Topic Miami Dade County HIV Seroprevalence and risk behavior among clients

Topic: Miami Dade County HIV Seroprevalence and risk behavior among clients.”

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Review and discuss the methods of those 5 articles .
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327
Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 82, No. 2,
doi:10.1093/jurban/jti056
?  The Author 2005. Published by Oxford University Press on behalf of the New York Academy of Medicine. All rights
reserved. For permissions, please e-ma il: journals.permissions@oupjournals.org
Advance Access publication May 25, 2005
The Miami, Florida, Young Men’s Survey: HIV
Prevalence and Risk Behaviors Among Urban
Young Men Who Have Sex with Men Who Have
Ever Runaway
Marlene LaLota, Bonnie W. Kwan, Melinda Waters,
Leticia E. Hernandez, and Thomas M. Liberti
ABSTRACT Youth in urban areas with a history of running away from home often have
special needs. Importantly, ri sk factors for HIV/AIDS might  be associated with such a
history. We assessed the association between having a history of running away from
home and the occurrence of HIV infection and risk behavior among young men who
have sex with men (YMSM), aged 15–22 years. A cross-se ctional epidemiologic and
behavioral survey was conducted between 1995 and 1996 in Miami, Florida, as part of
a national Young Men’s Survey. Of 488 YMSM, the prevalence of HIV infection
among those with a history of running  away from home was 10.5% (adjusted oIDs
ratio= 3.4; 95% CI 1.5–7.8). YMSM who had  ever run away were more likely to be
HIV infected, be out of school, and have ever had vaginal or anal sex with females,
been forced to have sex, injected drugs, and used need les for self-tattooing or body
piercing. The prevalence of HIV infection and associated risk behaviors among
runaways was high, highlightin g the ongoing need for prevention and social support
services for youth with a history of running away from home.
KEYWORDS HIV, Risk factor, Runaway, STD, Young men who have sex with men.
INTRODUCTION
It is estimated that up to 1.5 million young people run away from or are forced out
of their homes annually, and approximately 200,000 each year are homeless and
living on the streets nationwide.
1
A study of a nationally  representative sample of
youth indicated that 7.6% had experienced at least one night of homelessness over
a 12-month period.
2
In 1999, 20 Florida homeless coalitions reported that there
were at least 52,537 homeless persons in the state on any given day and that 25%
of them were children less than 18 years of age.
3
Most of the homeless children
were from urban areas.
Youth run away from home for a variety of reasons. Homelessness in Florida
has been linked to family disintegration, alcoholism, drug abuse, mental illness,
poverty, unemployment, and school failure or lack of education.
2
Previous national
or city-specific studies have indicated that homeless and runaway youth engaged in
Mrs. LaLota, Kwan, Waters, Hernandez, and Mr. Liberti are with the Florida Department of Health,
Tallahassee, Florida.
Correspondence: Marlene LaLota, MPH, Early Intervention Section Administrator, Florida Department
of Health, 4052 Bald Cypress Way, Bin A09,  Tallahassee, FL 32399-1715. (E-mail: marlene_lalota@
doh.state.fl.us)
328 LALOTA ET AL.
risky sexual and drug use behaviors that placed them at high risk for HIV infection
or other sexually transmitted diseases (STD).
4–15
For instance, a na tionally represen-tative study reported that 28% of street youth and 10% of shelter youth engaged in
“survival sex” in exchange for shelter, food, drugs, or money to meet subsistence
needs.
5
Another study conducted among a homeless cohort in Miami identified
male-to-male sex, drug injection, sex with high-risk partners, and sexual exchange
behaviors to be strongly associated with HIV seropositivity.
16

Although numerous reports have assesse d HIV prevalence and risk behaviors
among runaway youth, to our knowledge, there have been no reports that examine
how having a history of running away from  home correlates with these characteristics.
This study examines how a history of running away from home is associated with
the prevalence of HIV infection and sexual  and drug-use behaviors, specifically,
among young men who have sex with men (YMSM) in Miami.
MATERIALS AND METHODS
Sampling
The Young Men’s Survey (YMS) in Miami wa s part of a nation al cross-sectional
epidemiologic and behavioral survey conducted from 1994 through 1998 in seven
metropolitan US cities.
17
The purpose of the survey was to determine the prevalence
of HIV, hepatitis B, syphilis infection, and HIV-related risk behaviors among
YMSM. Young men who were 15–22 years of age and residents of Miami-Dade or
Broward County (the Miami and Fort Lauderdale metropolitan statistical areas,
respectively) were eligible to participate. Details of the venue-based sampling design
have been discussed elsewhere.
