Date of Award

Summer 8-23-2025

Document Type

Dissertation

Degree Name

Ph.D. in Social Work

Organizational Unit

Graduate School of Social Work

Second Advisor

Anamika Barman-Adhikari

Third Advisor

Tyrone Hamler

Fourth Advisor

Erin Harrop

Copyright Statement / License for Reuse

All Rights Reserved
All Rights Reserved.

Keywords

HIV/STI prevention, HIV/STI testing, Social networks, Social norms, Social support, Youth experiencing homelessness

Abstract

Youth experiencing homelessness (YEH) face disproportionately high risk for HIV and sexually transmitted infections (STIs), yet rates of testing remain low. This dissertation examines the individual and social network level factors that influence HIV/STI testing behaviors among YEH. Guided by insights from multiple theoretical frameworks, this three-paper dissertation integrates quantitative and qualitative approaches to better understand how personal relationships and social context shape HIV/STI testing decisions in this population.

Paper 1 presents a secondary data analysis of the Homeless Youth Risk and Resilience Survey (HYRRS), which includes 1,426 YEH across seven U.S. cities. Logistic regression models identified geographic variation in HIV/STI testing rates, with youth in Los Angeles and New York City reporting higher testing rates than those in other cities. YEH reporting early sexual debut were less likely to test for HIV while those with multiple sex partners were more likely to test for HIV and STIs.

Paper 2 uses egocentric network data from the HYRRS to examine how social network norms across five relationship types (family, home-based peers, street-based peers, intimate partners, and agency staff) relate to HIV and STI testing among YEH. Communication norms around HIV/STI disclosure and safe sex communication, particularly from family, home-based peers, and street-based peers, were significantly associated with recent HIV/STI testing. Agency staff also influenced HIV testing through personal status disclosure. Findings suggest that interventions promoting positive norms and supportive relationships may increase HIV/STI testing uptake and reduce disparities among YEH.

Paper 3 draws on semi-structured interviews with 15 YEH recruited from a youth shelter in Denver, Colorado. Using an interpretive description approach, this qualitative study explores how youth conceptualize sexual health and how their beliefs, attitudes, and social environments shape HIV/STI testing behaviors. Two central themes emerged: (1) moral reasoning, emotional complexity, and the practice of sexual health and (2) navigating support, stigma, and silence in social networks. Family and staff were identified as key sources of support, while stigma, misinformation, and fractured relationships often hindered testing.

The findings from this dissertation highlights the importance of trauma-informed, youth-centered, and social network-based approaches to promoting HIV/STI testing and improving sexual health equity for YEH.

Copyright Date

8-2025

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Alexander A. Ochs

Provenance

Received from ProQuest

File Format

application/pdf

Language

English (eng)

Extent

198 pgs

File Size

908 KB

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