Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Sep 1.
Published in final edited form as: Urban Soc Work. 2025 Dec;9(3):127–143. doi: 10.1891/usw-2025-0010

Housing Instability Among Young Men Who Have Sex With Men in a U.S. National Sample

Amanda Sisselman-Borgia 1, Viraj V Patel 2, Christian Grov 3
PMCID: PMC13034811  NIHMSID: NIHMS2153707  PMID: 41918977

Abstract

Youth experiencing housing instability are among the fastest growing groups of individuals diagnosed with sexually transmitted infections (STIs). The unpredictable nature of the lives of youth experiencing housing instability can lead to inconsistent health care, leaving gaps about the most prominent needs for intervention. We examined factors associated with housing instability in a national sample of 2,228 sexual and gender minority (SGM) youth aged 16–24 who were having sex with men. Behavioral risk factors for STI and reported sex work were associated with housing instability. Social support, health insurance, older age, and partner violence were associated with stable housing. Implications for addressing risks for STIs and housing instability in urban areas among adolescent SGM men having sex with men are discussed.

Keywords: STI prevention, sexually transmitted infections, adolescents, youth, housing instability, homelessness, social determinants of health

Introduction

Youth homelessness and housing insecurity is growing in the United States - 4.2 million children and young adults are impacted annually by physical, mental, and emotional impacts of being unhoused (Morton et al., 2018). Within New York City, one of the world’s biggest urban center, between 2023 and 2024, there was a 498% increase in youth reporting unstable housing situations, in part due to better survey methods. The nightly count of youth reporting homelessness or unstable housing on the night of the survey in 2024 was over 14,000 (New York City Department of Youth and Community Development, 2024). Even this high number is likely a substantial underestimate given that many youth sleep in public spaces that might be missed, such as subways or on the street each night (Hatchimonji, Flatley, Treglia, & Cutuli, 2021). Youth who identify as LGBTQ+ (Lesbian, gay, bisexual, transgender, Queer, Intersex, Asexual) are also at a higher risk for becoming homeless and contracting HIV than heterosexual youth (Srivastava et al., 2019). LGBTQ+ youth experiencing homelessness (YEH) or housing insecurity also have high rates of trading sex for food, housing, or other necessities leading to additional victimization on the streets (Srivastava et al., 2019). For example, 75% of transgender youth reported periods of homelessness; and are more likely to engage in survival sex with multiple partners and injection drug use (IDU), increasing risk of HIV infection (Drescher et al., 2019; Eastwood et al., 2019).

LGBTQ+ youth experiencing housing instability are at a higher risk for health and mental health problems including post-traumatic stress and are heavily impacted by health disparities and racism (Middleton et al., 2022; Morton et al., 2018; Petry et al., 2022). Behavioral risk factors such as sex work and injection drug use, are heavily associated with homelessness especially among trans gender youth, putting youth experiencing housing instability at an increased risk for sexually transmitted infections (STIs) (Côté, 2019; Eastwood et al., 2019; Heerde & Hemphill, 2016; Yoshioka-Maxwell & Rice, 2019). Youth, including those who are experiencing homelessness or housing insecurity, are among the fastest growing groups of individuals with new STI diagnoses, including HIV (Cdc, 2016; Guilamo-Ramos et al., 2019). The unpredictable nature of the lives of youth experiencing housing instability often leads to inconsistent or non-existent health care and preventive follow up. Unhoused youth are less likely to have access to condoms and STI testing and may engage in condomless sex, which puts them at a higher risk for STI (Halverson et al., 2022). Relatedly, LGBTQ+ youth experiencing housing instability often engage in sex work or sex trade in order to barter for food, housing, and other basic needs. Experiences related to homelessness or housing insecurity including sex work, community violence, and sexual assault are also associated with physical health issues such as STIs and additional trauma and post-traumatic stress (Wong et al., 2016).

Trauma experiences and post-traumatic stress disorder are prevalent in existing studies for numerous reasons including prior childhood abuse, witnessing violence in the community, and peer victimization or bullying (Petering, 2016). Youth experiencing housing instability are also particularly vulnerable to intimate partner violence (IPV), although a recent study reported that queer youth experiencing housing instability may be less likely to report IPV (Hail-Jares et al., 2021; Ragavan et al., 2020). LGBTQIA youth, including men having sex with men (MSM) are over-represented in the YEH population and are at higher risk for having experienced trauma at home before becoming homeless (Morton et al., 2018). Peer-victimization and bullying is also prevalent in this group either on the street or from peers in other circumstances, such as school or work (Tyler & Schmitz, 2018). Many MSM youth have been kicked out of their families of origin because of their sexual or gender identities, while some youth experiencing housing instability have been forced to the streets because their parents or guardians have been incarcerated (McCann & Brown, 2019; Morton et al., 2018; Ormiston, 2022). All of these scenarios pose additional risks for trauma experiences.

Lack of support from adult role models, parents, and/or guardians poses additional hardships for YEH, who are adolescents and young emerging adults in a vulnerable period of development. Programs that serve YEH are often short staffed and shelter beds are few and far between, given the numbers of youth experiencing homelessness, likely resulting in inadequate adult support (Morton et al., 2020).The limited existing research with small and geographically restricted samples suggest that social support might have protective qualities for YEH, especially programs that provide significant support from adults (Griffin et al., 2019; Kidd et al., 2019). Also, social support (both from peers and adults) has been associated with reductions in depressive symptoms in some studies and possibly better coping skills, such as less drug use in other studies (Griffin et al., 2019; Standley & Foster-Fishman, 2021). For transgender youth, lack of transgender friend/peer support has been associated with higher likelihood of homelessness, however lack of trans peer support has not been extensively studied in large samples or with large diverse groups of youth experiencing housing insecurity (Eastwood et al., 2019). Gaps remain overall in the literature on the association between social support and homelessness in larger, national samples of diverse MSM.

