Longitudinal Exploration of Pathways to HIV/STI Risk Reduction among Homeless Young Adults through a Youth-Centric Rapid Re-Housing Program - ABSTRACT
This R21 study is a longitudinal exploration of pathways to HIV/STI risk reduction among homeless young
adults ages 18-24 (YAEH) through a youth-centric rapid re-housing program (YRR). Given that young adults
are one of the age groups most at risk of homelessness and of acquiring HIV and STIs in the US, an urgent
need exists for effective and developmentally-appropriate structural intervention approaches to HIV/STI
prevention for YAEH. YRR is widely used by communities across the U.S. as a solution to addressing youth
homelessness; however there has been limited research on the impact of short-term housing programs, such
as YRR, on YAEH's HIV/STI risk. Prior studies have identified a range of likely causal factors linked to HIV/STI
risk behaviors among YAEH; however, little is known about the specific beneficial causal processes, i.e., the
interacting variables and pathways generating the outcomes, to HIV/STI risk reduction among YAEH through a
short-term housing intervention with service supports. Furthermore, much of the evidence linking housing
instability and HIV/STI risk among YAEH has been cross-sectional, limiting our understanding of the
mechanisms that should be targeted for HIV prevention. The specific aims of this study are to: Aim 1: Explore
potential causal (bio-, psycho-, social- and environment-level) processes that contribute to resilience and
reduction in HIV/STI risk (multiple sex partners, substance use, trading sex, unprotected sex) among YAEH
through an established short-term youth-centric housing intervention, utilizing a panel design and mixed
methods approach (in-depth interviews, surveys, HIV/STI and stress biomarkers) to track clients' (n=50)
change in HIV/STI behavioral risk outcomes over a 12-month period; Aim 2: Build a theory that describes the
interrelated pathways and directions among different causal processes and HIV/STI risk outcomes for model
building; and Aim 3: Pilot test newly created, developmentally-appropriate measures of housing stability for
YAEH and relevant causal processes, using findings from Aims 1 and 2 and interviews with key informants
(n=5) and YAEH YRR clients (n=10). Results from the proposed study will be used to develop a theoretical
framework and pilot-tested measures in order to build the foundation for a large-N mixed-methods study to test
causal mechanisms linking YRR and HIV/STI risk among YAEH. The impact of this study is to reduce health
disparities in HIV/STIs among high risk and vulnerable populations by helping communities improve their
interventions for YAEH.
