The Boston HAPPENS program: needs and use of services by HIV-positive compared to at-risk youth, including gender differences

Objective: The Boston HAPPENS (HIV Adolescent Provider and Peer Education N etwork for Services) Program is a linked services network of care for HIV-p ositive, homeless, and at risk youth in Metropolitan Boston funded by the S pecial Projects of National Significance Program. This report studies the n eeds and use of services by HIV-positive youth compared with negative and u ntested at-risk youth, including gender differences. Design: Providers collected information prospectively at outreach and servi ces encounters, including demographic information, risk behaviors, and serv ice utilization data. Results: Youth (N = 1044) were 19.6 +/- 3.0 years old; 38% male; 43% youth of color; and 4% self-identified as gay/lesbian/bisexual and 11.0% as homel ess and/or runaway youth. HIV-positive clients (N = 26) were more likely to use a range of network related health services. HIV-positive young women w ere more likely to report previous pregnancy (21% vs 5%, p = 0.04) or sexua l contact with high risk partners such as an injection drug user (57% vs 6% , p = 0.0009), an HIV-positive person (p < 0.00001), or survival sex (33% v s 8%, p = 0.04) than the other young women. HIV-positive young men were mor e likely to be youth of color (75% vs 43%, p = 0.04) and self-identify as g ay or bisexual (42% vs 4%, p = 0.005), and to report same sex partners (80% us 29%, p = 0.03) and substance use (100% vs 26%, p = 0.006) than other yo ung men. Youth seen at an outreach site were 10 times as likely to access m edical care through the program (95% CI, 6.9-14.6). Conclusions: HIV-positive youth are accessing coordinated care and there ar e gender differences in the needs for services. Health care policies should facilitate the development and evaluation of comprehensive, youth-specific health services for these hard to reach populations. (C) 2000 Elsevier Sci ence Ltd. All rights reserved.