Although there have been numerous studies conducted examining correlates of housing instability and homelessness among youth experiencing housing instability overall and LGBTQ+ youth who experience housing instability grouped together, there have been no national studies to our knowledge, focusing specifically on youth experiencing housing instability who identify as sexual and gender minority (SGM) men who have sex with men. Housing insecurity among SGM is a large issue facing urban environments like NYC every day. The current study seeks to fill gaps in the social work literature by examining the factors associated with housing instability among a large national cohort of young SGM men who have sex with men experiencing housing instability in order to be able to identify the public health problems needing most attention in this vulnerable population. In this paper, we focus on SGM men having sex with men to learn more about correlates of housing instability in this specific population, to control for confounding variables and identify possible factors that are unique to SGM men having sex with men that might get masked in a more general sample. Our analysis was grounded in social ecological theory (Baral et al., 2013), as we sought to understand multi-level influences on housing insecurity and STI prevention (individual behavioral risk factors including sex work and intimate partner violence and community network factors, like social support).

Methods

Participants and Procedures

The data used in this analysis came from the Together 5000 (T5K) study, which used an internet-based survey to collect data from a U.S. national cohort focused on men having sex with men (MSM) who were HIV vulnerable. Cisgender MSM, trans men, and trans women who have sex with men were also included. Enrollment and research protocols are described elsewhere (Grov et al., 2019; Nash et al., 2019). In 2017–2018, participants were recruited through ads on geosocial networking apps used by MSM. Participants were deemed eligible if they were between the ages of 16 and 49, reported at least two male sex partners in the last 90 days, not taking PrEP, self-reported negative HIV status, and report behavioral risk for HIV (i.e., engaged in receptive condomless anal sex or insertive condomless anal sex or engaged in injection drug use). A total of 8,674 people were eligible to enroll in the study of which 2,228 completed the baseline survey and were between the ages of 16 and 24 years old. All study procedures were approved by the T5K study PI’s Institutional Review Board.

Measures

Main outcome variable

Housing instability, our main outcome variable, was assessed through one question, “Has there been a period of time in your life when you have been unstably housed (including couch surfing)?” Response options ranged from “yes, within the last 5 years”, “yes more than 5 years ago”, and “no”. For the purposes of this analysis, we created a dichotomous housing instability variable, where “yes” indicated lifetime history of housing instability. We hypothesized that housing instability would be associated with increased intimate partner violence (IPV), increased behavioral risk factors for STIs, decreased social support, increased former peer victimization (i.e., bullying), decreased resilience, and decreased LGBT+ support systems.

Hypothesized factors associated with housing insecurity

Based on existing literature on SGM men who have sex with men, we hypothesized factors associated with housing insecurity. STI history was measured by asking participants if they had been diagnosed with a sexually transmitted infection in their lifetimes (yes/no). History of sex work was assessed by asking participants if they have exchanged sex for money or other items in the last three months (yes/no). Health insurance status was assessed with three options (yes/no/I don’t know). Behavioral risk for sexually transmitted infection was measured using six items developed by the T5K study team, (Grov et al., 2020) which asked about engagement in behaviors such as injection drug use, condomless sex, and sharing sex toys within the last 12 months. Participants responded yes or no and the items were summed to create a total risk index (range 0 to 6). Sex work was included in the analysis as its own variable, not a part of this 6-item scale.

Resilience was measured using the Connor-Davidson Resilience Scale (Connor & Davidson, 2003), 10-item version. Responses are rated on a 5-point likert scale, ranging from 0 (not true at all) to 5 (true nearly all the time) and responses are summed, with a total range 0–50. Examples of items are, “I am able to adapt to change” and “I can handle unpleasant feelings” (chronbach alpha = .87). Use of LGBT+ resources was measured using seven items ascertaining how frequently participants visited LGBT+ friendly places, such as houses of worship, coffee shops, and healthcare providers (Cronbach alpha = .69); responses were measured on a 5-point likert scale, ranging from 0 (never) to 4 (more than 10 times), with a range of 0–28. Examples of items were, “In the last 6 months, how often did you visit a nearby LGBT community center?; In the last 6 months, how often did you visit a nearby LGBT+ friendly house of worship?”. Social support was measured using the Multidimensional Scale of Perceived Social Support (Cronbach alpha = .94) (Zimet et al., 1990). There were a total of 12 items, asking participants to rate their agreement on a 6-point Likert scale, ranging from 1 (very strongly disagree) to 6 (very strongly agree) with a range of 12–72.

Intimate partner violence (IPV) was measured using an adaptation of the Revised Conflict Tactics Scale (Cronbach alpha = .91) (Greenwood et al., 2002; Straus et al., 1996). Participants were asked if they experienced any of a range of forms of IPV within the last five years. Twelve items were answered yes or no, and a total score was formed by summing the items, with total range of 0–12. Example items were, “hit with an open fist” and “verbally threatened you in any way”. Former peer victimization was measured using 12 items from the Multidimensional Peer Victimization Scale (Cronbach alpha = .91) (Joseph & Stockton, 2018). Participants were asked to think back to when they were in high school and respond to how often a peer did certain actions to them on a three-point scale, with responses 0 (not at all), 1 (once), and 2 (more than once) with total range 0–24. Example items were, “called me names”, “refused to talk to me”, and “beat me up”.

Sample

For this analysis, we included only participants aged 16 through 24 years old at the time of study enrollment, including those who identified as transgender (n = 2,228).

