HIV Prevalence Among Portland’s Homeless Youth Studied

Service providers are more concerned about youth's risk behaviors than they are HIV prevalence and transmission
The Lund Report

June 19, 2011—Small numbers of Portland’s homeless youth are infected by human immunodeficiency virus (HIV), according to a survey conducted by Cascade AIDS Project (CAP). It’s the first such survey conducted in 10 years.

“Not having really good local data,” said Michael Anderson-Nathe, CAP’s director of education and prevention services, has left providers largely ignorant of how many homeless youth in Portland are HIV positive or at risk of becoming so.

The survey was conducted in collaboration with the homeless youth agency Outside In and Oregon Health and Science University’s HIV Research Program.

Over the course of nine months, 205 youth aged 18 to 25 were surveyed, and asked about their sexual orientation, sexual practices, drug and alcohol use and mental health. They were also able to take an HIV test orally.   

Six out of the 205 surveyed tested positive for HIV, equating to a 2.93 HIV prevalence rate, and two youth were unaware they were HIV positive. All six tested positive for HIV identified as lesbian, gay, bisexual, transgender, or pansexual (meaning that one is attracted to any gender or sexual orientation).

Although these results didn’t surprise Anderson-Nathe, he's  concerned about the rates of unprotected sex, injection drug use and other high-risk behaviors, which he called “pretty high.”   

About 12 percent, or 27 youth, said they were injection drug users. Of that population, about 25 percent indicated they shared used needles with others. Between half and three-quarters of respondents reported they had unprotected sex within 30 days of taking the survey.

Also, three quarters said they were active drug users; 60 percent had used multiple drugs; 60 percent reported depression and 53 percent reported problems with anxiety.

Those statistics are shocking to the executive directors of Portland’s three homeless youth agencies—Outside In, New Avenues for Youth and Janus Youth.

Multnomah County’s Health Department runs a needle exchange clinic, as does Outside In. Homeless youth services focus on reducing high-risk behaviors by providing information, resources and support to gradually coax youth away from engaging in such behaviors.

But high-risk behaviors are common among homeless youth. Those behaviors can include high alcohol and drug abuse, suicidal behavior, teen pregnancy, unsafe sex, having sex with multiple partners, prostituting one’s self, as well as problems associated with depression, anxiety, and other mental health disorders.

Gay homeless youth, sources say, are at even higher risk because their sexual or gender orientation is more stigmatized on the street.  

The National Gay and Lesbian Task Force refers to gay youth homelessness as an “epidemic,” estimating that between 20 to 40 percent of homeless youth identify as lesbian, gay, bisexual or transgender. Portland has a disproportionately high number of gay youth, with 40 percent of its 2,000 homeless youth identifying as LGBT.

The risk behaviors are as much survivalist behaviors as they are coping mechanisms. “Homeless young people have been through significant trauma,” said Juliana Scholl, a case manager with Outside In.

“Safe sex” and other healthy behaviors do “not rise up on the priority list,” Anderson-Nathe said, because youth are simply concerned about surviving.

Providers were also surprised by the disconnect between the risk behaviors and how much risk youth thought they are putting themselves in. “Even though they say they’re low risk, they’re engaging in very high risk behaviors,” Anderson-Nathe said.

For instance, half of the surveyed youth said they thought of themselves as being at low-risk for acquiring HIV, but reported having unprotected sex in the last 30 days.

“What they think is safe isn’t safe as it relates to HIV transmission,” Anderson-Nathe said.

Kathy Oliver, the executive director of Outside In, and Dennis Morrow, the executive of the homeless youth agency Janus Youth, hesitated to draw conclusions based upon the survey data.

Morrow did say that “sometimes we think we’re making more progress than we are,” sharing Oliver’s concern that the homeless youth agency’s emphasis on harm reduction techniques may not be as embraced by youth as they thought.

Oliver mentioned syringe use and unprotected sex as behaviors that need to be addressed, but didn’t indicate if her agency would take action. “We want to get feedback from youth,” before creating any new services or changing existing ones, she said.

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