18
Briefly, identification of potential venues frequented
by YMSM was extensively researched through interviews with public health profes-sionals, community informants, and focus groups of YMSM. Public venues
included, but were not limited to, bars, dance clubs, health clubs, public street loca-tions, and sex establishments. Extensive enumerations of young men attending these
venues were then conducted to develop  sampling frames of venues and four-hour
time periods when a minimum of seven eligible men might be encountered.
During each month, between 12 and 16 venues and daytime periods were
randomly selected and scheduled on a calendar for sampling events in the upcoming
month. The venues in the sampling frames were updated monthly. During sampling
events, young men who entered defined ar eas at each venue were counted and
approached for enrollment using systemic sampling. Sexual identity and sexual ori-entation were not eligibility criteria for enrollment. Those who agreed to participate
were escorted to a modified recreational vehicle where a trained interviewer
obtained informed consen t using pseudonyms, interviewed using a standardized
questionnaire, conducted prevention counseling on sexually transmitted diseases,
and obtained blood specimens for HIV, hepatitis B, and syphilis testing. Referrals to
appropriate social and medical support services were also  provided as needed. After
the interview and phlebotomy, participants were given a $40 stipend, an anony-mous survey identification number, and an appointment to return in 2 weeks to
obtain their laboratory test results.
Individuals who had participated previous ly were ineligible. Many strategies were
employed to avoid duplication in enrollment. To ensure removal of duplicates, if two
or more participants were found to have identical dates of birth and race/ethnicity, we
performed the Miragen Assay (Miragen, Irvine, CA) on the blood samples.
19,20
HIV PREVALENCE AND RISK BEHAVIORS AMONG URBAN RUNAWAY YMSM 329
When antibody profiles matched, only data from the first interview and specimen
were analyzed. The YMS protocol was appr oved by the Centers for Disease Control
and Prevention and Florida institutional review boards.
Measures
A standardized questionnaire was administered by trained interviewers. Sociodemo-graphic variables including age, race/ethnic ity, current living conditions, education
level, and employment status were ascertained. Participants were interviewed about
their sexual behaviors, both lifetime and in the past 6 months with males and
females; exchange partners (partners with  whom sex was exchanged for food, shelter,
transportation, drugs, or money); nonsteady partners (such as pickups, one-night
stands, or having sex with causal partners one or two times); and/or steady partners
(having sex with steadies, re gulars, or lovers three or more times). The frequencies
of needle/syringe use for both injecting drugs and steroids and for tattooing were
also assessed. All participants were as ked whether they had ever run away from
home or been removed from their parents’ or guardians’ home. In this article, “run-aways” refers to YMSM with a history of running away and “nonrunaways” refers
to YMSM without that history.
Blood specimens were tested for HIV antibodies by using an enzyme immunoas-say (Sanofi Diagnostics Pasteur, Chaska, MN, USA). Repeatedly reactive specimens
were confirmed by the Western blot (Organon Teknika, Durham, NC, USA). Speci-mens were also tested for hepatitis B surface antigen, hepati tis B surface antibody,
and hepatitis B core antibody for current or past infection (DiaSorin, Stillwater, MN
and Abbott Laboratories, Abbott Park, IL, USA) . Past or current hepatitis B infection
was defined as the presence of core (anti-HBc) antibody or hepatitis B surface
(HBsAg) antigens. Vaccine-associated immuni ty was defined as the presence of anti-HBs alone among YMSM who reported having  received one or more doses of the
hepatitis B vaccine. The rapid plasma reagin test was used for the detection of syph-ilis infection (Arlington Scientific, INC., Springville, UT, USA). Reactive specimens
were confirmed by microhemagglutination assay for  Treponema pallidum,
MHATP/FTA-ABS (Bayer Corporation, Pittsburgh, PA).
Statistical Analysis
Teens and youth who run away clearly face many problems, often find themselves
in risky situations, get involved in dangerous crimes, may take drugs or alcohol, and
are forced to do things they wouldn’t normally do to make money and survive. To
better understand sociodemographic characteristics and related risk behaviors
among runaways, we hypothesized that  compared with nonrunaways, more run-aways would report factors potentially asso ciated with prevalen ce of HIV infection
and related risk behaviors. We define as runaway the young men who answered
positively the following survey question: Have you ever run away from home, or
been removed from your parent’s or guardians’ home? We define nonrunaway as all
other respondents, excluding the ones who refused to answer.
