Social Networking Technology Use and Engagement in HIV-Related Risk and Protective Behaviors Among Homeless Youth

Understanding Homelessness Among Young People to Improve Outcomes

In the United States, an estimated 4.2 million young people experience homelessness during critical stages in their development-adolescence and emerging adulthood. While research on youth homelessness often emphasizes risk and vulnerability, the field must situate these issues within the developmental trajectories of adolescence and emerging adulthood to effectively prevent and end youth homelessness. This review uses the Risk Amplification and Abatement Model (RAAM) as a conceptual framework for contextualizing the landscape of youth homelessness research in the United States since 2010. An extension of ecological models of risk-taking, RAAM emphasizes both risk and resilience, positing that negative as well as positive socialization processes across interactions with family, peers, social services, and formal institutions affect key housing, health, and behavioral outcomes for youth experiencing homelessness. This review applies RAAM to our understanding of the causes and consequences of youth homelessness, recent interventions, and recommendations for future directions.

Social Network Characteristics Associated with More Frequent HIV and STI Prevention Conversations: The N2 Cohort Study in Chicago

Black cisgender sexually minoritized men (SMM) and transgender women (TW) are subgroups at highest risk of HIV and sexually transmitted infections (STIs) in the US. We sought to identify factors facilitating continued conversations - social reinforcement - surrounding HIV/STI prevention among this subgroup. Participants were recruited in Chicago from 2018 to 2019 from community health spaces. Participants provided information about themselves (level 2) and ⩽5 confidants (level 1). We used multinomial multilevel modeling to identify associations with HIV/STI prevention conversation frequency. A total of 370 participants provided information on 987 confidants (mean = 2.6). We found significantly positive associations between having biweekly or more often HIV/STI prevention conversations and a confidant being a kin family member, older by 15 years or more, racially homophilous, and emotionally close. Future interventions should harness social networks by including components that consider racial homophily, respect for elders, and strong ties, in addition to applying kin family systems interventions approaches and decreasing stigma surrounding HIV/STIs.

HIV preventive practice and its associated factors among street dwellers in Ethiopia: Application of health belief model

Street dwelling is the use of public space as a place of residence and nourishment for children, adolescents, and young people, revealing a complex and multifactorial situation. Moreover, homelessness facilitates HIV transmission and its progression due to the risky lifestyle of individuals. To the best of our knowledge, there is no study conducted in the study area on HIV preventive practices among street dwellers. The aim of this study was to assess HIV prevention practices and associated factors among street dwellers. A community-based cross-sectional study was conducted in Bahir Dar City from March 12, 2023 to April 30, 2023. By using the simple random sampling technique, 424 street dwellers were recruited. Bivariable and multivariable logistic regression were used for analysis. The magnitude of HIV preventive practice among street dwellers was 35.9%. Being male (AOR = 0.23, 95% CI: 0.10, 0.55), educational status (AOR = 7.53, 95% CI: 2.20, 25.6), practice of sex to earn money (AOR = 0.18, 95% CI: 0.08, 0.44), good knowledge about HIV preventive practice (AOR = 2.83, 95% CI: 1.46, 5.49), perceived susceptibility for HIV (AOR = 0.90, 95% CI: 0.81, 0.99), and perceived benefit of using HIV preventive practice (AOR = 1.09, 95% CI: 1.02, 1.17), were factors associated with HIV preventive practice. The magnitude of HIV preventive practice was low. Being male, the ability to read and write, the practice of sex to earn money, good knowledge about HIV preventive practice, perceived susceptibility to HIV, and the perceived benefit of using HIV preventive practice were significantly associated with HIV preventive practice. Therefore, responsible organizations, both governmental and non-governmental, should design inclusive strategies to improve HIV preventive practice among street dwellers by focusing on regular demand creation activities, awareness creation about HIV preventive practice, and sustainable condom distribution in the city.

LGBTQ+ Youth Homelessness in Delaware:: Building a Case for Targeted Surveillance and Assessment of LGBTQ+ Youth Needs and Experiences

Objective

In this article, we examine the issue of LGBTQ+ youth homelessness in Delaware, summarize current services available and prior research work that has been done, examining the number, needs, and experiences of unaccompanied unhoused LGBTQ+ youth.

Methods

We provide a literature review detailing risks associated with LGBTQ+ youth homelessness, resources available, and prior studies and surveys examining this population.