Analysis

We used descriptive statistics to report the demographic characteristics of the sample and to examine distributions and ensure statistical assumptions were met as necessary. Due to small sample sizes, we included gender in the multi-variable analysis as a dichotomous variable (cisgender male vs. not). We then conducted bivariate analysis using independent t-tests or chi-squared tests with our primary outcome variable (housing instability vs not) and hypothesized associated factors (included former peer victimization, resilience, LGBT+ resource use, health insurance status, IPV score, behavioral risk for sexually transmitted infection, sex work in the past 3 months, STI history, and social support). We then created a multivariable logistic regression model by including all factors hypothesized to be associated with housing instability. A binomial logistic regression was conducted to assess the impact of a number of factors on the likelihood that young SGM men having sex with men (cis gender male vs. not) between the ages of 16 and 24 would report housing instability. Our main hypothesis was that housing instability among young SGM men having sex with men (including Cis gender and transgender men and women) would be associated with increased intimate partner violence (IPV), increased behavioral risk factors for STIs, sex work or exchange in the last 3 months, decreased social support, increased former peer victimization (i.e., bullying), decreased resilience, and decreased LGBT+ support systems.

Results

Sample Characteristics

Table 1 reports demographic data. A total of 2,228 youth and young adults between the ages of 16 and 24 were included in our analysis (26% of the overall T5K sample), 569 (31%) of whom reported a history of housing instability. Our sample was primarily non-white. Among youth experiencing housing instability, 64% were non-white and among those stably housed, 60% were non-white. As per Table 1, the majority of the sample had at least a high school diploma in both groups and most participants were either working full or part time.

Table 1.

Demographic differences between those having experienced housing instability versus not.

Variable Experienced housing instability (n = 569)
n (%)		 Stably housed (n = 1648)
n (%)		 χ2
Gender 41.36*
 Male 520 (91%) 1604 (97%)
 Transfemale 17 (3%) 8 (.5%)
 Transmale 8 (1.4%) 9 (.5%)
 Something else 24 (4.2%) 27 (2%)
Race 12.28**
 White 203 (36%) 662 (40%)
 Black 125 (22%) 258 (16%)
 Latina/o 164 (29%) 493 (30%)
 Multi-racial 77 (14%) 235 (14%)
Education 71.87**
 Less than High School 43 (8%) 83 (5%)
 High School or Equivalent 163 (29%) 348 (21%)
 Some College 184 (32%) 391 (24%)
 Enrolled in College 125 (22%) 539 (33%)
 College degree or higher 54 (9.5%) 287 (17.2%)
Employment 90.13**
 Full time 213 (37%) 641 (39%)
 Part-time (including FT students) 201 (35%) 630 (39%)
 Disabled 9 (1.5%) 7 (.5%)
 Unemployed 146 (25%) 370 (33%)
Health Insurance (yes response) 233 (59%) 857 (74%) 33.10**
Sex work in past 3 mos (yes response) 149 (36%) 179 (15%) 86.93**
Lifetime STI (yes response) 219 (38.5%) 515 (31.3%) 10.01*
Age M = 22 SD = 2.00 M = 21 SD = 2.07
Open in a new tab
*

denotes p < .001;

**

denotes p < .000

Bivariate Results

In bivariate analyses (also in Table 1), those having experienced housing instability were significantly more likely to have also experienced trauma in the form of former peer victimization and reported significantly less social support. Those who reported housing instability were significantly more likely to report present day unemployment, less likely to have a college degree or health insurance, were more likely to have histories of sex work, had significantly higher levels of peer victimization scores, and report more behavioral risk factors for STI as well as a prior STI in their lifetimes. Within the youth experiencing housing instability sample, there were significant gender differences in former peer victimization scores, with trans male MSM reporting higher levels of peer victimization (M = 19.00, SD = 5.74) than participants identifying as male (M = 14.03, SD = 6.77), trans female (18.22, SD = 3.70), or something else (M = 17.33, SD = 5.06).

Similarly, trans male participants reported higher levels of behavioral risk factors for sexually transmitted infections (M = .50, SD = .25) than those identifying as cis-male (M = .22, SD = .15), trans female (M = .29, SD = .16), or something else (M = .23, SD = .16). Trans male participants also reported lower levels of IPV (M = 16.57, SD = 3.69) than participants identifying as male (20.40, SD = 3.76), trans female (M = 19.09, SD = 3.59), or something else (M = 21.05, SD = 3.92). There were no other significant demographic differences. Mean differences and significance levels of scaled items for youth experiencing housing instability versus those who did not report housing instability, are included in Table 2.

Table 2.

Descriptive and Bivariate Associations with Housing Instability

Item (range) Experienced housing instability
m (sd) 		Stably housed
m (sd) 		T (df) p
Resilience (0–50) 28.39 (6.48) 29.06 (5.91) 1.93 (1592) .05
Former peer victimization (0–24) 14.41 (6.69) 10.17 (6.36) −11.06 (1510) .000
GLBT resources (0–28) 3.74 (4.2) 3.11 (3.35) −3.02 (1546) .003
Intimate partner violence (0–12) 20.33 (3.79) 22.47 (2.53) 12.55 (1531) <.001
Behavioral risk factors for sexually transmitted infection (0–6) .23 (.16) .18 (.12) −5.95 (1531) .000
Social support (12–72) 46.44 (13.98) 51.75 (12.84) 6.88 (1530) .000
Open in a new tab
**

for all scales, higher numbers indicate higher levels of the variable

Multivariable Analysis

The logistic regression model was statistically significant, χ2 (11, N = 1462) = 270.10, p = .001, indicating that the model explained 25% (Nagelkerke R2) of the variance in housing instability and correctly classified 79.5% of the cases. As shown in Table 3, seven variables made a statistically significant contribution in the model at the .05 significance level (former peer victimization, gender, age, sex work, IPV, social support, and health insurance status). The strongest predictor of housing instability in our sample reporting sex work in the last three months recorded an odds ratio of 2.76, indicating that young people who reported participating in sex work in the last three months were almost three times as likely to report housing instability. Similarly, behavioral risk factors for sexually transmitted infection (i.e., condomless sex and injectable drug use) recorded an odds ratio of 2.57, but with a significance level of p = .07. This finding, approaching statistical significance, indicated that individuals with higher levels of behavioral risk for sexually transmitted infection were more than 2.5 times more likely to report housing instability.

