  HIV
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