Validation of a HIV Knowledge Assessment Among Homeless Populations and Prevention Strategies in Colombia, South America

Since the first cases of HIV/AIDS were reported more than 30 years ago, it is estimated that 75 million people have been infected worldwide with the virus, nearly 30 million have died of AIDS related causes, and an estimated .8% of the worldwide population ages 15-49 years old are living with HIV (WHO-HIV/AIDS, 2014). According to the United Nations AIDS (2013), HIV prevalence rates are approximately 28 times higher among injecting drug users and 12 times higher among sex workers; however little is known about the prevalence of HIV among homeless populations and their particular needs and challenges regarding HIV transmission (UNAIDS, 2013). Beijer, Wolf, & Fazel (2012) reported in a recent meta-analyses that the HIV prevalence in homeless range from .3% to 21.1%; the study results raised awareness about the importance of further understanding the dynamics of HIV. The current study aimed to develop and validate an instrument to evaluate HIV knowledge among homeless individuals; data collection procedures were approved by a National University in Colombia (South America) and data collection was conducted using respondent-driven sampling method (RDSAT). The assessment development process also included counseling and training on HIV prevention and sexually transmitted diseases (STDs) provided to N=338 homeless participants (ages 18 to 65, mean age 40, males 82%). Factorial analyses (EFA & CFA) results provided a 2 factor solution explaining 52% of the item variance and with great reliability scores (α = .94). Additional analyses included a set of logistic regressions to identify risk factors related to HIV transmission among homeless individuals. Results show an 8.1% prevalence of HIV infected participants in the study sample.  Risk factors identified were: not recognizing condom use as an effective protective behavior to avoid transmitting/contracting the HIV virus (OR: 4,14; IC 95% 0,75-22,77); having multiple sexual partners (OR: 3,45; IC95% 0,84-14,25); and lacking knowledge about the risk of contracting HIV by sharing needles with an infected person (OR: 4,28; IC 95% 0,41-44,33). The results in general suggest a significant lack of knowledge about HIV effective prevention practices and behaviors among homeless subjects putting them at a high risk for getting HIV or passing it to others. The practical and methodological implications for HIV prevention efforts will be further discussed as they relate to educational and medical services provided to the homeless population. The strengths and challenges of current practices as well as prevention/intervention efforts implemented in Colombia will be also addressed.