Table 3.

Logistic regression table

B SE Wald df p Odds ratio 95% CI for Odds Ratio
Resilience .003 .01 .06 1 .808 1.00 .98 1.03
Former peer victimization .07 .01 41.46 1 .000 1.07 1.05 1.10
GLBT resources .02 .02 .96 1 .327 1.02 .98 1.06
Behavioral risk factors for STI 1.13 .52 4.76 1 .029 3.09 1.12 8.50
IPV −.12 .02 27.20 1 .000 .89 .85 .93
Social support −.02 .01 12.16 1 .000 .98 .97 .99
Sex work .97 .15 41.65 1 .000 2.64 1.96 3.54
Health insurance .51 .15 10.88 1 .001 1.66 1.23 2.24
STI lifetime .33 .19 3.03 1 .08 1.40 .96 2.04
Constant .60 .68 .77 1 .38 1.82
Open in a new tab

Discussion

This study was one of the first to investigate STI risk and infection in the context of housing instability in a large U.S. national sample of young sexual and gender minority (SGM) men having sex with men. Not surprisingly, we observed that variables at multiple levels of the social ecological model influenced housing status. At the individual level, we found that engaging in sex work and behavioral risk factors for STI were two of the strongest variables associated with housing instability in our sample. Our finding related to behavioral risk factors for STI should be considered with caution, as it was approaching statistical significance with a p level of .07. Further investigation of this finding is warranted. Trauma in the form of former peer victimization was also a significant co-variate in our model, particularly for trans-identified men and women. And finally, IPV was also a significant co-variate in our model, though not in the hypothesized direction. SGM young men having sex with men who experienced housing instability were less likely to report history of IPV. This may be an issue specific to this group of diverse youth who experience housing instability and warrants further exploration. Young SGM men having sex with men might be staying in fraught, potentially violent relationships to avoid housing instability and related additional stigmas. Intimate partner violence is a leading cause for homelessness and housing instability and survivors stay in relationships with IPV to avoid financial instability. The cycle of abuse also includes financial abuse and isolation, leading survivors to feel no choice but to stay (Postmus et al., 2012). Hesitancy in reporting IPV, specific to this group of diverse youth who experience housing instability, also warrants further exploration.

As hypothesized, our findings that SGM who had sex with men and experienced housing instability were more likely to engage in behaviors that increased vulnerability for STIs and sex work, was consistent with existing literature on STI risk and the general population of youth experiencing housing instability, including those who identify LGBTQ+ (Eastwood et al., 2019; Heerde & Hemphill, 2016; Petry et al., 2022). MSM, including transgender men and women, who experience housing instability, may be more likely to engage in sex work or exchange-sex for basic needs such as food or shelter. Addressing structural barriers to housing and other basic needs, like food insecurity, has the potential to reduce vulnerability to STIs, and merits examining.

Our findings were also consistent with the literature around youth experiencing housing instability and trauma which indicate trauma is highly associated with homelessness and housing instability (Drescher et al., 2019; Eastwood et al., 2019; Wong et al., 2016). However, former peer victimization is a new angle that has not been studied as extensively in this population. This could be related to intersectionality and sexual and gender minority identification because youth who identify as SGM typically experience more bullying and victimization from peers and others (Greenwood et al., 2002; Heerde & Hemphill, 2016). Participating in sex work, a risk factor for STI, is also highly correlated with trauma and housing instability among youth in the literature and our findings support this (Halverson et al., 2022; Srivastava et al., 2019). Youth who experience housing instability and particularly SGM youth experiencing housing instability who have sex with men are a marginalized population with multiple intersecting stigmas, including housing related stigma (Sisselman-Borgia et al., 2018, 2022). They may be more likely to be placed in situations that lead them to participate in sex work because of housing problems and related structural inequities that lead to housing instability and homelessness.

At the community level and related to peer victimization, young SGM having sex with men who experienced housing instability reported less social support than those who did not report housing insecurity. This was consistent with the literature, which indicates that social support is a protective factor for youth, including young people experiencing housing instability (Yoshioka-Maxwell & Rice, 2019). Young MSM with adequate social support, including peers and adults might have more resources and be less likely to experience housing insecurity or feel pressured financially to engage in sex work or sex bartering for basic needs.

Implications

Our findings indicated that having experienced housing instability was associated, albeit marginally, with sexually transmitted infections (STIs) and related behavioral risk factors in a large U.S. national cohort of young sexual and gender minority (SGM) men having sex with men. Providing adequate social support is essential, as young SGM who have sex with men are vulnerable due to multiple intersecting marginalized identities and those who also experience homelessness are at an even higher risk (Griffin et al., 2019). We found that SGM who had sex with men who experienced housing instability were less likely to have social support. Mentoring and support from adult role models, including social workers who have adequate time to spend cultivating a relationship will be protective of future success for youth experiencing housing instability (Dang et al., 2014; Rice et al., 2023; Sisselman-Borgia, 2021). It may be helpful to consider matching young SGM who have sex with men with practitioners and mentors who are also sexual or gender minorities to help address past and current trauma and assist with accessing needed resources (Forbes & Venema, 2022).

