ARCHIVED: E-SYS Quick Facts – Sexual behaviours of Canadian street youth: how risky are they?

 

Sexual Behaviours of Canadian Street Youth: How Risky Are They?

Cat. No HP5-15/2006E-PDF
ISBN 0-662-43488-9

PDF version 1.16 MB, 3 pages

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Introduction

Street youth are predominantly homeless, or they live in highly unstable residential conditions.1They have varied back- grounds and cultures but share characteristics that jeopardize their health and well-being. Street youth frequently engage in high-risk behaviours, such as unprotected sex with multiple partners or sex while under the influence of drugs and alcohol.1-4 These behaviours increase their risk of contracting and transmitting sexually transmitted infections (STIs) and blood-borne infections (BBIs).

The information presented in this overview is based on Enhanced Surveillance of Canadian Street Youth (E-SYS). E-SYS is a sentinel surveillance system that monitors rates of STIs and BBIs, risk behaviours and health determinants in the Canadian street youth population. The data presented below are from the 1999, 2001, and 2003 cycles of E-SYS data collection.

STIs are more common in street youth than in general population youth

  • As shown in Table 1, the prevalence rate of chlamydia in street youth increased from 8.6% in 1999 to 11.0% in 2003. It is substantially higher than the reported prevalence in general population youth.5,9
  • In the general youth population, the prevalence of chlamydia rose from 0.7% to 0.9% in the same time period.5,9
  • As with chlamydia, the prevalence of gonorrhoea is high in the street youth population, about 20 to 30 times higher than in the general youth population.

The prevalence of gonorrhoea among street youth has increased significantly, from 1.4% in 1999 and 2001 to 3.1% in 2003. This increase is substantially higher than the general youth population's, where the rate increased from 0.06% in 1999 to 0.09% in 2003.5,9

“E-SYS is a collaboration between the Public Health Agency of Canada’s Surveillance and Epidemiology Unit (Community Acquired Infections Division, Centre for Infectious Disease Prevention and Control), Health Canada’s Office of Research and Surveillance (Drug Strategy and Controlled Substances Program), participating surveillance sites and the youth who provide the data and samples collected.”

An increase in infectious syphilis (primary, secondary and early latent syphilis) among street youth was noted between 2001, when there were no detected cases, and 2003, when the prevalence rate was 0.7% (10 cases).9

Street youth report early initiation of sexual activity and frequent sexual activity

  • More than 95% of street youth surveyed by E-SYS reported being sexually active. This is consistent with other studies conducted on this population.6
  • The average age at first sexual intercourse among street youth (both male and female) was 14 years, which is much lower than among youth in the general population (16.8 years).7
  • In 2003, among female street youth who reported recent sexual activity, the average number of sexual episodes per week ranged from 2 with casual partners* to 13 with paying** partners (Figure 1). Among male street youth who reported recent sexual activity, the average number of sexual episodes per week ranged from 3 with casual partners to 8 with paying partners (Figure 1).
  • Male street youth reported having sex more frequently with regular*** and casual partners than did females.
  • Female street youth reported having sex with paying partners more frequently than did males.

Street youth have many sex partners

  • On average, street youth reported having had more than 17 sex partners in their lifetime. Males reported a higher number of lifetime partners than did females (Figure 2).
  • The average number of partners was highest in male street youth who reported MSM**** activities (data not shown).

Table 1. Prevalence rates of selected STIs in street youth and in the general youth population in 1999, 2001 and 2003

Street Youth (General Youth Population)* 5

Age

1999

2001

2003

Chlamydia

 

 

 

15–19 years

8.98% (0.65%)

11.51% (0.74%)

10.88% (0.82%)

20–24 years

7.87% (0.75%)

11.38% (0.88%)

11.04% (0.99%)

Gonorrhoea

 

 

 

15–19 years

1.56% (0.06%)

1.04% (0.07%)

2.19% (0.08%)

20–24 years

0.90% (0.07%)

2.12% (0.09%)

4.38% (0.10%)

Infectious syphilis

 

 

 

15–19 years

0% (< 0.01%)

0.25% (< 0.01%)

20–24 years

0% (< 0.01%)

1.31% (< 0.01%)

* Rates in street youth are prevalence rates; the rates they are compared to in the general youth population are derived from reported cases. Rates from reported cases may underestimate actual prevalence in the general population, due to asymptomatic cases and those who do not report for testing.

Figure 1. Average number of times street youth had sex per week by partner type in 2003

Figure 1. Average number of times street youth had sex per week by partner type in 2003

Figure 2. Average lifetime number of sexual partners of street youth by gender in 1999, 2001 and 2003

Figure 2. Average lifetime number of sexual partners of street youth by gender in 1999, 2001 and 2003

Condom use is low among street youth

  • As shown in Figure 3, more street youth reported not using a condom with a male partner than with a female partner.
  • In 2001, males were significantly more likely to report not using condoms with their male partners than with their female partners (data not shown).
  • The rate of condom use in street youth is very low - in all survey years, approximately 50% of street youth reported not using condoms at their last sexual encounter.
  • These findings are consistent with those of other studies. For instance, in a study of AIDS risk behaviours among homeless youth in the United States, one-third of sexually active youth reported irregular condom use.6 Similarly, 32% of youth in Canada's Street Youth and AIDS study reported never using condoms.8

