HIV Risk Reduction Needs of Homeless Women in Los Angeles

Background: In the county of Los Angeles, there are an estimated 43,000 homeless persons, two-thirds of whom are unsheltered, and 1/3 of whom are women. Substance use, housing instability, and transactional sex all contribute to HIV risk engagement among homeless women. Because of their increased risk of HIV infection, this study sought to understand the context of sexual behaviors and condom use among homeless women and elucidate modifiable factors to be targeted by interventions.

Methods: During July 2009 and May 2010, six (6) focus groups were conducted with 45 homeless women in Los Angeles, CA. These took place at homeless shelters throughout Los Angeles County. All groups were audio-recorded; recordings were transcribed verbatim for analysis. Thematic analysis guided the process of data reduction, coding, and creation of themes to elucidate the HIV risk behaviors and prevention needs of homeless women.

Results: Analyses revealed that like other high risk women, homeless women engage in sex with multiple types of partners; condom use by partner type was inconsistent. Women spoke of hopelessness and how this contributes to risk engagement. Women expressed to need to promote an intervention program beyond traditional means. Outreach, involving HIV positive persons, and involving peers as interventionists emerged as the most salient intervention qualities.

Conclusions: Interventions targeting homeless women should include self-esteem building, acknowledgment and use of inherent resilience qualities gained during homelessness, respect for current knowledge and skills, and an exploration of when women choose to trust their partners and how they make safer sex choices.