The two-sample t test was used to compare the  mean age differences (e.g., age
at first anal sex) between runaways and nonrunaways. We examined associations
between a history of running away and the prevalence of HIV infection and related
risk behaviors by using the Cochran-Mantel-Haenszel oIDs ratios. The Breslow-Day
test for homogeneity was used to assess effect modifi cation. Variables associated
with runaways in univariate analyses were included for logistic regression. Variables
with more than two levels were coded as a group of indicator (dummy) variables.
330 LALOTA ET AL.
Independent predictors that met the entry criteria ( P < .05) were entered into the
model. The final model was selected based on the likelihood ratio and the Hosmer
and Lemeshow goodness-of-fit tests.
21
The final model had a  P -value of 0.7983,
indicating adequate fit. Furthermore, regression diagnostics of the final model did
not detect any evidence of collinearity. Statistical tests were carried out using Epi
Info 6.04 (Centers for Disease Control and Prevention, Atlanta, GA) and Statistical
Analysis Software, version 8.01 (SAS Institute, Inc., Cary, NC, USA).
RESULTS
Participants
Between August 1995 and December 1996, 182 sampling events were conducted in
Miami-Dade and Broward counties. Of the 2,879 men approached during these
sampling events, 2,642 (92%) completed a brie f eligibility interview,  766 were eligible,
and 573 (74.8% of the eligible) enrolled. There were 37 confirmed duplicate enroll-ees, which were removed from analyses. Of the remaining 536, 2% never had sex
with another person, and 7% never had sex with men. Final analyses were limited
to 488 young men who had ever had se x with men. Of the 488 YMSM, 163
(33.4%) reported a history of running aw ay from home; 89 (18.2%) reported having
run away on more than one occasion.
Sociodemographic Characteristics
Of the 163 runaways, 53.4% were between the ages of 20 and 22 at the time of the
interview, and 69.3% were of Hispanic origin (Table 1). Results of univariate anal-yses indicated that runaways and nonrunaways did not differ according to age
group or race/ethnicity. However, runaways were more likely to be out of school,
have a high school education or less, and live alone or with friends or lovers. None
of the participants was homeless or living in a shelter at the time of the interview.
Sexual and Lifetime Risk Behaviors
Runaways experienced oral sex (P = .01) and anal sex ( P < .001) one year younger
(oral sex at the age of 14 and anal sex at  the age of 16), compared with nonrun-aways (oral sex at the age of 15 and anal sex at the age of 17). However, an age
difference was not observed between runaways and nonrunaways who engaged in
vaginal or anal sex with females. Analyses  with respect to sexual identity indicated
that runaway YMSM were less likely to self-identify as homosexual or bisexual.
There was no difference among runaways and nonrunaways with regard to age
when one first thought of himself as gay, bisexual, or transgender. However, run-aways were significantly younger when they first “came out” ( P = .01). Runaways
were more likely to have sex with both  males and females and reported a greater
number of lifetime male or female partners (Table 1). Analyses also revealed that
runaways were more likely to report having a history of forced sexual contact, hav-ing been told that they had an STD, having  ever used drugs, injected drugs, or used
needles for self-tattooing or body piercing compared with nonrunaways.
HIV and STD Infection
The prevalence of HIV infection among runaways was 10.5% (Table 1). The oIDs
of being HIV infected were 3.3 times higher among runaways compared with non-runaways. AIDitionally, among the runaways who were infected with HIV, 11 or 65%
HIV PREVALENCE AND RISK BEHAVIORS AMONG URBAN RUNAWAY YMSM 331
TABLE 1. Factors associated with a history of running away from home among young men
who have sex with men (YMSM), Miami, Florida, 1995–1996
