Reaching homeless youths for Chlamydia trachomatis and Neisseria gonorrhoeae screening in Denver, Colorado

In the United States, as many as 1.6 million youths are homeless each year. ¹ In Denver, approximately 250 youths under the age of 21 are sleeping on the streets of Denver every night. ² Homeless youths are characterised by high levels of substance abuse, mental illness, and physical and sexual abuse. ^{3- 6} There is also evidence that homeless youths are at high risk for sexually transmitted infections (STIs). A study of Los Angeles street youths found that 70% of youths sampled were sexually active with an average of 11.7 sexual partners during the last month. ⁷ Bailey et al ⁸ reported similar findings in their study of substance use and risky sexual behaviour among homeless and runaway youths, arguing for more targeted prevention among this population, especially among young homeless women. In a study among homeless youths in a large city in the northwestern United States, Noell et al ⁹ found annualised chlamydia incidence rates of 7.4% among men and 12.1% among women. HSV-2 incidence rates were 11.7% and 25.4% respectively. Inconsistent condom use was the primary factor associated with incident STIs, especially among women with high numbers of partners. ⁹

Though a recognised healthcare concern among the general population of adolescents, STIs are not typically addressed with homeless and runaway youths. The 1997 Institute of Medicine report on "The Hidden Epidemic" identified a need to design and implement essential STD related services in innovative ways for adolescents and underserved populations. The report recommended "innovative methods and alternate venues for intervention because these groups are difficult to reach through traditional health care settings." ¹⁰ Based on several recent studies of STI rates among homeless and runaway youths, Kipke et al ⁷ and Bailey et al ⁸ concur with a need for more effective interventions aimed at targeting this high risk population.

Because homeless and runaway youths are difficult to reach for STI services, the availability of non-invasive, urine based, testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) provides a unique opportunity for screening this population in an outreach setting. We investigated the feasibility of street based CT/GC screening in the context of an outreach programme among street/homeless adolescents in Denver. The objective of this study was to describe the collaboration between...