Online Social Network Communication and HIV Risk Behaviors Among Homeless Youth

Background: Online Social Networking Technologies (SNS’s) are changing the way adolescents communicate. While there is a growing body of work focused on the impact of SNS’s on housed youth, few studies have tried to assess how homeless youth use SNS’s and the impact it has on their health-behaviors.  Researchers have noted both positive and negative aspects of SNS’s.  For example, among homeless youth, SNS's can offer them a way to disengage from their street identities by connecting them to non-street relationships. However, SNS's can also facilitate risk as it allows for real-time and two-way interaction that can be used to initiate sexual encounters. Furthermore, the ability to generate their own content presents adolescents with an opportunity to display information about their private lives in a relatively public forum.  Recent findings suggest that adolescents who are exposed to friends’ risky online displays of behavior are more likely to engage in risky behaviors.  This study assessed associations between SNS use and HIV risk behaviors among homeless-youth in Los Angeles, California.  

Methods: Los-Angeles area homeless-youth ages 14-27 years (N=829) were recruited from two drop-in centers (Santa-Monica & Hollywood) as a part of a longitudinal study from 2011 to 2014. Participants were asked to complete a computerized self-administered questionnaire. Independent variables included questions related topics of discussion held on social media sites (class/school, media, drugs, sex/love, being homeless, school/work, family issues, and goals).  Additionally, youth were asked about who they connected with on SNS’s (people from home, partners, streets peers, people met online, and caseworkers). Outcome -variables used to measure HIV behaviors, included condom-use, recent HIV-test, exchange-sex, exchange-sex with a partner met online, sex with someone met online, and concurrent-sex partners.

Results: Approximately, 80% of the participants reported using SNS’s; with almost 50% reporting using SNS’s daily. Multivariate logistic-regressions revealed that both who these youth communicated with on SNS’s as well as what they talked about were significantly associated with their sexual health behaviors. Specifically, talking about sex and/or love significantly predicted an increased likelihood of having a recent HIV-test (OR=2.40, CI 95%=1.35, 4.23). Talking about goals (OR=2.43, CI 95%=1.62, 3.61) and talking to someone from class (OR=1.72, CI 95%=1.15, 2.56) significantly predicted an increased likelihood of engaging in safe sex (with a condom). Furthermore, talking about sex and/or love was associated with an increased likelihood of having a recent HIV test (OR=2.40, CI 95%=1.35, 4.23).

Conclusion: Research using online social networks to bring about health behavior change is still in its early stages of development. Social media provide opportunities to reach traditionally underserved populations especially a hard to reach population such as homeless youth. Given the pervasiveness of social media use and the significant associations between social media communication and sexual health behaviors, an internet based peer led health intervention could be particularly effective for this population.