218775 Heterosexual sex among homeless men in Los Angeles: Partner selection, condom use, and HIV-related beliefs

Wednesday, November 10, 2010

Ryan A. Brown, PhD , RAND Health, RAND Corporation, Santa Monica, CA
David P. Kennedy, PhD , RAND, Santa Monica, CA
Gery Ryan, PhD , RAND Health, RAND Corporation, Santa Moncia, CA
Daniela Golinelli, PhD , RAND Corporation, Santa Monica, CA
Suzanne Wenzel, PhD , School of Social Work, University of Southern California, Los Angeles, CA
Joan Tucker, PhD , RAND Health, RAND Corporation, Santa Moncia, CA
Samuel Wertheimer, MPH , RAND Health, RAND Corporation, Santa Monica, CA
Heterosexual sex is a significant source of HIV risk among the homeless population, yet little is known about the belief systems and sexual experiences of homeless men who have sex with women. This study reports the results of semi-structured interviews with 30 randomly sampled men using shelters or meal lines in downtown Los Angeles. Men ranged in age from 22 to 54 (mean=44), and most (n=22) self-identified as African American. Interviewers collected narratives of two contrasting sexual events - usually one with a condom and one without - using a novel grid-based technique to obtain five key dimensions - social context, sexual behavior, thoughts and feelings, condom use, substance use - across four stages of the sexual event – set-up, pre-intimacy, intimacy, post-intimacy. We used Atlas.ti to code interviews and contrasted the characteristics of high and low risk sexual events. Respondents reported a wide variety of patterns of sexual activity and beliefs about HIV risk. A minority of men (n=5) reported having monogamous relationships on the street, while close to half (n=12) reported engaging in sex for direct trade of money or substances, and a third (n=9) reported spontaneous sexual encounters with new partners. Notable was the presence of “folk beliefs” regarding visual cues (combed hair, clean feet, etc.) to determine whether a potential sexual partner was disease-free, as well as the tendency of men to continue unprotected sex with formerly monogamous partners after the exclusive relationship dissolved. These findings have implications for HIV risk reduction interventions for homeless men.

Learning Areas:
Diversity and culture
Protection of the public in relation to communicable diseases including prevention or control
Public health or related education
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe sampling and semi-structured interviewing technique to obtain narratives of sexual events from homeless men List the range of female partner types and sexual encounters reported Compare aspects of high and low risk sexual events Analyze reasons given for partner selection and condom use Discuss implications for behavioral interventions among homeless men

Keywords: Sexual Risk Behavior, Homeless

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an anthropologist with expertise in working with high risk populations, was involved in the planning of the protocol, conducted field interviews for this project, analyzed data for this paper, and am the lead author on this paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.