Evaluation of a street-based STI and HIV testing model for homeless youth in San Francisco

Homeless youth suffer from disproportionately high rates of both STIs and HIV. This high-risk population is more likely to benefit from screening for asymptomatic STIs and HIV, however those youth who are not connected to services are least likely to access medical care. The Street START program is a collaborative project intended to develop a model for street-based STI and HIV screening, treatment and linkage to care for homeless youth in San Francisco. A total of 184 street youth were tested for STIs in the outreach setting during the course of the project; all positives were treated. However, the project was not successful at integrating HIV testing.

We completed a qualitative evaluation of the project when it was concluded. Open-ended interviews were conducted with clinicians and staff from the three main agencies involved in the project. Participants were asked for their opinions on the benefits and risks of street-based STI and HIV testing as provided during the project, the barriers to providing testing in the homeless youth population, and for ways in which the program might be improved in the future.

All fifteen respondents were in favor of continuing the street-based STI testing, while the majority of respondents (11/15) were in favor of modifying or discontinuing the street-based HIV testing. The principal issues were the time it took to complete the HIV test, logistics involved in the confirmatory blood draw, and concerns regarding patient confidentiality.