Gender, sexual relationships, and HIV risk among homeless men in Los Angeles County

Risk of HIV transmission within heterosexual relationships is significant, especially among homeless people. Many studies have explored the association between traditional masculine attitudes, imbalance of power in heterosexual relationships and risky sex. However, most of these studies have explored this dynamic from women's perspectives. Few have explored gender and heterosexual relationships from the perspective of homeless men. The objective of this study is to describe the beliefs about gender roles among homeless men in Los Angeles. We randomly sampled 30 homeless men and interviewed them using a semi-structured interview protocol designed to elicit their conceptualization of expected gender roles for men and women. We also asked them to discuss how homelessness affects relationships between men and women and to describe particular relationships and sexual events. We analyzed qualitative data systematically to compare idealized gender role beliefs with their pursuit of and experiences with sexual relationships with women. We found that many men had a mixture of traditional gender beliefs and egalitarian views of gender roles within sexual relationships. Men frequently described men's roles as financial support of households and protection while women's roles were limited to child rearing and domestic activities. On the other hand, men also frequently described their belief in egalitarianism within relationships in which men and women share everything, including decision making. We contrast these ideal beliefs with descriptions of these men's actual relationships. Based on these findings, we discuss opportunities and challenges for programs that target HIV reduction among heterosexual homeless men, especially couples based interventions.