Predictors of HIV testing among runaway and homeless adolescents

doi:10.1016/1054-139X(94)90140-X

Journal of Adolescent Health

Volume 15, Issue 7, November 1994, Pages 566-572

https://doi.org/10.1016/1054-139X(94)90140-X Get rights and content

Abstract

Purpose: Although runaway and homeless adolescents are at high risk for acquiring HIV infection, little is known about which of these youth obtain HIV testing or whether those considered to be at highest risk are being tested. The purpose of our study was to determine demographic characteristics and risk profiles of runaway and homeless adolescents who had obtained an HIV test and compare them to those who had not been tested.

Methods: We analyzed data collected by the State of California from a survey of 202 San Francisco Bay area runaway and homeless youth aged 13–18 years conducted in 1990–1991. Adolescents were interviewed about AIDS-related knowledge, attitudes, beliefs, and behaviors, including HIV testing experience.

Results: Most subjects were 16 years or older (80%), white (61%), sexually active (91%) and heterosexual (82%). Twenty-three percent reported a previous sexually transmitted disease (STD); 27% had used injection drugs. Over half (54%) had been HIV antibody tested. Free/community clinics were the most common site for testing. In a logistic regression model, four variables were independent predictors of having obtained an HIV antibody test: history of an STD (p = 0.01), 5 or more years of sexual activity (p = 0.01), injection drug use (P = 0.04), and age (p = 0.04).

Conclusions: Our study demonstrates that many runaway and homeless adolescents have obtained an HIV antibody test and that those with known risk factors are more likely to have been tested. These data support the need for community-based expansion of HIV-related services for homeless youth. The effects of HIV antibody testing on subsequent beliefs and behaviors need further study.

