Youth experiencing homelessness and HIV prevention communication: a multi-level dyadic network analysis

Youth experiencing homelessness (YEH) are at increased risk of HIV. Communication among social network members of YEH about sexual health has the potential to promote safer sex practices. We collected self-reported social network data from 731 YEH (age 14-26) accessing homeless youth services in Los Angeles, California, between 2016 and 2018. Multi-level dyadic network analysis was performed to examine the individual- and network-level characteristics associated with communication about condoms, pre-exposure prophylaxis (PrEP), HIV and HIV testing. YEH were significantly more likely to report talking to a social network member about PrEP if the youth was transgender (OR = 3.65, 95% CI 1.53-8.76) or had a gender-expansive identity (OR = 3.06, 95% CI 1.22-7.68). YEH were more likely to talk to a social network member about PrEP if that network member identified as a sexual minority (LGBQ+) (OR = 8.45, 95% CI 1.13-2.77). YEH were also more likely to talk to a romantic/sexual partner about condom use (OR = 5.86, 95% CI 1.25-2.33) or HIV testing (OR = 1.90, 95% CI 1.08-3.35). Study findings highlight opportunities for improving PrEP uptake among transgender and gender-expansive YEH and for emphasizing partner communications within future HIV prevention interventions for youth experiencing homelessness.