It is important to educate social workers and other interdisciplinary health care professionals about the risk and protective factors discovered in our analysis. Developing and implementing training programs that target social workers across medical and inter-disciplinary settings, including with the legal/justice and education systems is also a necessity (Narendorf et al., 2020). Clinicians can provide support groups for those involved in sex work to address sexual health safety and social determinants of health to mitigate for those who engage in sex work. For example, assisting with finding housing and financial assistance and food insecurity. Street outreach efforts should include finding youth experiencing housing instability who are doing sex work and offering services where they are (Weare, 2021). The justice system should support urban social workers who are professionally trained to implement programming targeting youth experiencing housing instability who enter the system, knowing their vulnerabilities and provide support rather than further criminalization. Monies spent on the justice system and policing could be re-routed to support for youth experiencing housing instability and longer term programs that offer adult guidance and mentoring that includes concrete support for housing and food, training for jobs and school (Petrosino et al., 2022; Smith, 2025). Programs must include funds for staff to help young SGM men having sex with men experiencing housing instability develop coping skills to address trauma that is often ongoing due to their life circumstances while helping them to obtain and maintain safe independent housing with supportive services and a financial safety net (Beker & DeAngelis, 2021). Trauma and PTSD diagnoses will follow people for years and require long term care and help while in recovery (Weber et al., 2021).

Implications for Urban Social Work

This work has implications specifically for urban social workers. Social workers should implement multi-level interventions, addressing issues at the individual and community levels. Urban centers are often hubs for sexual and gender minorities, including men who have sex with men, indicating that the implications of our findings are important for urban social workers. Social work clinicians have the opportunity to work with SGM populations in many different health-related settings, including but not limited to hospitals and addiction treatment centers (Lombardi et al., 2024). The young SGM men having sex with men in our sample experiencing housing instability were more likely to have histories of sex work and were more vulnerable to behavioral risk factors to STI, like IDU. Screening young people, particularly those who identify as SGM is important in identifying adverse impacts of social determinants of health, like homelessness or housing instability that might go un-noticed. Also important to consider, is how to provide housing resources and support to young people who do not have adequate social support. Affordable housing crises in urban centers are abundant in recent times (Keene & Blankenship, 2023). Urban social workers should be trained in all settings about available resources and support services for housing instability. Each city and urban area has its own networks. Urban social workers should have direct access to services and organizations that address housing insecurity and related problems. Providing support for social determinants of health, like housing, provides support for health, well-being, and social mobility of our newest generations (Kushel et al., 2006). Medical doctors and social workers often collaborate in discharge planning of their patients (Ashcroft et al., 2023). This collaboration must extend to the preventive realm. Social workers should be placed in all primary health centers and schools and should be trained to provide housing resource support. Interdisciplinary professionals should advocate for social workers to have active roles in the treatment of their clients/consumers and should become involved in the development of universal screening procedures, particularly for those most at risk, such as young SGM having sex with men.

Limitations

Although this was a large U.S. national sample, it was limited to SGM men who were having sex with men, leaving out youth experiencing homelessness who identify as cisgender female and heterosexual males. At least half of the population of youth who experience housing instability, and in some cases more depending on location, identify as LGBTQ+ so the large sample used in this study was meaningful despite its limitations. Also, the data used for this analysis were cross sectional, limiting the ability to make causal inferences. Finally, the data used in this analysis were self-report and does not include objective measures of observation.

Conclusion and Future Directions

There are opportunities for further research to learn more about larger samples of youth experiencing housing instability who identify as female and heterosexual male. It is essential to understand the largest co-variates of housing insecurity, including STI, among youth across the country and more globally in order to solve this important public health issue. We will not solve large public health issues including the spread of sexually transmitted infections, unless we address social determinants of health, such as housing insecurity. We should conduct further research, particularly across different cities in multiple geographic regions, to learn more about STIs in particular among this group, and to learn more about why young people experiencing housing instability more broadly are not engaging in preventive measures.

Future research also should focus on developing interventions that involve collaborative inter-disciplinary efforts to improve access to housing and other basic needs for these vulnerable populations, particularly in urban areas. Navigating services and resources in different sized urban areas is an important consideration for urban social workers. Learning collaboratives across cities could come together to develop guides for resource navigation and templates for connecting networks. Interventions that reduce stigma around sexual identity and STIs are important for the general public and also to address peer-related bullying. Our findings point to this form of victimization as a significant issue to young SGM men having sex with men experiencing housing instability. Studying the implications of mental health and mental health disparities related to housing insecurity, stigma, and trauma is also crucial to understanding how to engage youth in STI prevention. Finally, future interventions must address the structural inequities that are driving the housing shortages and lack of resources for young people who experience housing instability or homelessness (Olivet et al., 2021). Finding remedies to address health equity and financial insecurity are paramount in communities that have been marginalized because of racial and ethnic identification, socioeconomic status, or other marginalized identities.

In conclusion, addressing factors associated with housing insecurity among one of the most vulnerable groups of adolescents, youth experiencing homelessness and housing insecurity, is crucial to public health and to resolving social determinants of health. SGM men who have sex with men are particularly vulnerable as they experience intersecting stigmas as youth experiencing housing instability, SGM, and often times marginalized race or ethnicity. Using a large U.S. national sample, we have identified several prominent problems that should be imminently addressed in this group, including STI treatment, support for youth who engage in sex work, peer victimization and bullying, and behavioral issues associated with sexually transmitted infection (i.e., injectable drug use, condomless sex). Additionally, improving social support from peers and adult role models is important. Finally, we should further investigate IPV and examine why young SGM men who have sex with men who were stably housed were more likely to experience IPV.

Table 4.