Results

LGBTQ+ youth experiencing homelessness are particularly vulnerable to physical and mental health challenges, abuse, and violence. The unique needs of this population necessitate specialized resources, yet there are a limited number of such resources available in Delaware and a dearth of information on youth homelessness in general, including LGBTQ+ youth. For example, administrative barriers exist for unaccompanied queer youth seeking shelter services, such as need for legal identification or being grouped in shelter populations based on sex assigned at birth rather than gender identity. Exposure to unsafe environments is a general problem for queer youth. This can make public spaces feel unsafe and increase risk of physical or mental harm, mistreatment, or abuse when seeking shelter outside of agency services and resources. In order to accurately identify and appropriately serve this population, additional research is necessary.

Conclusions

Evidence building is a critical first step in creating an effective study to examine the issue of LGBTQ+ youth homelessness in Delaware. With the evidence acquired in our literature review our next step to establish an informed methodology is to hold service provider and LGBTQ+ lived experience focus groups. Through a qualitative approach we aim to learn how to appropriately utilize the quantitative tools identified in our analysis and to assess what questions are missing to advance the needs of this population.

HIV knowledge and protective factors among racial-ethnic minority youth: Moderation by Ethnic identity and LGBQ+ identity

Due to systemic racism and homophobia, Lesbian, Gay, Bisexual, and Queer (LGBQ+) youth of color are disproportionately affected by HIV (human immunodeficiency virus) / AIDS (acquired immunodeficiency syndrome) and viral hepatitis (VH). Innovative approaches that acknowledge strengths such as ethnic identity need to be examined to understand specific protective factors that can support LGBQ+ youth of color. This study aimed to examine the moderating effects of ethnic identity and LGBQ+ identity on indicators of HIV knowledge (i.e., VH knowledge, sexual negotiation skills, and perception of sexual risk). Youth who identified as Hispanic/Latinx, African American/Black, and mixed racial-identity (N = 564) were included in the delimited sample. Using linear regression modeling, results showed that there was a positive association between sexual negotiation skill, sexual risk perception, ethnic identity and HIV knowledge. Ethnic identity displayed a positive and significant moderating effect between predictors and HIV knowledge. Three-way interactions between predictors by ethnic identity x LGBQ+ interaction showed equally interesting associations with HIV knowledge. Study implications include the need for strengthening ethnic identity and pride among LGBQ+ youth of color within HIV prevention programming.

A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness

INTRODUCTION

Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services.

METHODS

731 youth (M_age = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up).

RESULTS

The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge.

CONCLUSIONS

The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.

The Impact of Social Media Shared Health Content on Protective Behavior against COVID-19

The use of social media has increased during the COVID-19 pandemic because people are isolated and working from home. The use of social media enhances information exchange in society and may influence public protective behavior against the COVID-19 pandemic. The purpose of this study is to identify the factors affecting public protective behavior when relying on COVID-19 pandemic-related content shared on social media. A model based on Protection Motivation Theory (PMT) was proposed and validated using a quantitative survey approach. A questionnaire was distributed to random respondents, and 488 responses were received and analyzed using Smart-PLS software. The findings showed that perceived risk, e-health literacy, public awareness, and health experts' participation influence public protective behavior when using social media to share COVID-19-relevant content. The outcomes of this study can enhance government agencies' and public health care authorities' understanding of how to use social media to raise awareness and reduce panic among the public.

Social network and HIV/AIDS: A bibliometric analysis of global literature

Social networks (SN) shape HIV risk behaviors and transmission. This study was performed to quantify research development, patterns, and trends in the use of SN in the field of HIV/AIDS, and used Global publications extracted from the Web of Science Core Collection database. Networks of countries, research disciplines, and most frequently used terms were visualized. The Latent Dirichlet Allocation method was used for topic modeling. A linear regression model was utilized to identify the trend of research development. During the period 1991-2019, in a total of 5,698 publications, topics with the highest volume of publications consisted of (1) mental disorders (16.1%); (2) HIV/sexually transmitted infections prevalence in key populations (9.9%); and (3) HIV-related stigma (9.3%). Discrepancies in the geographical distribution of publications were also observed. This study highlighted (1) the rapid growth of publications on a wide range of topics regarding SN in the field of HIV/AIDS, and (2) the importance of SN in HIV prevention, treatment, and care. The findings of this study suggest the need for interventions using SN and the improvement of research capacity via regional collaborations to reduce the HIV burden in low- and middle-income countries.