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In the United States, Black women are disproportionately affected by HIV, accounting for most new HIV infections diagnosed among women. Socio-structural barriers to HIV testing include stigma and discrimination but may be mitigated by resilience.
We aimed to examine the effect of discrimination and resilience on HIV testing behaviors among Black women.
Between 2016 and 2018, we conducted The ESSENCE Project, a retrospective cohort study on the role of physiological and environmental factors on the association between sexual assault and HIV risk among Black women in Baltimore, Maryland, USA. Black women aged 18-44 were recruited from public health STD clinics and completed an audio-computer-assisted self-interview survey. Hierarchical multiple negative binomial regression models were used to examine the associations of everyday discrimination (subtle and overt) and resilience on HIV testing frequency; resilience and its subscales (relational maintenance, personal fortitude, positive coping, independence and insight) were also examined as moderators.
Among 236 Black women reporting HIV testing history, the median number of lifetime HIV tests was 4 (IQR = 2, 6). Mean everyday discrimination was 2.3 (SD = 1.2). Mean resilience was 5.3 (SD = 0.8). Everyday discrimination and its subscales (overt and subtle) were negatively associated with lifetime HIV testing frequency, while overall resilience was not associated with lifetime HIV testing frequency. Accounting for demographics, overall resilience moderated the association of subtle discrimination and lifetime HIV testing frequency. For the resilience subscales, more specifically: (1) associations of subtle discrimination and HIV testing frequency were significant at the lowest relational maintenance and lowest positive coping resilience; and (2) the association of subtle discrimination and HIV testing frequency was significant at the highest resilience for all four subscales.
These findings highlight the need for provider- and community-level interventions addressing the deleterious effects of everyday discrimination and more specifically subtle everyday discrimination to encourage HIV testing.
Risky sexual behavior and STI testing among teens experiencing homelessness
2022, Children and Youth Services Review
Citation Excerpt :
For example, Clemenzie-Allen et al. (2019) found that individuals experiencing homelessness who are HIV-positive have 34% lower odds of receiving chlamydia and gonorrhea screening than HIV-positive, housed individuals. In contrast, several other studies demonstrate that over 50% of youth experiencing homelessness have been tested for either HIV or STIs, which is higher than their housed counterparts (Goodman & Berecochea, 1994; Gwadz et al., 2010; Tyler & Melander, 2010; Young & Rice, 2011). A handful of studies have assessed predictors of STI testing rates among populations experiencing homelessness.
Teens who experience homelessness are more likely to engage in risky sexual behavior, though less is reliably known about sexually transmitted infection (STI) testing rates in this group. We tested for differences in sexual behaviors and STI/HIV testing based on student homelessness and intersecting factors using data from the 2019 Youth Risk Behavior Survey administered in 7 states and 3 school districts. Students who experienced homelessness were more likely to report risky sexual behavior. Race moderated this link, suggesting that Asian students who experienced homelessness were at greater risk. Homelessness was linked to a greater likelihood of having been tested for STIs/HIV among those who seemed to be in groups recommended for testing. Student sex and lesbian, gay, and bisexual (LGB) identity did not moderate associations between homelessness and risky sexual behavior or STI/HIV testing. The overall sample demonstrated low STI testing rates, indicating a continued need to improve testing rates for all youth at risk for STIs/HIV.
Determinants of late diagnosis of HIV infection in Spain
2014, Psychosocial Intervention
The main goal of this study was to analyse the determinants of late diagnosis of HIV infection. Secondly, we studied the role of the perception of risk and sexual orientation in HIV testing. Twenty-five people with late HIV diagnosis were interviewed. They were contacted through hospitals and non-governmental organizations (NGOs). To design the interview, we integrated the variables considered in the main models of health-related behaviour. We followed a mixed strategy of analysis. Firstly, we carried out thematic analysis of the interviews, followed by quantitative analysis of the initially qualitative data. The results revealed that the most relevant determinants were the appraisal of the threat of HIV and the low perception of HIV risk. Also, the study found many missed opportunities for diagnosis in health-care setting. Low perception of HIV risk was related to unrealistic optimism, low levels of information about HIV, and the presence of stereotypes about people with HIV. High perception of HIV risk was related to strategies to avoid testing. Homosexuals reported a more positive balance between the benefits of knowing their diagnosis and having the disease. The results provide clues that can guide the design of future strategies to promote early diagnosis.
El objetivo principal de este estudio fue analizar los determinantes del diagnóstico tardío de la infección por VIH. Asimismo, se estudió el papel que jugaban en ello la percepción de riesgo y la orientación sexual. Se entrevistó a 25 personas con VIH, con las que se estableció contacto a través de hospitales y de organizaciones no gubernamentales (ONG). Para el diseño del guión de la entrevista se partió de una integración de las variables consideradas en los principales modelos de conductas de salud. Se siguió una estrategia mixta de análisis. Primeramente, se realizó análisis temático de las entrevistas. Seguidamente, se realizaron análisis cuantitativos sobre los datos cualitativos. Se halló que los determinantes más relevantes eran la valoración de amenaza del VIH y la baja percepción de riesgo. Se hallaron también oportunidades perdidas de diagnóstico en el sistema sanitario. La baja percepción de riesgo se asociaba con el optimismo irrealista, la poca información sobre el VIH y los estereotipos sobre las personas con VIH. La alta percepción de riesgo se relacionaba con las estrategias de evitación del test. Los discursos de las personas homosexuales mostraron un balance más positivo de los beneficios de conocer el diagnóstico. Los resultados sugieren claves que pueden guiar el diseño de futuras estrategias de promoción del diagnóstico precoz.
