Initiation of Services in the Boston HAPPENS Program: Human Immunodeficiency Virus-Positive, Homeless, and At-Risk Youth Can Access Services

Abstract

This study evaluates the factors associated with initiation of services in the Boston HAPPENS Program, which is a collaborative network of care consisting of multiservice outreach agencies, community health centers and hospitals, for human immunodeficiency virus (HIV)-positive and hard to reach youth who are 12-24 years old. The program served 2116 youth who were 19.8 +/- 2.9 years old; 64% female; 45% youth of color; 16% gay/lesbian, bisexual, or undecided; and 10% homeless or runaway. At first contact with the program, 56% received outreach services; and 91% received a health intervention. Among those receiving a health intervention, 55% had HIV counseling and testing services, 49% medical care, 24% case management, and 9% mental health services. HIV-positive youth needed more contacts before a first medical visit than those who were HIV-negative or untested (p < 0.001). Different kinds of service sites reached different populations of at-risk youth. Logistic regression modeling showed that for young women, older age, lesbian-bisexual orientation, substance use, high-risk sexual behaviours, and receiving outreach services at first contact were independent predictors of initiation of services at outreach agencies; however, unprotected sex with males, and pregnancy were associated with a greater likelihood of care at hospitals or community health centers. For young men, older age, Asian/other ethnicity, and substance abuse were associated with care at outreach agencies; however, positive HIV status and unprotected sex with females were associated with care at hospitals or community health centers. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect underserved youth to health care.

The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial

“…The disparity between the rates of HIV among homeless youth and youth in the general population is significant given that .2-.4% of adolescents in the general population test positive for HIV (Rotheram-Borus et al 2003), highlighting the need for risk reduction methods developed for homeless youth. Homeless youth are difficult to connect to care and the need for intervention is high (Ensign and Bell 2004;Rotheram-Borus et al 2003;Woods et al 2002). The current study examined HIV risk behaviors and an integrated intervention targeted at reducing these behaviors in a sample of homeless youth between the ages of 14 and 22.…”

“…Two studies report that between 10.2% and 11.5% of their sample of homeless youth (between the ages of 12 and 24) was positive for HIV (Pfeiffer and Oliver 1997;Woods et al 2002). The disparity between the rates of HIV among homeless youth and youth in the general population is significant given that .2-.4% of adolescents in the general population test positive for HIV (Rotheram-Borus et al 2003), highlighting the need for risk reduction methods developed for homeless youth.…”

Perceptions of Human Immunodeficiency Virus (HIV) Testing Services Among HIV-Positive Persons Not in Medical Care

“…41 Case management has been shown to influence positively the proportion of HIV-positive persons who receive medical care, 31 underserved youths' access to HIV medical care, 42 and infected persons' use of communitybased support services. 43 Persons who used crack cocaine, compared with persons who did not, reported that they were not given enough time.…”

Six‐ and Twelve‐Month Outcomes among Homeless Youth Accessing Therapy and Case Management Services through an Urban Drop‐in Center

“…Complicating these adverse health outcomes is the fact that many homeless youth are alienated from health and social services (Wright 1990b;Woods et al 2002). De Rosa et al (1999) found that only 28 percent of street youth reported ever accessing medical care services, 10 percent accessed substance abuse treatment services, and 9 percent accessed mental health services.…”