STDs and Homeless Youth – What Do We Know about STD Prevalence and Risk?

Background: In the US, there are approximately 1.6 million homeless youth annually. Compared to housed youth, homeless youth are more likely to engage in high risk behaviors, including early sexual debut, inconsistent condom use, multiple sex partners, survival sex and alcohol/drug use, putting them at increased risk for acquiring STDs. However, there is no national estimate of STD prevalence among this population. This review documents STD prevalence among homeless youth and identifies associations with behavioral factors.  

Methods: We identified 10 peer-reviewed articles reporting STD prevalence among homeless youth in the US (2000-2015). Descriptive and qualitative analyses were conducted to identify STD prevalence ranges among youth, and factors associated with STD risk.

Results: Prevalence of specific STDs, mainly chlamydia, gonorrhea, and syphilis, were reported in 8 studies. Overall STD prevalence among homeless youth ranged from 6%- 32%; HIV rates ranged from 0.3- 8%. STD rates for females varied from 16.7% to 46%, and 9% to 13.1% in males. Most studies were conducted in the West, 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. Females had lower rates of condom use and higher rates of STDs; males were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to significant protective or negative effects on individual sexual behavior.

Conclusions: STD prevalence among homeless youth fluctuated greatly by study. STD 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.