Characteristic (N = 488)* Runaways (%)† Nonrunaways (%)†  OIDs ratio (95% CI)‡
Age group
15–19  76 (46.6)  136 (41.8)  1
20–22  87 (53.4)  189 (58.2)  0.8 (0.6, 1.2)
Race/ethnicity
White  28 (17.2)  59 (18.2)  1
Black  15 (9.2)  63 (19.4)  0.5 (0.2, 1.0)
Hispanic  113 (69.3)  183 (56.3)  1.3 (0.8, 2.2)
Asian/Asian American/
Pacific Islander 2 (1.2)  6 (1.8)  0.7 (0.1, 4.3)
Mixed or other  5 (3.1)  14 (4.3)  0.8 (0.3, 2.3)
Currently in school
Yes  54 (33.1)  187 (57.5)  1
No  109 (66.9)  138 (42.5)  2.7 (1.8, 4.1)
Education
Some college/technical/
vocational/ college 41 (25.2)  122 (37.5)  1
High school or less  122 (74.8)  203 (62.5)  1.8 (1.2, 2.7)
Living arrangement
With parents/guardians/relatives  77 (47.2)  190 (58.5)  1
Alone/with friends/lover/other  86 (52.8)  135 (41.5)  1.6 (1.1, 2.3)
Employment
Yes  95 (58.3)  210 (64.6)  1
No  68 (41.7)  115 (35.4)  1.3 (0.9, 2.0)
Sexual orientation
Heterosexual  9 (5.6)  5 (1.5)  1
Homosexual  79 (48.8)  192 (59.1)  0.2 (0.1, 0.7)
Bisexual  66 (40.7)  127 (39.1)  0.3 (0.1, 0.9)
Transgender  8 (4.9)  1 (0 .3)  4.4 (0.4, 236.0)
Sex partners
Males and females  119 (73.0)  194 (59.7)  1
Males only  44 (27.0)  131 (40.3)  0.6 (0.4, 0.8)
Anal sex with males—ever
No  15 (9.2)  49 (15.1)  1
Yes  148 (90.8)  276 (84.9)  1.8 (1.0, 3.2)
Vaginal or anal sex wi th female—ever
No  49 (30.1)  183 (56.3)  1
Yes  114 (69.9)  142 (43.7)  1.8 (1.2, 2.7)
Number of male partners, lifetime
1–4  50 (30.7)  136 (41.8)  1
5–19  61 (37.4)  132 (40.6)  1.3 (0.8, 2.0)
>19  52 (31.9)  57 (17.5)  2.5 (1.5, 4.2)
Number of female partners, lifetime
0  44 (27.0)  130 (40.0)  1
1–4  67 (41.1)  136 (41.8)  1.5 (0.9, 2.3)
>4  52 (31.9)  59 (18.2)  2.6 (1.5, 4.2)
332 LALOTA ET AL.
did not perceive themselves to be at risk of infection compared with 5 or 45% of
nonrunaways. Among runaways, the prevalence of markers for hepatitis B virus
was 10%, and only 5.6% had evidence of hepatitis B immunization. The oIDs of
hepatitis B infection and syphilis were similar between runaways and nonrunaways.
Factors Associated with a History of Running Away
from Home
Sociodemographic variables and lifetime beha viors significant in univariate analyses
were entered into logistic regression models. In multivariate analyses, while control-ling for all other variables, runaways were more likely to be HIV infected, report
not being in school, have had vaginal or  anal sex with females, have ever been
*May not sum up to 488 because of “refused” category.
†Runaways indicate YMSM who reported a history of running away.
‡Fisher’s exact confidence limits if at le ast one expected cell is less than 5.
§Included amphetamines, cocaine,  lysergic acid diethylamide (LSD), methylenedioxymethamphetamine
(ecstasy), and nitrites.
TABLE 1. Co nt inued
Characteristic (N = 488)* Runaways (%)† Nonrunaways (%)†  OIDs ratio (95% CI)‡
Ever forced to have sex
No  92 (56.4)  231 (71.1)  1
Yes  71 (43.6)  94 (28.9)  1.9 (1.3, 2.8)
Ever been told to have an STD
No  142 (87.1)  305 (93.8)  1
Yes  21 (19.2)  20 (6.2)  2.3 (1.2, 4.3)
Ever used party drugs§
No  43 (26.4)  176 (54.2)  1
Yes  120 (73.6)  149 (45.8)  3.3 (2.1, 5.1)
Ever used crack cocaine or heroin
No  69 (42.3)  208 (64.0)  1
Yes  94 (57.7)  117 (36.0)  2.4 (1.6, 3.6)
Ever injected drugs
No  143 (87.7)  322 (99.1)  1
Yes  20 (12.3)  3 (0.9)  15.0 (4.1, 64.5)
Ever self-piercing or self-tattooing
No  97 (59.5)  247 (76.2)  1
Yes  66 (40.5)  77 (23.8)  2.2 (1.5, 3.3)
HIV
Negative  145 (89.5)  314 (96.6)  1
Positive  17 (10.5)  11 (3.4)  3.3 (1.5, 7.3)
Hepatitis B
Negative  144 (90.0)  296 (91.1)  1
Positive  16 (10.0)  29 (8.9)  1.1 (0.6, 2.1)
Hepatitis B immunization
No  128 (78.5)  258 (79.4)  1
Yes  35 (21.5)  67 (20.6)  1.1 (0.6, 1.7)
Syphilis
Negative  159 (98.8)  319 (99.7)  1
Positive  2 (1.2)  1 (0.3)  4.0 (0.28, 112.6)
HIV PREVALENCE AND RISK BEHAVIORS AMONG URBAN RUNAWAY YMSM 333
forced to have sexual contact, have ever injected drugs, and report a history of using
needles for self-tattooing or body piercing (Table 2).