Multivariate associations with youth housing instability

Adjusted Odds Ratio (AOR) AOR 95% CI Scale range, if applicable
Resilience 1.00 .98 1.03 0–50
Former peer victimization 1.07 1.05 1.10 0–24
GLBT resources 1.00 .96 1.04 0–28
Behavioral risk factors for STI 2.57 .922 7.18 0–6
IPV scale .89 .85 .93 0–12
Social support .98 .97 .99 1–72
Sex work (1 = yes) 2.76 2.04 3.74
Health insurance (1 = yes) 1.63 1.21 2.21
STI lifetime (1 = yes) 1.21 .82 1.78
Age in years 1.13 1.05 1.22
Cisgender male (1 = yes) .34 .18 .63
Open in a new tab

Acknowledgements:

Special thanks to additional members of the T5K study team: Matthew Stief, Drew Westmoreland, Alexa B. D’Angelo, Chloe Mirzayi, Michelle Dearolf, Pedro B. Carneiro, David Pantalone, Adam W. Carrico, Sarit A. Golub, Sabina Hirshfield, Donald R. Hoover, Denis Nash, Gregorio Millett, & Sarah Kulkarni. Thank you to the program staff at NIH: Gerald Sharp, Sonia Lee, Lori Zimand, and Michael Stirratt. And thank you to the members of our Scientific Advisory Board: Michael Camacho, Demetre Daskalakis, Claude Mellins, and Milo Santos. While the NIH financially supported this research, the content is the responsibility of the authors and does not necessarily reflect official views of the NIH.

Funding:

Together 5,000 (T5K) was funded by the National Institutes of Health (UH3 AI 133675 - PI Grov). Other forms of support include the CUNY Institute for Implementation Science in Population Health, the Einstein, Rockefeller, CUNY Center for AIDS Research (ERC CFAR, P30 AI124414). D.A.W. was supported, in part, by a career development award (K01 AA 029047).

Footnotes

There are no potential conflicts of interest to disclose, real or perceived for any of the authors.

Contributor Information

Amanda Sisselman-Borgia, CUNY Lehman College Department of Social Work, 250 Bedford Park Blvd West, Bronx, NY 10468.

Viraj V Patel, Albert Einstein College of Medicine, Division of General Internal Medicine, 1300 Morris Park Avenue, Bronx, NY 10457.

Christian Grov, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom., New York, NY, 10027 United States.

