The news this week from the Centers for Disease Control about HIV and young people may have startled some, but to people who work at San Francisco's Larkin Street Youth Services, it was a spotlight on what they see every day.
More than a quarter of all new infections every year are in young people between ages 13 and 24 -- and more than half of those youth infected don't know it. Hardest hit are African Americans -- 57 percent of people in this young age group.
In advance of World AIDS Day on Saturday, The California Report's host Rachael Myrow visited Larkin Street Youth Services, which helps homeless teens get off the streets and get tested for HIV. She talked to two women who manage programs at the organization.
Here is an edited transcript of their discussion:
LARA TANNENBAUM, Larkin Street's housing programs: The majority of our youth have experienced a severe amount of abuse or neglect in the home, parental substance use, perhaps a lot of poverty in the home where families weren’t able to care for them. Many of our clients are LGBT and their parents asked them to leave because of their sexual orientation. So people really become homeless for a variety of reasons.
RACHAEL MYROW: How do you start a conversation with a teenager about HIV/AIDS?
RAE SUBER, Larkin Street's HIV testing & prevention program: Getting a client to consider testing is like getting them to consider medical care in general. Usually there’s a crisis. They think they might have a sexually transmitted infection. They think they might be pregnant. They think their partner might have an infection or be pregnant, and they’re concerned. So they come in and, if testing is indicated, we’ll recommend it.
RACHAEL MYROW: What is it that stands between a young person who may be homeless or may be insecure about their housing situation and medical care in general?
LARA TANNENBAUM: There are a lot of barriers that prevent young people from thinking about HIV prevention and testing while they are on the streets. Just meeting basic needs is really the primary thing on most of our youths' mind -- finding a place to stay for the night, having food.
In addition, the things that youth have to do to survive for the night on the streets put them at higher risk for HIV. Many of our youth engage in what we call "survival sex," trading sex for food or a place to stay, or even money. Very often in those interactions, youth are not able to negotiate safer sex, so that puts them at risk for HIV. Many of our youth on the streets are using substances as part of their coping mechanism. They may be using intravenous drugs; they may be sharing needles. That puts them at risk for HIV. So there are a lot of risk factors for homeless youth as well as a lot of barriers to getting them tested.
RACHAEL MYROW: There have been a number of reports that point to new infections coming primarily among men and teenage boys who have sex with other men and teenage boys -- and new infections are high among African Americans. Have you decided to tailor your programs any differently, in light of these reports, or is it just something you bear in mind as you do your work?
LARA TANNENBAUM: The statistics are really alarming nationwide. The disproportionality of HIV infection is really concerning. If you are a young person, if you are a man who has sex with men, if you are a man of color who’s a young person -- who has sex with men -- you are at extremely high risk of HIV in the United States, and we see that in our programs. Of the 70 to 80 HIV positive youth a year who we serve, the vast majority are young men of color who have sex with men.
RACHAEL MYROW: If you're a traveler, if you’re having sex in circles where there’s already a higher incidence of HIV infection, you’re at a statistically higher risk.
LARA TANNENBAUM: Absolutely. Part of what we try to do when we identify someone who is positive is encourage them to have their friends get tested. We’re very much aware that homeless youth in particular are travelers and do tend to have social networks, and there’s a lot of potentially drug use and/or sexual partners within those networks and so the risk can be very high in those networks. We do see sometimes youth who come into our program for positive youth, we have had occasion where a young person will come in, and then a friend comes in, and then another friend comes in, so we’ve actually see that play out.
Listen to Rachael Myrow interview Lara Tannenbaum and Rae Subaro: