Good Practices
Youth living on the street and the high risk for HIV, hepatitis B and C and other blood borne diseases
Youth living on the street or in correctional institutions are at high risk for HIV, hepatitis B and C and other blood borne diseases because they combine high levels of risky drug use with high levels of risky sexual behaviour.
Standard household or school surveys cannot reach these youth, so the best way to investigate the situation is through in-depth interviews with the youth in their own environment. This article synthesizes information from three studies: youth in a correctional setting in Australia (166 surveyed), and homeless youth in the US (186) and Canada (919). The results of these studies may not apply to other street youth or other youth in correctional settings, but they do give us an idea of the conditions and issues in the lives of youth in similar situations.
The youth in these studies tend to have difficult family backgrounds. Among the youth in the US, injection drug users (IDUs) were more likely than non-IDU homeless and runaway youth to report backgrounds that included parental substance use, forced institutionalization, a history of "survival sex" and use of abandoned buildings as shelter.
The three studies show that injection drug use is common among these youth:
? Australia: 17% of males and 38% females had injected in the previous month;
? US: 45% had injected at least once;
? Canada: 36% had injected at least once.
Other risky behaviours reported by these youth:
? Needle sharing: among the US IDUs, 44% had used a shared needle the last time they used; the Australian study found girls much more likely to share injecting equipment;
? Heavy use of alcohol and cannabis: the Australian youth, for example, had a daily consumption 3-4 times the recommended safe levels;
? Risky sexual activity: unprotected sex, sex while intoxicated, multiple partners, working in the sex trade;
? Poor knowledge: not knowing how hepatitis B, C are transmitted.
The Canadian study asked questions about the injecting experience. Many of these youth did not see the first injecting experience as a big deal for them, claiming that everyone was doing or it was just another way to take a drug.
Similarly, it didn't seem to matter which drug they took -- it was the experience that was most important -- they would have taken whatever was available. Their use didn't seem to result from a dependence on a specific drug, instead it was just another aspect of their heavy, erratic drug use.
This suggests that it is not helpful to label these youth cocaine or heroin addicts. Many IDUs have had treatment but they often report that it didn't work because they were forced against their will.
The IDU youth tended to spend more of their time looking for money or making a purchase, while other street youth (non-IDUs) were more likely to be involved in other recreational activities such as reading, writing, drawing, listening to music or skateboarding.
Clearly, traditional ways of helping or treating these young people are not likely to be effective. Are any of the groups in the network working with youth who inject drugs? What ways of working with these youth are most effective?
Sources:
Copeland J., Howard J., Fleischmann S. Gender, HIV knowledge and risk taking behaviour among substance using adolescents in New South Wales (1998). Journal of Substance Misuse, Vol 3: 206-212.
Roy E., et al. Injection drug use among street youth: a dynamic process (1998). Canadian Journal of Public Health, Vol 89. #4 (239-240).
Martinez, T.E., et al. Psychosocial histories, social environment and HIV risk behaviours of injection and non-injection drug using homeless youth (1998). Journal of Psychoactive Drugs, Vol 30. #1: (1-10).
** for more articles on injection drug use, search the database of the Canadian Centre on Substance Abuse: http://ccsa.ca/Databases/hepsrche.htm