Perspectives in Sexual and Reproductive Health
Exploring Contextual Factors of Youth Homelessness And Sexual Risk Behaviors: A Qualitative Study
HIV disproportionately affects homeless youth, and interventions to date have had minimal success in reducing sexual risk behaviors in this population. Few qualitative studies have been conducted to provide insight into the influence of homelessness‐related factors on sexual risk behaviors.
A qualitative study with a quantitative component was conducted with a nonprobability sample of 64 homeless youth aged 14–24; participants were recruited from a variety of venues in Houston between October 2013 and March 2014. Thirteen focus group discussions were conducted; thematic analysis was used to identify themes related to HIV risk.
Participants were predominantly black (75%), sheltered (67%) and aged 18 or older (77%). Youth discussed how the circumstances of their homelessness and the struggle to meet their immediate needs led to behaviors and experiences that put them at risk for HIV. Three themes emerged: Homeless youth frequently engage in risky sexual behavior, sometimes as a way to cope with stress; they often trade sex, either voluntarily or involuntarily, for such necessities as money or a place to sleep; and many experienced childhood sexual victimization or have been victimized since becoming homeless. Youth also described how stress, stigma and self‐reliance contributed to their involvement in HIV risk behaviors.
HIV prevention methods that target stress and stigma while respecting youths’ self‐reliance may help reduce sexual risk behaviors. Further research is needed to determine suitable behavioral change techniques to address these potentially modifiable factors.
Long‐Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On‐Site Provision
Many incarcerated women have an unmet need for contraception. Providing access to long‐acting reversible contraceptive (LARC) methods—IUDs and implants—before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described.
A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009–2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses.
Eighty‐seven LARC devices were inserted during the study period—53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4).
It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.
Guttmacher Policy Report
Guttmacher Institute Monthly State Policy Update
This update provides information on legislation,
as well as relevant executive branch actions and judicial decisions in states across the country