The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents

Objective: To assess HIV-related drug and sex risk behaviors and evaluate factors associated with change in risk behaviors among runaway and homeless adolescents, 244 street youth were recruited from a community drop-in center serving high-risk youth. Method: Using a cross-sectional design, approximately half of study participants received training in a peer-based intervention that included principles derived from the health belief model, while the remaining subjects received no intervention. Subjects were interviewed at baseline, immediately following the intervention (for those receiving the training) and 3 months later. Logistic regression and analysis of covariance were used to analyze intervention effects. Results: Compared to youth in the control condition, runaways receiving the intervention significantly increased their knowledge about HIV. Contrary to the health belief model, in multivariate analyses knowledge and greater perceived chance for HIV were associated with high risk behavior. On the other hand, lower concern about HIV infection was also associated with high risk behavior, supporting the health belief model. Conclusions: Despite the intervention's success in increasing knowledge of HIV and AIDS, the association between knowledge, perceived likelihood of infection and high risk behaviors suggest that, without other alternatives, runaways will maintain their risks. The association noted between lower concern and high risk behaviors underscores the challenge faced in developing effective interventions with this population. (C) 1999 Elsevier Science Ltd.