Structural factors associated with an increased risk of HIV and sexually transmitted infection transmission among street-involved youth

Between September 2005 and October 2006, 529 street-involved youth were enroled in a prospective cohort known as the At Risk Youth Study (ARYS). We examined structural factors associated with number of sex partners using quasi-Poisson regression and consistent condom use using logistic regression.At baseline, 415 (78.4%) were sexually active, of whom 253 (61.0%) reported multiple sex partners and 288 (69.4%) reported inconsistent condom use in the past six months. In multivariate analysis, self-reported barriers to health services were inversely associated with consistent condom use (adjusted odds ratio [aOR] = 0.52, 95%CI: 0.25 – 1.07). Structural factors that were associated with greater numbers of sex partners included homelessness (adjusted incidence rate ratio [aIRR] = 1.54, 95%CI: 1.11 – 2.14) and having an area restriction that affects access to services (aIRR = 2.32, 95%CI: 1.28 – 4.18). Being searched or detained by the police was significant for males (aIRR = 1.36, 95%CI: 1.02 – 1.81).Although limited by its cross-sectional design, our study found several structural factors amenable to policy-level interventions independently associated with sexual risk behaviours. These findings imply that the criminalization and displacement of street-involved youth may increase the likelihood that youth will engage in sexual risk behaviours and exacerbate the negative impact of resultant health outcomes. Moreover, our findings indicate that environmental-structural interventions may help to reduce the burden of these diseases among street youth in urban settings.Structural factors, defined as the economic, social, policy, and organizational environments that "structure" the context in which risk production occurs [1], are increasingly recognised as important determinants in the acquisition, transmission, and prevalence of HIV disease [2]. In recent years, extensive research has examined the structural factors that produce and re-produce HIV risk among high prevalence po