HIV & STI Testing As a Socially Embedded Process: A Qualitative Study of Youth Experiencing Homelessness

Background and Purpose
Youth experiencing homelessness (YEH) face high rates of HIV and sexually transmitted infections (STIs), yet engagement in testing remains inconsistent despite elevated risk. Existing research has focused on individual-level risk behaviors, with less attention to how YEH conceptualize sexual health and how social contexts shape testing decisions. Grounded in social network and health behavior frameworks, this study explored how YEH understand sexual health and how beliefs, values, and social support within their networks influence HIV/STI testing behaviors. By centering youths’ lived experiences, this study addresses gaps in understanding the relational processes shaping engagement in sexual health services.

Methods
This qualitative study used interpretive description to generate practice-relevant insights into HIV/STI testing behaviors among YEH. Semi-structured interviews were conducted with 15 youth (ages 18–24) receiving services at a shelter for unhoused youth in Denver, Colorado, between January and February 2025. Participants were recruited through a community-based partnership with a local youth-serving organization. Interviews explored beliefs about sexual health, experiences with HIV/STI testing, and the influence of social relationships on decision-making. Interviews were transcribed verbatim and coded by two analysts using Dedoose. Data were analyzed using thematic analysis, with an iterative coding process to identify patterns and construct themes reflecting shared meanings and variation in experience. Findings were shared with the community partner to ensure resonance with practice contexts.

Findings
Two overarching themes emerged. First, Moral Reasoning, Emotional Complexity, and the Practice of Sexual Healthcaptured how youth framed HIV/STI testing as self-care, responsibility to others, and community protection. However, decisions were often shaped by emotional complexity, including fear, stigma, and discomfort, which at times conflicted with health-promoting intentions. Second, Navigating Support, Stigma, and Silence in Social Networks highlighted the critical role of social relationships in shaping testing behaviors. Youth in networks where sexual health was openly discussed and testing was modeled were more likely to test. Conversely, stigma, misinformation, and avoidance of sexual health conversations discouraged testing. Family members were frequently sources of informational and emotional support, while agency staff primarily provided instrumental and emotional support. Peer influences varied, with some encouraging testing and others reinforcing stigma or disengagement. Notably, some youth described navigating testing decisions independently due to fractured or unreliable support systems.

Conclusion and Implications
Findings underscore HIV/STI testing among YEH as a socially embedded, relational process rather than solely an individual behavior. Trauma-informed, relationship-centered interventions may promote testing by leveraging existing support systems and fostering safe spaces for open sexual health communication. Efforts to reduce stigma, strengthen supportive relationships, and enhance dialogue within social networks, particularly with family and trusted providers, may increase engagement in HIV/STI testing. These findings highlight the need to integrate social network-informed approaches into HIV/STI prevention and address structural and relational barriers shaping health behaviors among YEH.