References

  1. Ashcroft R, Lam S, Feryn N, Sur D, Abudiab S, Sheffield P, Rayner J, Mehta K, & Brown J (2023). A mixed-methods examination of the role of social work in primary care teams in Ontario, Canada. Healthcare Services, Delivery, and Financing. NAPCRG 51st Annual Meeting - Abstracts of Completed Research 2023. 10.1370/afm.22.s1.5171 [DOI] [Google Scholar]
  2. Baral S, Logie CH, Grosso A, Wirtz AL, & Beyrer C (2013). Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health, 13(1), 482. 10.1186/1471-2458-13-482 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Beker J, & DeAngelis T (2021). Life skill development and its impact on perceived stress, employment and education pursuits: A study of young adults with a history of homelessness and trauma. Student Journal of Occupational Therapy. 10.46409/001.XVOH2735 [DOI] [Google Scholar]
  4. Cdc. (2016). HIV surveillance report: Diagnoses of HIV infection in the United States and dependent areas. [Google Scholar]
  5. Connor KM, & Davidson JRT (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. 10.1002/da.10113 [DOI] [PubMed] [Google Scholar]
  6. Côté P-B (2019). Sexual Health Services for Homeless Youth: A Qualitative Analysis of their Experiences. Journal of Social Service Research, 45(3), 429–443. 10.1080/01488376.2018.1480568 [DOI] [Google Scholar]
  7. Dang MT, Conger KJ, Breslau J, & Miller E (2014). Exploring Protective factors among homeless youth: the role of natural mentors. Journal of Health Care for the Poor and Underserved, 25(3), 1121–1138. 10.1353/hpu.2014.0133 [DOI] [PubMed] [Google Scholar]
  8. Drescher CF, Griffin JA, Casanova T, Kassing F, Wood E, Brands S, & Stepleman LM (2019). Associations of physical and sexual violence victimisation, homelessness, and perceptions of safety with suicidality in a community sample of transgender individuals. Psychology & Sexuality, 1–12. 10.1080/19419899.2019.1690032 [DOI] [Google Scholar]
  9. Eastwood EA, Nace AJ, Hirshfield S, & Birnbaum JM (2019). Young Transgender Women of Color: Homelessness, Poverty, Childhood Sexual Abuse and Implications for HIV Care. AIDS and Behavior. 10.1007/s10461-019-02753-9 [DOI] [PubMed] [Google Scholar]
  10. Forbes C, & Venema K (2022). LGBTQ+ youth experiencing homelessness. Mental Health Practice with LGBTQ+ Children, Adolescents, and Emerging Adults in Multiple Systems of Care. https://books.google.com/books?hl=en&lr=&id=udKUEAAAQBAJ&oi=fnd&pg=PA211&dq=lgbtq+youth+mentors+homelessness&ots=YHHRJQYFby&sig=thHdJhHjJRhs-hJkHbQ3itYlmnU [Google Scholar]
  11. Greenwood GL, Relf MV, Huang B, Pollack LM, Canchola JA, & Catania JA (2002). Battering victimization among a probability-based sample of men who have sex with men. American Journal of Public Health, 92(12), 1964–1969. 10.2105/ajph.92.12.1964 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Griffin AM, Sulkowski ML, Bámaca-Colbert MY, & Cleveland HH (2019). Daily social and affective lives of homeless youth: What is the role of teacher and peer social support? Journal of School Psychology, 77, 110–123. 10.1016/j.jsp.2019.09.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Grov C, Westmoreland DA, Carneiro PB, Stief M, MacCrate C, Mirzayi C, Pantalone DW, Patel VV, & Nash D (2019). Recruiting vulnerable populations to participate in HIV prevention research: findings from the Together 5000 cohort study. Annals of Epidemiology, 35, 4–11. 10.1016/j.annepidem.2019.05.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Grov C, Westmoreland DA, Carrico AW, & Nash D (2020). Are we on the precipice of a new epidemic? Risk for hepatitis C among HIV-negative men-, trans women-, and trans men- who have sex with men in the United States. AIDS Care, 32(sup2), 74–82. 10.1080/09540121.2020.1739204 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, & Futterman D (2019). Youth at risk of HIV: the overlooked US HIV prevention crisis. The Lancet. HIV, 6(5), e275–e278. 10.1016/S2352-3018(19)30037-2 [DOI] [PubMed] [Google Scholar]
  16. Hail-Jares K, Vichta-Ohlsen R, Butler TM, & Byrne J (2021). Queer homelessness: the distinct experiences of sexuality and trans-gender diverse youth. Journal of LGBT Youth, 1–25. 10.1080/19361653.2021.199081736855462 [DOI] [Google Scholar]
  17. Halverson M, Hatchimonji DR, Treglia D, Flatley CA, Herbers JE, & Cutuli JJ (2022). Risky sexual behavior and STI testing among teens experiencing homelessness. Children and Youth Services Review, 139(106538), 106538. 10.1016/j.childyouth.2022.106538 [DOI] [Google Scholar]
  18. Hatchimonji, Flatley, Treglia, & Cutuli. (2021). High School Students Experiencing Homelessness: Findings from the 2019 Youth Risk Behavior Surveillance System (YRBSS). https://files.eric.ed.gov/fulltext/ED616088.pdf [Google Scholar]
  19. Heerde JA, & Hemphill SA (2016). Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth: A Systematic Review of Associations With Substance Use. Trauma, Violence & Abuse, 17(5), 468–489. 10.1177/1524838015584371 [DOI] [PubMed] [Google Scholar]
  20. Joseph S, & Stockton H (2018). The multidimensional peer victimization scale: A systematic review. Aggression and Violent Behavior, 42, 96–114. 10.1016/j.avb.2018.07.009 [DOI] [Google Scholar]
  21. Keene DE, & Blankenship KM (2023). The affordable rental housing crisis and population health equity: A multidimensional and multilevel framework. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 100(6), 1212–1223. 10.1007/s11524-023-00799-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kidd SA, Vitopoulos N, Frederick T, Daley M, Peters K, Clarc K, Cohen S, Gutierrez R, Leon S, & McKenzie K (2019). Peer support in the homeless youth context: Requirements, design, and outcomes. Child & Adolescent Social Work Journal: C & A, 36(6), 641–654. 10.1007/s10560-019-00610-1 [DOI] [Google Scholar]
  23. Kushel MB, Gupta R, Gee L, & Haas JS (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine, 21(1), 71–77. 10.1111/j.1525-1497.2005.00278.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Lombardi BM, de Saxe Zerden L, & Fraher E (2024). Varying estimates of social workers in the United States: Which data source to use? Medical Care Research and Review: MCRR, 81(5), 408–416. 10.1177/10775587241257983 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. McCann E, & Brown M (2019). Homelessness among youth who identify as LGBTQ+: A systematic review. Journal of Clinical Nursing, 28(11–12), 2061–2072. 10.1111/jocn.14818 [DOI] [PubMed] [Google Scholar]
  26. Middleton J, Edwards E, Roe-Sepowitz D, Inman E, Frey LM, & Gattis MN (2022). Adverse childhood experiences (ACEs) and homelessness: A critical examination of the association between specific ACEs and sex trafficking among homeless youth in kentuckiana. Journal of Human Trafficking, 1–14. 10.1080/23322705.2021.2020061 [DOI] [Google Scholar]
