WITHDRAWN: Homeless Youth and Unprotected Sex: Understanding Multiple Levels of Influence Utilizing Multilevel Dyadic Analyses

Homeless youth are disproportionately affected by HIV, and while condoms are considered effective prevention mechanisms, this population reports relatively low rates of condom-use and high rates of unprotected sex. Social network norms, defined as perceived beliefs about what behaviors are considered acceptable or common within a given group, have consistently been linked to condom-use among homeless youth. Moreover, social norms are not one-dimensional in nature; different kinds of referent groups (e.g., family, peers, etc.) communicate, encourage, and/or discourage various norms pertaining to both risk and protective behaviors. For instance, family norms might encourage condom-use; peer norms, conversely, might discourage use. Accordingly, this study sought to further understand how different types of relationships contributed to norms about condom-use and whether such norms were associated with self-reported condom-use among homeless youth.

Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N=260). Social norms were assessed by: 1) perceived condom-use by street-peers (descriptive), 2) encouragement to engage in condom-use from social network members (injunctive), and 3) communication regarding condom-use with social network members (communicative). The communicative and injunctive norms were separated by relationship roles (i.e. family, street and home-based peers, serious partner, staff, etc.). Multilevel dyadic analyses first examined associations between source-specific communicative and injunctive norms with descriptive peer norms about condom-use. The second multivariate model assessed associations between all types of norms (descriptive, injunctive, and communicative) and condom-use among the sample.

Descriptive analyses indicated that youth communicated and received encouragement about using condoms from a multitude of sources. Bivariate dyadic analyses demonstrated that street peers talking about (OR=3.94) and encouraging condom-use (OR=11.36), and talking to a relative (OR=8.80) or a home-based peer (OR=2.94) about condoms were significantly associated with having more protective perceptions of peer norms about condom-use. Multilevel dyadic analyses indicated that talking to (OR=2.31) and receiving encouragement from street peers (OR=11.23) about condom-use was significantly associated with having more protective perceptions of peer norms about condom-use. Furthermore, perception of peer condom-use (OR=6.04) was the only significant factor associated with using a condom during last sexual encounter.

Findings suggest that communicating and receiving encouragement from social network members (particularly street peers) reinforce condom-use norms within networks, which, in turn, influences self-reported condom-use among homeless youth. Interventions intended to promote safer-sex norms may thus benefit from tapping into naturally occurring patterns of communication to reduce HIV vulnerability among this at-risk population.