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NEW AT-RISK POPULATION IN CHICAGO |
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Since the earliest days of the epidemic, people with AIDS and those suspected of being infected with HIV have been subjected to social ostracism and discrimination. Originally known as the “gay man’s disease,” AIDS has provided a homophobic population with a symbolic hook upon which to hang their preexisting antigay attitudes; a means of expressing disapproval for an overtly sexual and drug induced subculture. Despite evasion and contradiction at the highest levels of medical, political, and media establishments, many individuals within the gay community struggled to alert the nation to the enormity of the disease (1). Having contributed greatly to the guidelines for prevention, treatment, and care of people living with HIV/AIDS, when the national government finally started paying attention, homosexuals who used drugs were the first to receive individualized care. Today, little has changed. Adolescents, particularly those of color, represent the fastest growing demographic group for new HIV infections in the United States (2). Nearly 50 percent of all new HIV infections are among people under the age of 25, and yet, the national cumulative AIDS rates for youth between 13 to 24 years of age is very low- roughly 11 cases per 100,000 people in 1999 (3). This discrepancy between rates of HIV and AIDS suggests that the problem is a recent one- most adolescents currently diagnosed with HIV have yet to progress to an advanced stage. In Chicago, infected youth are clustered around distinct high-risk groups- specifically Englewood- a black community defined by poverty and low income, putting the people at risk for homelessness (4). According to the self sufficiency standard, a family of one adult and two children would need to earn $ 38,281 a year to pay for living expenses without government assistance; the mean family income for this area is $18.955 with a mean public assistance income of 2,718 (5). According to Chicago Coalition of Homeless, the great majority of homeless youth come from families suffering from similar economic instability (6). Those facing homelessness shoulder a highly disproportionate burden of the AIDS epidemic in Chicago because of heightened risk-related behavior for HIV infection (7). Adolescents on the streets are more susceptible to high levels of sexual activity, unprotected sexual intercourse, and homosexual or bisexual activity in males (8), resulting from limited education, lack of marketable job skills, and generalized instability-all heavily associated with homelessness in itself (9). In Chicago, nearly half of those interviewed in a CCH study of unaccompanied homeless youth reported they hadn’t graduated high school, while 91.7 percent of the unaccompanied homeless youth in Chicago reported having sex (10). Not only are these youth at greater risk for having multiple partners, but also buying condoms may not be a priority for many, especially if they are concerned about how they are going to pay for their next meal or find a safe place to sleep for the night (11). The majority of homeless youth in Chicago reported having 3 sexual partners within one year, while more than 20 percent reported never using a condom as protection (12). In these populations, there may be a low seroprevalence of current AIDS cases, but there are incredibly high rates of HIV risk behavior among young men for which targeted interventions are necessary (13). A recent study conducted in New York indicates similar trends in the particular sexual risk behaviors of this homeless population. While both cities differ geographically, Chicago and New York are demographically similar in homeless counts and HIV/AIDS at risk populations (14 CITE). In a 1998 New York study, youths having unprotected sex and youths having multiple partners was significantly higher for older groups aged 19-23 (15), while youths aged 22 to 23 were currently engaged in drug injection: two attributes that had originally placed homosexual communities at risk for contraction. Homeless youths, therefore, are perhaps particularly vulnerably because such a high proportion of them “engage in one or both of these risk behaviors with one or both of these two populations with high background seroprevalence” (16). Chicago youths, too, are not exempt from risks taken by the adult population attributed to high rates of MSM and injection drug use, characteristics defining particular neighborhoods in the city (17). A quarter century into the epidemic, the AIDS response in Chicago exists at a standstill. While the government has increased funding towards the development of AIDS programs targeting the new at-risk population of homeless youth in recent years, the barriers to adherence among homeless youth has been largely overlooked. Currently in Chicago, the highest targeted population is youth between ages 18-21, with two-thirds of service providers in Chicago only offering services to youth if they were homeless. The State of Illinois spent 4.17 million on programs (18) specifically designed for homeless youth and served 3,092 in Chicago (19). However, with an estimated 8,991 youth who experienced chronic homelessness in 2004, these programs are not serving the needs of all youth on the street (20). Not only do many infected adolescents remain unidentified due to low rates of testing (21), but among those served, the majority of unaccompanied homeless youth are not adhering to complex anti-HIV medication regimens that are available in institutionalized clinics (22). REASONS FOR NON-ADHERENCE AMONG HOMELESS YOUTH
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