Rapid point-of-care HIV testing in youth: A systematic review
2013, Journal of Adolescent Health
This review examines the literature surrounding acceptability of, and preference for, rapid point-of-care (POC) human immunodeficiency virus (HIV) testing in youth, documents notification rates when youth were offered rapid POC testing, and identifies the sociodemographic factors associated with testing.
The reviewers searched the scholarly literature indexed in MEDLINE, Embase, CINAHL, and PsycInfo using a set of keywords related to youth and rapid POC HIV testing. A total of 14 articles were included in the review.
Four themes were identified: (1) Youth will accept rapid POC testing, particularly if offered; (2) youth prefer rapid POC testing to traditional testing; (3) youth receive their rapid POC HIV test results; and (4) older youth and those with HIV risk factors or a concurrent genitourinary diagnosis are more likely to accept rapid POC HIV testing when it is offered.
Evidence shows that youth accept and prefer rapid POC HIV tests when offered. The routine use of rapid POC HIV tests in emergency departments and adolescent primary care clinics should be considered because of higher uptake in these environments. Youth receive their rapid POC test results more frequently and sooner than traditional test results. However, further work is needed to develop HIV testing programs that target younger adolescents.
Correlates of service utilization among homeless youth
2012, Children and Youth Services Review
Citation Excerpt :
Factors associated with STI testing include older age, amphetamine usage, and being a gay or bisexual male or heterosexual female (Solorio, Milburn, Weiss, & Batterham, 2006; Tyler & Melander, 2010). Positive correlates of HIV testing include being older, female, sexually active for more than five years, homeless for more than one year, and having a history of an STI/STD, using injection drugs, engaging in survival sex, or knowing someone with HIV (Goodman & Berecochea, 1994; Johnson De Rosa et al., 2001; Tyler & Melander, 2010). Those who seek HIV testing tend to be those who are at highest risk for contracting the disease (Goodman & Berecochea, 1994; Johnson De Rosa et al., 2001).
Though few studies exist on service utilization among homeless youth in the U.S., services are important because without them, many of these young people may resort to delinquent strategies in order to meet their daily survival needs. The current study examines frequency and correlates of service utilization (i.e., shelters, food programs, street outreach, counseling, STI and HIV testing) among a sample of 249 homeless youth ages 14 to 21. Multivariate analysis revealed significant differences in service usage by sex, age, and sexual orientation. Experiencing family physical and/or sexual abuse, being kicked out of the family home, spending more nights per week sleeping on the street, and having ever stayed in a group home facility were significant correlates of homeless youths' service usage.
Acceptability and feasibility of rapid HIV testing in an adolescent clinic setting: Youth testing attitudes, knowledge, and behaviors
2011, Journal of Adolescent Health
To assess youths' attitudes, knowledge, and behaviors regarding rapid HIV testing (RHT) and measure acceptability and feasibility of RHT in an adolescent clinic setting.
A 2007–2008 project introduced free RHT at an urban, hospital-based adolescent and young adult clinic in Boston, MA. Patients and HIV testing clients were offered either free nonrapid tests or fingerstick RHT. An anonymous questionnaire assessed youths' testing attitudes, knowledge, and behaviors (N = 127). Ordinal logistic regression model was used to determine associations with youth demographic characteristics and testing experience.
Most participants valued rapid results. A minority desired confidentiality from parents and insurance providers. Older youth were more likely to know about testing methods (OR: 1.25; CI: 1.04–1.51) and plan for follow-up (OR: 1.43; CI: 1.14–1.81). Age, gender, and race were unrelated to testing facilitators such as rapidity, confidentiality, and cost, although younger clients were more likely to prefer noninvasive methods. Individuals with previous testing experience were more likely to say that they would contribute to expenses and value rapidity over cost.
There was strong support for RHT among youth receiving HIV testing. Offering RHT to youth may facilitate routine testing. Future research should focus on increasing RHT access among diverse populations of youth.

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^☆: This work was supported in part by a grant from the Robert Wood Johnson Foundation, Princeton, NJ, The Henry J. Kaiser Family Foundation, Menio Park, CA, and project MCJ-MA 259195 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, DHHS.

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Predictors of HIV testing among runaway and homeless adolescents☆

Abstract

J Adolesc Health

J Adolesc

J Adolesc Health Care

J Adolesc

JAMA

A Decade of Denial: Teens and AIDS in America

Risky business: adolescents and human immunodeficiency virus

Pediatrics

A risk profile comparison of runaway and non-runaway youth

Am J Public Health

Health care needs of homeless and runaway youths

JAMA

HIV infection and homeless adolescents

Child Welfare

Acquired immunodeficiency syndrome and adolescents. Knowledge, attitudes, and behaviors of runaway and homeless youths

Am J Dis Child

Sexual risk behaviors, AIDS knowledge, and beliefs about AIDS among runaways

Am J Public Health