Figure 3. Proportion of street youth who reported not using condoms for protection at their last sexual encounter by gender of partner in 2001 and 2003

Figure 3. Proportion of street youth who reported not using condoms for protection at their last sexual encounter by gender of partner in 2001 and 2003

Sex with high-risk partners and unwanted sexual experiences are common among street youth

As seen in Table 2, many street youth report having sex with high-risk partners. In addition, there are gender differences in the sexual risk behaviours reported by street youth:

  • The proportion of female street youth in E-SYS surveys who reported having experienced unwanted sex was more than double that of males.
  • On average, female street youth were also more likely to report having traded sex than their male peers.9
  • In 2003, the number of males who reported not using a condom at the last encounter where sex was traded was more than double that of females.
  • About 50% of street youth reported having had sex with someone who was under the influence of drugs.
  • Almost 20% of street youth had had sex with someone who had been diagnosed with an STI.

Street youth perceive themselves to be at low risk of contracting STIs

  • Figure 4 shows that the majority of street youth who participated in E-SYS believed that they were at no or low risk of contracting an STI.
  • About one-quarter of street youth believed that they were at no risk at all.

Table 2. Proportion of street youth reporting selected risk behaviours and reporting sex with partners with certain high-risk characteristics

Sexual behaviour of street youth

2001

2003

Ever had unwanted sex* (%)

Male

11.0

12.5

Female
28.0
27.8

Overall

18.3

18.2

Ever felt obligated to have sex (%)

Male

 

14.3

Female
25.5

Overall

 

18.5

No condom use at last obligated sexual encounter (%)

Male

 

47.0

Female
39.0

Overall

 

44.0

Ever traded sex (%)

Male

16.5

14.5

Female
26.5
29.3

Overall

20.9

20.2

No condom use at last encounter where sex was traded (%)

Male

26.4

29.0

Female
24.5
10.0

Overall

25.0

19.0

Percentage of street youth reporting having had sex partners with selected risk characteristics in previous 3 months

Under the influence of drugs during sex

47.4

50.8

Had been told they had an STI

17.0

16.0

Had traded sex

7.1

9.5

* Unwanted sex is defined as having sex, but not wanting to do so, with someone in a position of authority.

Figure 4. Self-perceived risk of STIs among street youth

Figure 4. Self-perceived risk of STIs among street youth

Conclusions

E-SYS findings on sexual risk behaviours among street youth are a cause for concern. Upstream intervention and educational outreach initiatives are needed to reduce the risk of exposure to STIs in this population. Accessible harm reduction programs and measures are also required to help reduce the ill effects of street involvement. In addition, interventions that are sensitive to gender differences, sexual orientation and unwanted sexual experiences are necessary for this population. The social aspects of life on the street, specifically the unstable living and economic conditions youth face, cannot be ignored. Only by tackling the full spectrum of issues confronting street youth will inroads be made in lowering rates of risk behaviour and STIs in this population.

Contact

For further information please contact:
Surveillance and Epidemiology Section
Community Acquired Infections Division (CAID)
Centre for Infectious Disease Prevention and Control (CIDPC)
Public Health Agency of Canada (PHAC)
AL 0603B
Ottawa, ON K1A 0K9
Tel. 613-946-8637
Fax. 613-946-3902
www.publichealth.gc.ca/sti
www.santepublique.gc.ca/its

References

* A "casual" sex partner is someone with whom the youth has had sexual relations once or a few times, but with whom there is no emotional involvement.

** A "paying" sex partner is someone that hasw given the youth money, drugs, goods or anything else in exchange for sex.

*** 0* A “regular” sex partner is someone with whom the youth has a relationship and with whom he or she is emotionally involved.

****0* MSM: Men who have sex with men.

  1. Roy E, et al. Mortality in a Cohort of Street Youth in Montreal. Journal of the American Medical Association. 2004; 292(5):569-574.
  2. DeMatteo D, et al. Toronto Street Youth and HIV/AIDS: Prevalence, Demographics, and Risks. Journal of Adolescent Health. 1999; 25(5):358-366.
  3. Weber AE, et al. HIV Risk Profile and Prostitution Among Female Street Youth. Journal of Urban Health. 2002; 79:525-535.
  4. Shields S, et al. Prevalence and Correlates of Chlamydia Infection in Canadian Street Youth. Journal of Adolescent Health. 2004; 34:384-390.
  5. Public Health Agency of Canada. 2002 Canadian Sexually Transmitted Infections Surveillance Report. CCDR. 2005; 31:S2.
  6. Johnson TP, et al. Self-reported risk factors for AIDS among homeless youth. AIDS Education and Prevention. 1996; 8(4): 308-322.
  7. Hansen L, et al. Sexual Health. BMC Women's Health. 2004; 4 Suppl 1:S24.
  8. Radford JL, et al. Street Youth and AIDS. Kingston: Social Program Evaluation Group, Queen's University; 1988.
  9. Public Health Agency of Canada. Sexually Transmitted and Blood-Borne Infections in Canadian Street Youth Report. Ottawa; 2006.
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