Pregnancy, Not High-risk Behavior, Predictor of STD Testing Among Newly Homeless Youth

Sexually Transmitted Diseases

In the first study of its kind focusing on newly homeless youth, UCLA researchers have found that high-risk sexual behavior did not predict whether these youths were tested for sexually transmitted diseases. Instead, they were tested only when someone became pregnant or got someone pregnant.

The findings, to be published in the May issue of the peer-reviewed journal AIDS and Behavior, indicate that there is an urgent need for outreach programs targeting sexually active homeless youths - who are at particularly elevated risk for becoming infected with the human immunodeficiency virus (HIV) - for early STD screening.

Contracting an STD can predispose one to becoming infected with the deadly virus that leads to acquired immunodeficiency syndrome (AIDS), said Dr. Rosa Solorio, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the study's lead researcher. Some of these infections do not present symptoms and these youths may not be aware of the need for testing, despite the high rates of sexually transmitted diseases among them.

"We have to screen these youths to prevent a more negative outcome like HIV," Solorio said. "They need timely STD detection and treatment, and what the study shows is that the kids who are at highest risk are not getting tested."

The researchers surveyed 261 homeless youth who were aged 12 to 20, had been away from home at least two nights but less than six months and, if under age 17, were away from home without their parents' or guardians' permission or had been kicked out of the house. They were interviewed over 12 months between 2001 and 2002. The subjects were selected from 17 shelters and drop-in centers and 13 street hangout sites throughout Los Angeles County. Of those surveyed, half had been sexually active in the previous three months.

The researchers found a 32 percent sexually transmitted disease rate among the study subjects who had received an STD test in the past three months, a number that may actually be an underestimate of rates among sexually active homeless youth in general, as many diseases such as chlamydia and genital herpes may be asymptomatic. The researchers also found that while STD testing rates were similar for both boys and girls (46 percent), girls were likelier to have positive test results (46 percent vs. 9 percent), most likely because they use condoms less consistently than boys, who nonetheless engaged in higher-risk behaviors such as having multiple sex partners and engaging in anal intercourse.

The only independent predictor of STD testing the researchers found was whether homeless youths had become pregnant or had gotten someone pregnant in the prior three months. Physicians are likely to offer STD testing to pregnant girls.

These youths need to be better informed about the risks they face on the streets and the importance of STD testing.

"In order for us to improve STD testing in this population - we are talking about very young kids - we have to develop outreach programs to educate them and advise them where they can get tested," Solorio said. "They're so young they may not think they have acquired an STD. Some STDs are asymptomatic; they may not know they have an STD at all."

The National Institute of Mental Health funded the study.