Planning a sexual health promotion intervention with homeless adolescents

Background: Homeless adolescents are at very high risk for sexually transmitted diseases (STDs), but few street-based interventions have been developed, tested, and made available to reduce risk and promote sexual health within this growing population. Objectives: This study, part of a larger study of the sexual health practices of homeless adolescents, explores participants' perceived need for more knowledge about sexual health and their ideas about developing a brief intervention to promote positive sexual health practices that would reflect their perspective. Methods: Four focus groups with five to six participants each were conducted with 22 youth aged 16-20 years, randomly selected from the study sample of 425 homeless youth. Most participants (82%) were White, one was American Indian, two were Hispanic, and one did not indicate ethnicity. Local groups were audiotape recorded, transcribed, and analyzed for manifest and latent content. Results: Participants were knowledgeable about symptoms, transmission, prevention, and treatment of STDs, but perceived the need for more knowledge about types of hepatitis, cancer, and long-term sequelae of untreated STDs. Participants identified barriers to seeking diagnosis and treatment for symptoms of STDs including cost, not knowing where to go, and lack of services specifically for females. They suggested developing a sexual health intervention based on respect that would provide concrete examples of how to promote their sexual health. Conclusions: Homeless adolescents were generally knowledgeable about symptoms and prevention of STDs and thought that street outreach interventions should be (a) brief, (b) gender-specific, (c) focused on the unique vulnerabilities and strengths of homeless youth, and (d) accessible.