Social presence for strategic health messages: An examination of state governments' use of Twitter to tackle the Covid-19 pandemic

Scholars investigated the role of social presence theory in numerous communication contexts. However, we have limited knowledge about the impact of social presence strategies on public attention during a pandemic. This study fills this gap by investigating the connections between social presence strategies, Covid-19 strategies, and public attention. Twitter data of state governments from January 21, 2020 to July 21, 2020 were downloaded for this study. Content analysis of 1500 randomly selected posts revealed that social presence strategies were effective in generating public attention on Twitter. Furthermore, expressing appreciation, providing guidance, and informing the publics about governments' actions generated public attention. Theoretical and practical implications are discussed.

Substance use and sentiment and topical tendencies: a study using social media conversations of youth experiencing homelessness

Purpose

This study investigates associations between Facebook (FB) conversations and self-reports of substance use among youth experiencing homelessness (YEH). YEH engage in high rates of substance use and are often difficult to reach, for both research and interventions. Social media sites provide rich digital trace data for observing the social context of YEH's health behaviors. The authors aim to investigate the feasibility of using these big data and text mining techniques as a supplement to self-report surveys in detecting and understanding YEH attitudes and engagement in substance use.

Design/methodology/approach

Participants took a self-report survey in addition to providing consent for researchers to download their Facebook feed data retrospectively. The authors collected survey responses from 92 participants and retrieved 33,204 textual Facebook conversations. The authors performed text mining analysis and statistical analysis including ANOVA and logistic regression to examine the relationship between YEH's Facebook conversations and their substance use.

Findings

Facebook posts of YEH have a moderately positive sentiment. YEH substance users and non-users differed in their Facebook posts regarding: (1) overall sentiment and (2) topics discussed. Logistic regressions show that more positive sentiment in a respondent's FB conversation suggests a lower likelihood of marijuana usage. On the other hand, discussing money-related topics in the conversation increases YEH's likelihood of marijuana use.

Originality/value

Digital trace data on social media sites represent a vast source of ecological data. This study demonstrates the feasibility of using such data from a hard-to-reach population to gain unique insights into YEH's health behaviors. The authors provide a text-mining-based toolkit for analyzing social media data for interpretation by experts from a variety of domains.

The role of online social networks in improving health literacy and medication adherence among people living with HIV/AIDS in Iran: Development of a conceptual model

Online social networks have been used to enhance human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevention, diagnosis, and treatment programs worldwide. This study aimed to develop a conceptual model of using online social networks in improving health literacy and medication adherence among people living with HIV/AIDS in Iran. This mixed-method sequential exploratory study was conducted in three phases. Firstly, a series of semi-structured interviews with a purposive sample of 29 HIV-positive patients were conducted to investigate the perceptions and experiences of HIV-positive patients about using online social networks to support health literacy and medication adherence. Thematic analysis was used to analyse qualitative interviews, extract potential components, and design a conceptual model. Then, a Delphi study with 27 HIV-positive patients was subsequently conducted to examine the consensus of patients on the proposed model. Finally, the trustworthiness and credibility of the proposed model were reviewed and evaluated by expert panel members from epidemiology and public health. Seven themes and 24 sub-themes emerged from the qualitative interviews. Five themes encompassed components of online social networks that supported communication and information-seeking behaviour of people living with HIV/AIDS. The two other themes encompassed social support and health-related outcomes including medication adherence. The credibility of the proposed conceptual model was confirmed methodologically using the expert panel and Delphi technique. Our findings highlighted that using online social networks has empowered Iranian people living with HIV/AIDS, making them more connected, safe, and able to access HIV/AIDS-related information and services. The role of online social networks in improving health literacy and medication adherence was also demonstrated in a conceptual model to understand the supportive components of online social networks in the HIV care continuum as well as customized interventions to improve the success of antiretroviral therapies.

Burden, Belonging, and Homelessness: Disclosure and Social Network Differences among LGBTQ Youth Recruited from a Suicide Crisis Service Provider

Among LGBTQ youth, suicidality and homelessness occur at heightened rates. Using the Interpersonal Theory of Suicide (ITS), this study seeks to explore the associations of having a parent, family member, friend, or romantic partner in one's social network and not being "out" to specific network members (lack of disclosure) with ITS constructs (perceived burdensomeness and thwarted belonging), considering homelessness history. Data include 462 youth aged 12-24 who contacted an LGBTQ youth-focused suicide crisis provider from 2015 to 2017. Disclosure status and network composition differed by homelessness experience. Homeless youth were more likely to disclose to their parents and less likely to disclose to other family members. Youth who had not disclosed to their parents reported higher perceived burdensomeness and thwarted belonging whereas having more family members and peers in one's network was associated with lower scores on ITS constructs. Implications for prevention approaches with youth who may be at increased risk for suicide are discussed.

