Home and health: Experiences of transition into permanent supportive housing from youth previously experiencing homelessness

This presentation will detail results from a recent study on “transitional aged homeless youth” (TAHY, 18-24), who suffer health disparities largely related to drug and sexual risk behaviors. Research indicates that providing permanent supportive housing (PSH) to adults experiencing homelessness reduces their drug and sexual risk behaviors. However, the effects of PSH on the health behaviors of TAHY have not been studied. In January of 2014, the first San Francisco city-funded PSH building exclusively designated for TAHY opened its doors. From April 2014 to July 2015, we recruited 40 of the 44 building residents into a mixed-methods longitudinal study, collected baseline data with participants and ongoing ethnographic data in the building. Baseline data collection included a baseline survey, a semi-structured in-depth interview, and biological testing for HIV and other sexually transmitted infections. Preliminary quantitative findings through the baseline survey reveal gaps in health care access and ongoing and severe levels of food insecurity. Over half of respondents reported recent gaps in health care utilization, with 53 percent reporting that there was a time in the past year when they thought they should seek medical care but did not. The most commonly cited reasons for not seeking care were believing that the issue would resolve itself, lacking transportation, not knowing where to seek care, and being concerned about how they would be treated. 63 percent of respondents had visited an emergency department for urgent care treatment within the past year. Baseline surveys also reveal that PSH residents are experiencing a high level of food insecurity, with 71 percent scoring at a level of severe food insecurity on the Household Food Insecurity Access Scale and an additional 16 percent scoring as moderately food insecure. Preliminary epidemiological findings indicate that this is a population at high risk for HIV and other STIs. Of 35 participants who engaged in biological testing, we identified 2 HIV-positive individuals and seven individuals testing positive for one or more STIs (chlamydia, gonorrhea, and/or syphilis). All participants testing STI-positive were referred immediately into treatment and resources for partner-delivered therapy. Preliminary qualitative findings reveal changes in drug use and sexual risk behavior among youth entering PSH. Changes in drug use patterns appear mixed, with some participants reporting ceasing use while others reporting increasing drug use or adoption of new substance use patterns since entering into PSH. Among many residents, marijuana use remains high, in part because marijuana is seen as a socially sanctioned medication. Several participants describe decreased engagement in sexual risk behavior, including survival sex. They frequently reported decreased episodes of resorting to violence to resolve conflicts or of theft to make ends meet, in part out of a desire not to lose housing. Our research suggests that while PSH provides youth critical respite from the streets, it is not a panacea. Residents continue to face challenges to their health and wellbeing, including ongoing barriers to health care access, high levels of food insecurity, and high prevalence of unidentified and untreated STDs.