Narrative Review: Sexually Transmitted Diseases and Homeless Youth—What Do We Know About Sexually Transmitted Disease Prevalence and Risk?

Abstract

Background Homelessness affects an estimated 1.6 million US youth annually. Compared with housed youth, homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk. However, there is no national estimate of STD prevalence among this population. Methods We identified 10 peer-reviewed articles (9 unique studies) reporting STD prevalence among homeless US youth (2000–2015). Descriptive and qualitative analyses identified STD prevalence ranges and risk factors among youth. Results Eight studies reported specific STD prevalence estimates, mainly chlamydia, gonorrhea, and syphilis. Overall STD prevalence among homeless youth ranged from 6% to 32%. STD rates for girls varied from 16.7% to 46%, and from 9% to 13.1% in boys. Most studies were conducted in the Western United States, with no studies from the Southeast or Northeast. Youths who experienced longer periods of homelessness were more likely to engage in high-risk sexual behaviors. Girls had lower rates of condom use and higher rates of STDs; boys were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to protective effects on individual sexual risk behavior. Conclusions Sexually transmitted disease prevalence estimates among homeless youth fluctuated greatly by study. Sexually transmitted disease risk behaviors are associated with unmet survival needs, length of homelessness, and influence of social networks. To promote sexual health and reduce STD rates, we need better estimates of STD prevalence, more geographic diversity of studies, and interventions addressing the behavioral associations identified in our review.

Eviction From Renter-occupied Households and Rates of Sexually Transmitted Infections: A County-level Ecological Analysis

“…This study extends a larger body of research on STI/HIV risk associated with homelessness. 16,17 While homelessness is important to consider due to high associated vulnerabilities, it alone fails to capture the wide range of forms that housing instability may take and the extent to which more common housing problems, in this case, eviction, may affect population health with respect to STI.…”

“…However, few studies have considered the health consequences of eviction, in contrast to a much larger body of literature related to homelessness and a recently burgeoning literature on the health consequences of foreclosures that have been summarized in numerous reviews. 1,3,4,16,17 A smaller body of literature has identified negative health outcomes associated with eviction including poor general health, depression, substance use, exposure to violence, poor treatment outcomes for people living with HIV, suicide, and all-cause mortality. 18–24…”

The growing epidemic of sexually transmitted infections in adolescents: a neglected population

“…A recent review found STIs among homeless adolescents to be associated with length of homelessness, coercive sex, and unmet survival needs [25]. Adolescent drug use and incarceration are also associated with higher rates of STIs due to combination of behavioral risk factors and unequal access to the health care system [26, 27].…”

Sexually Transmitted Infection Prevalence among Homeless Adults in the United States: A Systematic Literature Review

“…Research that has examined associations between infectious diseases such as sexually transmitted infections (STIs) and sexual or behavioral risk factors among homeless persons has often highlighted youth, who are at high risk for STIs. 15–18 However, less is known about STI rates and the associated risks among homeless adults, or the extent to which STIs play a role in the health issues facing homeless adults.…”