HIV-related knowledge, information, and their contribution to stigmatization attitudes among females aged 15-24 years: regional disparities in Indonesia

BACKGROUND

Stigmatization attitudes among youths toward people living with HIV (PLWH) is still an issue and concern in Indonesia. The purpose of this study was to determine the regional disparities, levels of HIV-related knowledge, information, and contributions related to stigmatization attitudes among females aged 15-24 years in Indonesia.

METHODS

A cross-sectional study with The 2017 Indonesian Demographic Health Survey (IDHS) was used. A total of 12,691individual records of females aged 15-24 years were recruited through two-stage stratified cluster sampling. The endpoint was stigmatization attitude. Then, bivariate and multivariate binary logistics were performed.

RESULTS

The findings showed that female youths who have no HIV-related knowledge (62.15%) and some source of information (52.39%). The highest prevalence of stigmatizing attitude was 59.82%, on Java Island. Multivariate analysis showed that females living in Sulawesi and Kalimantan; those living in a rural area; and those with more HIV-related knowledge were less likely to have a stigmatizing attitude. Conversely, females with the middle- to richest-wealth index and had some HIV-related information were more likely to have a stigmatizing attitude.

CONCLUSION

An understanding of stigmatizing attitudes should be considered through demographic factors, knowledge, and source of HIV-related information. The Indonesian government should pay more attention to indicators of HIV-related knowledge and information. Moreover, we suggest that the government collaborates with youths to disseminate information and restructure and reanalyze policies about HIV.

Lessons Learned in Centering Youth Voices in HIV Prevention: The Adolescent Health Working Group

BACKGROUND

There remains critical need for community-based approaches to HIV prevention which center youth voices and needs.

OBJECTIVES

We established an adolescent health working group (AHWG) to convene youth, parents, providers, and advocates in agenda-setting for interventions to increase pre-exposure prophylaxis uptake in Durham.

METHODS

Our three study phases included six AHWG meetings from 2019 to 2020, youth-only meetings guided by a participatory engagement framework (Youth Generate and Organize), and interviews (n=13) and surveys with youth in the community (N=87). We also developed materials such as an AHWG mission statement, a list of themes and informational needs, and documented strategies about pivoting the project during the onset of the COVID-19 global pandemic.Lessons Learned/Conclusions: Engaging adults in youth-focused HIV prevention differs greatly to engaging youth themselves. Creating spaces to promote adolescent sexual Health requires trust building, breaking down sensitivities and stigma to, and flexibility to navigate both virtual and in-person spaces to do so.

A Scoping Review on Access and Use of Technology in Youth Experiencing Homelessness: Implications for Healthcare

Introduction: Youth are among the fastest growing subset of the homeless population. Youth experiencing homelessness (YEH) face multiple barriers in accessing health information and health care services. As such, they may best be reached through information and communication technologies (ICTs); however, limited efforts have been made to synthesize literature on this topic. In this paper, we review studies on access and use of ICTs among YEH. We also discuss the implications of the review for healthcare.

Methods: Using scoping review methodology, we searched four databases (Medline, Embase, PsycInfo, and CINAHL) for studies published between 2005 and 2019, screening 1,927 titles and abstracts.

Results: We identified 19 articles reporting on studies with YEH between the ages of 12-30, the majority of which were published in the USA. On average, more than half of the samples owned smartphones, used social media, and accessed the internet weekly to search for housing, employment, health information, and to communicate with family, peers, and health workers; however, many youths faced barriers to sustaining their access to technology. Benefits of using ICTs were connecting with home-based peers, family, and case workers, which was associated with a reduction in substance use, risky sexual health behaviors, and severity of mental health symptoms. Connecting with negative, street-based social ties was identified as the most common risk factor to using ICTs due to its association with engaging in risky sex behaviors and substance abuse.

Discussion: This review supports the advancement of research and practice on using ICTs to deliver public health information and health services to YEH, while also considering the health-related risks, benefits, and barriers that YEH face when accessing ICTs.

