Substance use and risky sexual behavior among homeless and runaway youth

Purpose: To (a) characterize human immunodeficiency virus (HIV)-related ris k behaviors of homeless youth; (b) determine whether substance use is assoc iated with risky sexual behavior in this population; and, if so, (c) explor e explanations for this relationship. Methods: A purposive sample of 327 homeless youth (ages 14-21 years) in Was hington, DC, were surveyed in 1995 and 1996. Survey items were adapted from items used in a national study of adult substance use and sexual behavior and measured global (lifetime) and event-specific (most recent sexual encou nter) behaviors. Results: Sexual activity with many partners, "survival" sex, and substance use were common. However, needle use was rare, and consistent condom use wa s evident in half the sample. Nearly all correlations between global measur es of substance use and risky sex were statistically significant, but only a few of the event-specific correlations were significant. Marijuana use du ring the most recent sexual encounter was associated with nonuse of condoms , but this relationship disappeared in the multivariate model. However, cra ck use during the last encounter was associated with condom use; this relat ionship remained significant in the multivariate model. Lack of motivation to use condoms, longer histories of sexual activity and homelessness, sympt oms of drug dependency, not discussing HIV risks with partner, and being fe male were also associated with nonuse of condoms. Conclusions: Homeless youth do use condoms, even within the context of subs tance use and casual sex. Results suggest that prevention and targeted inte rvention efforts have had some positive effect on this population, but youn g homeless women are in need of targeted prevention. Finally, additional re search is needed to investigate the observed relationship between crack use and condom use in this sample. (C) Society for Adolescent Medicine, 1998.