Counter-Narratives of Structural Oppressions, Stigma and Resistance, and Reproductive and Sexual Health Among Youth Experiencing Homelessness

Abstract

Youth experiencing homelessness (YEH) face myriad injustices regarding their reproductive and sexual health and rights. Reproductive and sexual health research with YEH often explores condom-use and sexually transmitted infections, potentially contributing to narrow conceptualizations of YEH as “unclean” or in need of disease-screening. A narrative theory perspective was applied to this study, which allowed for the emergence of alternative storylines, or counter-narratives, which attend to manifestations of power and oppression within the lives of marginalized individuals. Qualitative interviews engaged 30 young people (ages 18–21) accessing shelter services. Narrative analyses identified YEHs’ documentations of dominant narratives related to structural oppressions, stigma, and numerous dimensions of reproductive and sexual health including how they create, through their resistance, counter-narratives that include their preferred futures. YEH emphasized systemic sources of stigma and outlined their criticisms of the state. Within-group stigma emerged as a noteworthy theme, with YEH showing both empathy and ambivalence towards other YEH, along with internalization of stigmatizing narratives about pregnancy and homelessness. Approaches to service provision that further amplify youths’ voices in naming and challenging the many oppressions and stigmas they face should be prioritized. Moreover, policies should be implemented to dismantle the actual root causes of challenges faced by YEH, rather than perpetuating them through measures rooted in interlocking oppressions of discrimination, inequity, and judgment.

Understanding effects of the group process on drinking outcomes for emerging adults experiencing homelessness

“…Overall, findings highlight that for group MI, it is important to include both standard MI measures, such as percent change talk, and group process‐specific measures, such as climate and cohesion, as these can help provide a more in‐depth understanding of what is happening in the group session. This can be particularly important with populations who may be marginalized, like young people experiencing homelessness, as they often experience discrimination and feel shamed (Henriques et al., 2022; Toolis & Hammack, 2015), which may make them more wary of participating in groups addressing sensitive issues, such as substance use.…”

Sexual assault and vulnerability to sexually transmitted infections among homeless Brazilian women: a cross sectional qualitative study

“…Homeless women have limitations in their access and use of health services, including sexual and reproductive health care with regard to contraception, prenatal care, appropriate STIs treatment, and access to safe abortion [ 6 , 8 ]. The nonuse of these services may be related to a lack of knowledge [ 8 , 11 ], to not knowing where to go to receive assistance [ 11 ], or to a lack of health insurance [ 11 ], fear, stigma, the possibility of suffering discrimination by health professionals [ 8 ] or the fear of becoming involved in the legal system [ 11 ].…”

“…The social environment of the streets is complex, stigmatizing and permeated by gender-based power imbalances [ 5 , 6 ]. In this context, women are subject to violence, sexual exploitation, rape, prostitution, reproductive disorders, and a greater risk of sexually transmitted infections (STI) and unintended pregnancy, contributing to the perpetuation of the cycle of poverty and misery, in addition to unsafe abortion practices [ 6 – 9 ]. Among their numerous deprivations on the streets, sex can be configured as a means of meeting the subsistence needs of these women in a context of marginalization [ 10 ].…”

Estigma en personas sin hogar y atención en salud: reflexiones desde un programa Housing First en Barcelona, España

“…Al mismo tiempo, la experiencia del sinhogarismo está asociada a procesos de fuerte estigmatización que, en muchas ocasiones, tienen su reflejo en el trato que las personas reciben del equipo profesional y del propio sistema de atención en salud. De este modo, aunque España cuente con servicios de salud universales, públicos y gratuitos, se despliegan otro tipo de barreras no económicas que dificultan el acceso a los dispositivos sanitarios, generando incluso distancia y rechazo (7,8,9,10) . Esta situación retroalimenta las condiciones de precariedad, las dificultades en las condiciones de salud y el aumento del riesgo de muerte (11,12,13,14) .…”