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

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.