The contextual determinants of sexually transmissible infections among street-involved youth in North America

Young people living on the urban street are at a significantly increased risk of HIV and other sexually transmitted infections (STIs). Much research examining the epidemiological basis for their heightened susceptibility has concentrated on the individual behaviours and characteristics associated with acquiring these infections. However, contextual factors, including the social, structural and environmental forces that influence sexual risk behaviour, are increasingly found to play an important role in shaping the transmission dynamics of HIV and STIs within these marginalised populations. This paper reviews research describing the individual and contextual factors that have been shown to influence street youth sexual behaviour and provides an analysis of the potential impact of such factors on HIV and STI transmission. In order to implement effective sexual health programmes for street-involved young people, innovative programmes are required that take into account the unique social and structural context of youth homelessness. Interventions to reduce the elevated prevalence and incidence of HIV and STIs among this population must explicitly target multi-level factors influencing the transmission dynamics of these diseases.