ISSUE: Homeless/runaway youths are the subpopulation of adolescents with the highest rates of HIV infection throughout many parts of the world. Current HIV prevention efforts for these youths tend to view sexuality as a homogenous construct and fail to address the array of contextual influences that impact sexual risk behavior. PROJECT: In order to develop ecologically sensitive HIV prevention interventions, a more qualitative understanding of the intricate web of contextual factors surrounding the sexual behavior of homeless/runaway youths is needed. To this end, individual semi-structured qualitative interviews were conducted with 60 youths (ages 14 to 21) recruited from two different community-based organizations serving homeless/runaway youths. Participants were asked to describe in detail two sexual scenarios that occurred within the previous year, one in which a condom was used for penetrative anal or vaginal intercourse, and one in which a condom was not used for such activity. Thematic analyses of the coded transcripts were conducted using QSR NUD*IST 4 software. RESULTS: The following themes emerged from these interviews regarding contextual factors that impact condom use: a) General interpersonal and sexual communication; b) Cognitive and behavioral impulsivity in the context of sexual arousal, condom accessibility, and novelty; c) Illusions regarding the nature of their relationship and their partners' sexual behaviors; d) Beliefs regarding HIV (e.g., treatability illusions, anticipation of a cure, HIV testing limitations); e) Risk appraisal based on reputation, appearance, and sexual rituals; and f) Personal reputation management around the meaning of condom use. These themes varied across gender, sexual orientation, and relationship type (e.g., primary vs. causal/anonymous sexual partner). LESSONS LEARNED: To address the complex set of influences on HIV sexual risk, it is recommended that future interventions with homeless/runaway youths include program components that: improve affective/interpersonal communication and impulse control; explore the impact of relationship type on personal risk; dispel myths regarding HIV testing and treatment; encourage non-penetrative sexual behaviors; increase the ability to accurately and reliably appraise sexual risk; and buffer against negative peer perceptions of condom users. (Authors)
