Strategies to Address HIV Among Homeless Youth in the United States

1. Strategies to Address HIV Among Homeless Youth in the United States International AIDS Conference July 22, 2012 Lara Tannenbaum, MSW Director of Health Services Larkin Street Youth Services

2. HIV Among Youth in the United States Youth in the U.S. are disproportionally affected by HIV in several ways: Age Gender Race Sexual Activity Location

3. Youth Population : HIV Infection Sources: CDC fact sheet: HIV Among Youth, 2011

4. Of the 34,733: Of the 69% male: 69% estimated 34,733 adolescents and young adults 13 to 24 years of age were living with a diagnosis of HIV infection in 2009 60% Sources: CDC fact sheet: HIV and AIDS among African American Youth ,2010

5. In 2009, young African Americans accounted for 65% (5,404) of diagnoses of HIV infection reported among persons aged 13–24 years 65% In 2010, 15% of adolescents were African American, yet an estimated 69% of diagnoses of HIV infection in 13 to 19 year olds were in black/African American adolescents. RACE Trends in HIV Incidence : African Americans 69% Sources: CDC fact sheet: HIV and AIDS among African American Youth ,2010

6. Among Adolescent and Young Adult Males Transmission attributed to male-to-male sexual contact IN 2010 Sources: CDC – HIV Surveillance in Adolescents and Young Adults, 2012

9. Homeless/Unstably Housed Youth and HIV Estimates of between 1.7-2 million youth experience homelessness each year in the United States • Young people in the United States become homeless for many reasons including: high levels of family conflict, parental substance abuse, physical or sexual abuse occurring in the home, neglect from parent or guardian, economic stress in the family, aging out of foster care or the juvenile justice system. • Estimates of LGBT homeless youth range from 11% to 35%. Homeless youths are at increased risk of contracting HIV due to: • Histories of childhood sexual abuse, sexual activity at an early age, depression, alcohol and drug abuse and lack of connectedness to trusted adults and family. • While on the streets risk factors include: High degree of participation in survival sex, sex with risky partners, IV drug use, needle sharing, having sex while intoxicated or high, minimal condom use, risk of sexual victimization. • Estimates of HIV prevalence among homeless youth range from 5.3 to 12.9 % or 2 to 12 times greater than housed adolescents. Sources:National Network for Youth; National Coalition for the Homeless; Coco Auerswald, MD, MS, Assoc. Professor, Division of Adolescent Medicine UCSF – research on homeless youth in SF; Federal Strategic Plan to Prevent and End Homelessness, 2010

10. HIV Among Homeless Youth in San Francisco Larkin Street served 80 HIV homeless/marginally housed youth in FY ‘11 Age: Majority (86%) are between the ages of 21-25 Gender: majority are male (84%) or transgender MTF (10%) Sexual Orientation: 81% identify as Gay, Bisexual, or Questioning Race: almost evenly split between African American (21%), Caucasian (21%) and Latino (25%) Health Status: 21% of youth had an AIDS diagnosis • Mental health issues at intake: • 82% have been in counseling • 52% have seen a psychiatrist • 61% have been prescribed psychiatric medications • 30% have been hospitalized for psychiatric reasons • 67% of youth report having felt seriously depressed in the previous 30 days • Level of substance use is high: • 86% have used any drugs • 46% have used cocaine • 23% have used crack • 46% have used speed • 17% have used heroin • 43% have injected drugs

11. What are the Outcomes we want to see for Homeless HIV Positive Youth? Improved Health • Clinical Benchmarks (CD4,viral load, immunizations, dental care) • Connection to medical care • Medication adherence Increased Stability • Obtain and maintain housing • Decrease substance use • Address mental health issues Strong Lifeskills development • Employment • Education • Confidence to navigate systems to get basic needs met • Ability to form healthy and trusting relationships with peers

12. Challenges in Meeting Outcomes Client Level Challenges Systems Level Challenges Having unaccompanied homeless youth recognized as a specific homeless population Ex: HEARTH Act, Opening Doors Need for increased coordination across federal agencies addressing homelessness, youth and HIV Ex: recent elimination of federal HIV funding specifically for youth Trend towards dismantling HIV specific funding and services HIV increasingly seen as chronic manageable disease, integrated within public health system Shifting of HIV funds to underserved areas of the country with growing epidemic Risk of dismantling effective systems of care elsewhere Health Care Reform lots of unknowns about impact on people with HIV • Fear of disclosing HIV status/ Dealing with stigma • Inability to decrease substance use • Failure to practice safer sex activities • Unaddressed mental health issues • Challenge of navigating multiple service delivery systems • Uncomfortable with services designed for adults • Developmental focus on present – not future thinking

13. Strategies to Support HIV Positive Homeless Youth Goal: To improve health of HIV positive youth by providing care and keeping youth connected to care (housing, support services, medical care) Advocacy and Education to address systems barriers on multiple levels Housing as Healthcare Harm Reduction philosophy Youth Culturally Competent Services Co-location of Services (one stop shopping)

14. What these strategies look like at Larkin Street Youth Services HIV Testing • Health Care • Youth focused HIV Primary Care • Nursing Care • Health Education • Medication Adherence Counseling Housing as Healthcare • Productive Activity • Employment • Volunteering • School • Appointments • Immediate access to Housing • Residential • Scattered Site Harm Reduction Philosophy • Social Services • Case Management • Peer Advocates • Life skills development • Nutritious Meals • Transportation Assistance • Employment and Education Svc. Youth Culturally Competent Services Research Study Participation • Substance Abuse and Mental Health Support • Therapist • Psychiatrist • Groups • medication Co-location of services • Prevention with Positives • Individual counseling • Medication adherence

15. Questions??? Lara Tannenbaum, MSW Director of Health Services Larkin Street Youth Services ltannenbaum@larkinstreetyouth.org 415-749-6968