Exchange and Survival Sex, Dating Apps, Gender Identity, and Sexual Orientation Among Homeless Youth in Los Angeles

We estimated the association between gender and sexual identities, and engagement in exchange and survival sex and seeking these partners via dating apps or websites, within a sample of homeless youth. In 2017, 253 homeless youth were interviewed from three different drop-in centers in Los Angeles. Multivariable regression analyses assessed associations between gender/sexual identity, and exchange and survival sex, adjusting for demographic characteristics. Sexual minority (43.6%) and gender minority (12.1%) youth reported elevated rates of exchange sex compared to cisgender heterosexual youth. Twenty-three percent of youth who engaged in survival or exchange sex used dating apps or websites to find partners. Exchange sex was associated with having recent HIV positive sex partners. Reporting an HIV positive partner and a relatively high number of sexual partners were significant predictors of engaging in survival sex. Programs and interventions for homeless youth should address engagement with technology and exchange and survival sex, and should respond to the unique needs of sexual and gender minority homeless youth.

LGBTIQ+ Homelessness: A Review of the Literature

Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ+) people’s experiences of homelessness is an under-explored area of housing and homelessness studies, despite this group making up 20–40% of homeless populations. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements, instead placing them into individual siloes. Our approach is an intersectional one; this paper identifies the key themes in the existing research, and analyses how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness. This intersectional-systems thinking approach to LGBTIQ+ homelessness can be used to develop well-informed, culturally sensitive support programmes.

Is Facebook use healthy for individuals experiencing homelessness? A scoping review on social networking and living in the streets

Background: Although they are faced with a situation of extreme social exclusion, individuals experiencing homelessness (IEH) have gradually begun to incorporate the use of social networking sites (SNS) into their everyday lives. Aims: To review the publications that have examined the use of SNS among IEH and to analyze the impact that this online activity has on the health of these individuals. Methods: This study employed a scoping review method, analyzing scientific literature published up to the end of 2016. Results: An analysis was performed on nineteen peer-reviewed articles and three grey literature publications. IEH, especially those who are younger, use SNS in a similar proportion to the overall population. When these individuals used the networks due to their own initiative, it was found to have a positive health effect in that it mitigated the consequences of living on the street. Interventions aimed at improving the participants' health achieved positive results, both in terms of preventing problems associated with drug abuse and high-risk sexual behavior and of promoting mental health. Conclusions: The use of SNS presents some health benefits for IEH. Virtual communication and information alternatives provide opportunities to improve the mental and general health of people in social exclusion situations.

HIV Prevention and Sex Behaviors as Organizing Mechanisms in a Facebook Group Affiliation Network Among Young Black Men Who Have Sex with Men

Online social networking sites (SNS)-the Internet-based platforms that enable connection and communication between users-are increasingly salient social environments for young adults and, consequently, offer tremendous opportunity for HIV behavioral research and intervention among vulnerable populations like young men who have sex with men (YMSM). Drawing from a cohort of 525 young Black MSM (YBMSM) living in Chicago, IL, USA April 2014-May 2015, we conducted social network analysis, estimating an exponential random graph model (ERGM) to model YBMSM's group affiliations on Facebook in relation to their sex behaviors and HIV prevention traits. A group's privacy setting-public, closed, or secret-was also modeled as a potential moderator of that relationship. Findings reveal that HIV positive individuals were more likely to affiliate with Facebook groups, while those who engaged in group sex were less likely to do so. When it came to the privacy of groups, we learned that HIV positive individuals tended not to belong to groups with greater privacy (e.g., closed and secret groups), while individuals who engaged in group sex and those who engaged in regular HIV testing were more likely to belong to those groups. Results also showed that individuals who engaged in condomless sex showed significant signs of clustering around the same set of groups. HIV positive individuals, on the other hand, were significantly less likely to demonstrate clustering. Implications for interventions and future research are discussed.

The impact of social media on risk perceptions during the MERS outbreak in South Korea

Analyzing nationally representative online panel survey data during the MERS outbreak in South Korea, this study examined the role of social media exposure in shaping public's risk perceptions of MERS. The present study also investigated the moderating role of heuristic-systematic processing and self-efficacy in the relationship between social media exposure and risk perceptions. The findings of this study showed that social media exposure was positively related to forming risk perceptions. Moreover, heuristic-systematic processing and self-efficacy were found to moderate the impact of social media on risk perceptions. The interaction effects suggested that the role of social media in increasing risk perceptions of MERS was heighted by heuristic-systematic processing and self-efficacy. The results and implications of this study are discussed in greater details.

Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature

Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.