  27. Morton MH, Dworsky A, Matjasko JL, Curry SR, Schlueter D, Chávez R, & Farrell AF (2018). Prevalence and correlates of youth homelessness in the United States. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 62(1), 14–21. 10.1016/j.jadohealth.2017.10.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Morton MH, Kugley S, Epstein R, & Farrell A (2020). Interventions for youth homelessness: A systematic review of effectiveness studies. Children and Youth Services Review, 116, 105096. 10.1016/j.childyouth.2020.105096 [DOI] [Google Scholar]
  29. Narendorf SC, Brydon DM, Santa Maria D, Bender K, Ferguson KM, Hsu H-T, Barman-Adhikari A, Shelton J, & Petering R (2020). System involvement among young adults experiencing homelessness: Characteristics of four system-involved subgroups and relationship to risk outcomes. Children and Youth Services Review, 108(104609), 104609. 10.1016/j.childyouth.2019.104609 [DOI] [Google Scholar]
  30. Nash D, Stief M, MacCrate C, Mirzayi C, Patel VV, Hoover D, Pantalone DW, Golub S, Millett G, D’Angelo AB, Westmoreland DA, & Grov C (2019). A Web-based study of HIV prevention in the era of pre-exposure prophylaxis among vulnerable HIV-negative gay and bisexual men, transmen, and transwomen who have sex with men: Protocol for an observational cohort study. JMIR Research Protocols, 8(9), e13715. 10.2196/13715 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. New York City Department of Youth and Community Development. (2024). New York City Youth Count. City of New York. [Google Scholar]
  32. Olivet J, Wilkey C, Richard M, Dones M, Tripp J, Beit-Arie M, Yampolskaya S, & Cannon R (2021). Racial Inequity and Homelessness: Findings from the SPARC Study. The Annals of the American Academy of Political and Social Science, 693(1), 82–100. 10.1177/0002716221991040 [DOI] [Google Scholar]
  33. Ormiston CK (2022). LGBTQ Youth Homelessness: Why We Need to Protect Our LGBTQ Youth. LGBT Health, 9(4), 217–221. 10.1089/lgbt.2021.0324 [DOI] [PubMed] [Google Scholar]
  34. Petering R (2016). Sexual Risk, Substance Use, Mental Health, and Trauma Experiences of Gang-Involved Homeless Youth. Journal of Adolescence, 48, 73–81. 10.1016/j.adolescence.2016.01.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Petrosino A, Fronius T, & Zimiles J (2022). Alternatives to youth incarceration. In Handbook of Issues in Criminal Justice Reform in the United States (pp. 685–700). Springer International Publishing. 10.1007/978-3-030-77565-0_34 [DOI] [Google Scholar]
  36. Petry L, Hill C, Milburn N, & Rice E (2022). Who Is Couch-Surfing and Who Is on the Streets? Disparities Among Racial and Sexual Minority Youth in Experiences of Homelessness. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 70(5), 743–750. 10.1016/j.jadohealth.2021.10.039 [DOI] [PubMed] [Google Scholar]
  37. Postmus JL, Plummer S-B, McMahon S, Murshid NS, & Kim MS (2012). Understanding economic abuse in the lives of survivors. Journal of Interpersonal Violence, 27(3), 411–430. 10.1177/0886260511421669 [DOI] [PubMed] [Google Scholar]
  38. Ragavan MI, Culyba AJ, Shaw D, & Miller E (2020). Social Support, Exposure to Parental Intimate Partner Violence, and Relationship Abuse Among Marginalized Youth. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 67(1), 127–130. 10.1016/j.jadohealth.2020.01.020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Rice E, Thompson N, Onasch-Vera L, Petry L, Petering R, Casey E, Cooper T, DiBattiste M, & McAlpin F (2023). Ending youth homelessness is about relationships: The importance of drop-in centers and staff to youth experiencing homelessness. Children and Youth Services Review, 154(107125), 107125. 10.1016/j.childyouth.2023.107125 [DOI] [Google Scholar]
  40. Sisselman-Borgia A (2021). An adapted life skills empowerment program for homeless youth: Preliminary findings. Child & Youth Services, 42(1), 43–79. 10.1080/0145935x.2021.1884542 [DOI] [Google Scholar]
  41. Sisselman-Borgia A, Budescu M, & Torino G (2018). The association of Racial and homelessness microaggressions and physical and mental health in a sample of homeless youth. Urban Social Work, 2(2), 139–158. 10.1891/2474-8684.2.2.139 [DOI] [Google Scholar]
  42. Sisselman-Borgia A, Menard L, Budescu M, & Torino G (2022). Differences in Discrimination Experiences Among Homeless and Nonhomeless Youth. Urban Social Work, 6(1), 69–83. https://connect.springerpub.com/content/sgrusw/6/1/69.abstract [Google Scholar]
  43. Smith L (2025). Reimagining alternative to incarceration programs for youth within the criminal legal system. Journal of Forensic Social Work. 10.15763/issn.1936-9298.2025.9.1.42-57 [DOI] [Google Scholar]
  44. Srivastava A, Rusow JA, Holguin M, Semborski S, Onasch-Vera L, Wilson N, & Rice E (2019). Exchange and Survival Sex, Dating Apps, Gender Identity, and Sexual Orientation Among Homeless Youth in Los Angeles. The Journal of Primary Prevention, 40(5), 561–568. 10.1007/s10935-019-00561-4 [DOI] [PubMed] [Google Scholar]
  45. Standley CJ, & Foster-Fishman P (2021). Intersectionality, social support, and youth suicidality: A socioecological approach to prevention. Suicide & Life-Threatening Behavior, 51(2), 203–211. 10.1111/sltb.12695 [DOI] [PubMed] [Google Scholar]
  46. Straus MA, Hamby SL, BONEY-McCOY S, & Sugarman DB (1996). The Revised Conflict Tactics Scales (CTS2): Development and Preliminary Psychometric Data. Journal of Family Issues, 17(3), 283–316. 10.1177/019251396017003001 [DOI] [Google Scholar]
  47. Tyler KA, & Schmitz RM (2018). Bullying at School and on the Street: Risk Factors and Outcomes Among Homeless Youth. Journal of Interpersonal Violence, 0886260518794024. 10.1177/0886260518794024 [DOI] [PubMed] [Google Scholar]
  48. Weare C (2021). Housing outcomes for homeless individuals in street outreach compared to shelter. Journal of Poverty, 25(6), 543–561. 10.1080/10875549.2020.1869664 [DOI] [Google Scholar]
  49. Weber M, Schumacher S, Hannig W, Barth J, Lotzin A, Schäfer I, & Kleim. (2021). Long-term outcomes of psychological treatment for posttraumatic stress disorder: A systematic review and meta-analysis. Psychological Medicine, 51(9), 1420–1430. https://www.cambridge.org/core/journals/psychological-medicine/article/longtermoutcomes-of-psychological-treatment-for-posttraumatic-stress-disorder-a-systematicreview-and-metaanalysis/618318B2D6266D011900EDAA160A03DB [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Wong CF, Clark LF, & Marlotte L (2016). The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth. Journal of Interpersonal Violence, 31(5), 831–854. 10.1177/0886260514556770 [DOI] [PubMed] [Google Scholar]
  51. Yoshioka-Maxwell A, & Rice E (2019). Exploring the Relationship Between Foster Care Experiences and HIV Risk Behaviors Among a Sample of Homeless Former Foster Youth. AIDS and Behavior, 23(3), 792–801. 10.1007/s10461-019-02417-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Zimet GD, Powell SS, Farley GK, Werkman S, & Berkoff KA (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 55(3–4), 610–617. 10.1080/00223891.1990.9674095 [DOI] [PubMed] [Google Scholar]

RESOURCES