Relation between Stress and Sexual Risk Behaviors in Homeless Youth

Background: Homeless youth are at significant risk for HIV & STIs. Yet, prevention interventions to date have been minimally effective. Homeless youth experience significant toxic stress related to adverse childhood events and current homeless circumstances. However, little is known about the associations between stress and sexual risk behaviors in homeless youth. We examined this association hypothesizing that high levels of stress are associated with increased sexual risk behaviors.

Methods: We conducted a survey of 441 homeless and unstably housed youth 13-24 years old residing in the Houston, TX area between October and December, 2014. Participants were recruited from shelters, drop-in centers, magnet events, and street canvasing and took a paper or ACASI computer-based survey. The Perceived Stress Scale-4 was used to measure stress and sexual risk behavior measures were derived from the YRBS. Additional questions regarding survival sex were asked. We used logistic regression to assess the association between stress and sexual risk behaviors.

Results: Findings indicate that a higher level of stress is significantly associated (p<0.05) with trade sex, oral and anal sex, and having sex against one’s will, but not with condom/contraceptive use, having more than 4 sex partners, drinking alcohol or using substances during last sex, or HIV/STI testing.

Conclusions: Stress appears to be a significant contributing factor to some sexual risk behaviors in homeless youth that may increase risk for HIV. HIV prevention interventions should consider addressing stress as a novel way to decrease HIV risk behaviors in high stress, vulnerable population.