Longitudinal Exploration of Pathways to HIV/STI Risk Reduction among Homeless Young Adults through a Youth-Centric Rapid Re-Housing Program

摘要 这项R21研究是对无家可归的年轻人降低艾滋病毒/性传播感染风险途径的纵向探索 18-24岁的成年人(YAEH)通过以年轻人为中心的快速安置计划(YRR)。考虑到年轻人 在美国，无家可归和感染艾滋病毒和性传播疾病的风险最大的年龄段之一，是一个紧迫的问题 需要对艾滋病毒/性传播感染采取有效和适合发展的结构性干预方法 YAEH的预防。YRR被美国各地的社区广泛用作解决青年问题的解决方案 无家可归；然而，关于短期住房计划的影响的研究有限，例如 就像你一样，YAEH的艾滋病毒/性传播感染风险。先前的研究已经确定了与艾滋病毒/性传播感染有关的一系列可能的原因 青年会的危险行为；然而，关于具体的有益因果过程，即 产生结果的相互作用的变量和途径，通过 短期住房干预和服务支持。此外，许多证据表明住房 YAEH之间的不稳定和HIV/STI风险一直是横截面的，限制了我们对 应针对艾滋病毒预防的机制。这项研究的具体目的是：目标1：探索 潜在的因果过程(生物、心理、社会和环境层面)，有助于恢复和 在青年会中降低艾滋病毒/性传播感染风险(多性伴、药物使用、交易性行为、无保护性行为) 通过既定的以青年为中心的短期住房干预，利用小组设计和混合 方法(深度访谈、调查、HIV/STI和压力生物标记物)跟踪服务对象(n=50) 艾滋病毒/性传播感染行为风险结果在12个月期间的变化；目标2：建立一个描述 模型中不同因果过程和HIV/STI风险结果之间相互关联的路径和方向 目标3：试行新制定的、适合发展的住房稳定措施 利用目标1和目标2的调查结果以及对主要信息提供人的访谈，对青年会和相关的因果过程进行调查 (5)和YAEH Yrr客户(n=10)。拟议研究的结果将被用来开发一种理论 框架和中试措施，以便为大N混合方法研究奠定基础 YRR与青年会HIV/STI风险之间的因果机制。这项研究的影响是降低健康 通过帮助社区改善艾滋病毒/性传播疾病在高危人群和弱势人群中的差异 YAEH的干预措施。

ABSTRACT This R21 study is a longitudinal exploration of pathways to HIV/STI risk reduction among homeless young adults ages 18-24 (YAEH) through a youth-centric rapid re-housing program (YRR). Given that young adults are one of the age groups most at risk of homelessness and of acquiring HIV and STIs in the US, an urgent need exists for effective and developmentally-appropriate structural intervention approaches to HIV/STI prevention for YAEH. YRR is widely used by communities across the U.S. as a solution to addressing youth homelessness; however there has been limited research on the impact of short-term housing programs, such as YRR, on YAEH's HIV/STI risk. Prior studies have identified a range of likely causal factors linked to HIV/STI risk behaviors among YAEH; however, little is known about the specific beneficial causal processes, i.e., the interacting variables and pathways generating the outcomes, to HIV/STI risk reduction among YAEH through a short-term housing intervention with service supports. Furthermore, much of the evidence linking housing instability and HIV/STI risk among YAEH has been cross-sectional, limiting our understanding of the mechanisms that should be targeted for HIV prevention. The specific aims of this study are to: Aim 1: Explore potential causal (bio-, psycho-, social- and environment-level) processes that contribute to resilience and reduction in HIV/STI risk (multiple sex partners, substance use, trading sex, unprotected sex) among YAEH through an established short-term youth-centric housing intervention, utilizing a panel design and mixed methods approach (in-depth interviews, surveys, HIV/STI and stress biomarkers) to track clients' (n=50) change in HIV/STI behavioral risk outcomes over a 12-month period; Aim 2: Build a theory that describes the interrelated pathways and directions among different causal processes and HIV/STI risk outcomes for model building; and Aim 3: Pilot test newly created, developmentally-appropriate measures of housing stability for YAEH and relevant causal processes, using findings from Aims 1 and 2 and interviews with key informants (n=5) and YAEH YRR clients (n=10). Results from the proposed study will be used to develop a theoretical framework and pilot-tested measures in order to build the foundation for a large-N mixed-methods study to test causal mechanisms linking YRR and HIV/STI risk among YAEH. The impact of this study is to reduce health disparities in HIV/STIs among high risk and vulnerable populations by helping communities improve their interventions for YAEH.