Sexual Behaviors in the Past 6 Months
Sexual activity with exchange partners, nonsteady partners, and steady partners
was ascertained for the past 6 months (Table 3). Runaways were more likely to
report having anal sex with any male partners; in particular, they were more likely
to have insertive anal sex. With respect  to having sex with any females, runaways
were more likely to report having vaginal or anal sex. AIDitionally, they were also
more likely to have unprotected vaginal or anal sex with any females.
DISCUSSION
In this study, the HIV prevalence among urban runaways was 10.5%, approxi-mately three times higher than that of nonrunaways. Compared to the data from
the multisite study of YMSM in seven cities, which found a 9% positivity rate, HIV
prevalence was high among runaways in our study.
17
We did not see a significant
association between a history of runnin g away and the prevalence of STDs, and
there were two runaways with syphilis compared with only one nonrunaway.
Recent studies have documented an increase in STDs, such as gonorrhea and syphilis
among MSM.
22–24
High prevalence of hepatitis B  infection, documented in our
study, has also been identified in a cohort of HIV- infected youth.
25
This is of partic-ular concern because it has been reco gnized that the presence of other STDs
increases the risk of tran smitting or acquiring HIV.
26
These findings  emphasize the
TABLE 2. Adjusted oID ratios reported for variables that remained in the final logistic
regression model young men wh o have sex with men (YMSM), Miami, Florida, 1995–1996
*May not sum up to 488 because of “refused” category.
†Fisher’s exact confidence limits if at least one expected cell is less than 5.
Characteristic (N = 488)*  Adjusted oIDs ratio (95% CI)†
Currently in school
Yes 1
No  2.1 (1.4, 3.2)
Vaginal or anal sex with females—ever
No 1
Yes  1.6 (1.0, 2.5)
Ever forced to have sex
No 1
Yes  1.7 (1.1, 2.6)
Ever injected drugs
No 1
Yes 9.8 (2.8, 34.6)
Ever self-piercing or  self-tattooing
No 1
Yes  2.0 (1.3, 3.0)
HIV
Negative 1
Positive  3.4 (1.5, 7.8)
334 LALOTA ET AL.
importance of incorporating STD prevention and treatment into existing HIV pre-vention programs.
26–29
Ideally, these programs should be adapted and incorporated
into existing prevention services target ed toward youth. Th ese services should
include prevention counseling and testing for HIV and other STDs and vaccination
for hepatitis B.
Our study illustrated that runaways were less likely to self-identify as homosexual
or bisexual. However, runaways were more likely to have sex with both men
and women compared with nonrunaways. Framing counseling and prevention
messages based on stated sexual orientation alone might not be effective. Pre-vention efforts that specifically diminish high-risk sexual behaviors, regardless
TABLE 3. Sexual behaviors during the past 6 mo nths and the history of running away from
home among young men who have sex with men (YMSM), Miami, Florida, 1995–1996
*May not sum up to 488 because of “refused” category.
†Runaways indicate YMSM who reported a history of running away.
‡Nonrunaways indicate YMSM who did not report a history of running away.
§Fisher’s exact confidence limits if at least one expected cell is less than 5.
Characteristic (N = 488)* Runaways (%)† Nonrunaway s (%)‡  OIDs ratio (95% CI)§
Anal sex with any males
No  33 (20.2)  97 (29.8)  1
Yes  130 (79.8)  228 (70.2)  1.7 (1.1, 2.6)
Insertive anal sex with any males
No  52 (31.9)  138 (42.5)  1
Yes  111 (68.1)  187 (57.5)  1.6 (1.1, 2.3)
Receptive anal sex with any males
No  77 (47.2)  153 (47.1)  1
Yes  86 (52.8)  172 (52.9)  1.0 (0.7, 1.4)
Insertive anal sex with any males
None or protected  115 (70.6)  231 (71.1)  71.1
Unprotected  48 (29.4)  94 (28.9)  1.0 (0.7, 1.6)
Receptive anal sex with any males
None or protected  113 (69.3)  235 (72.3)  1
Unprotected  50 (30.7)  90 (27.7)  1.2 (0.8, 1.7)
Vaginal sex with any females
No  119 (73.0)  283 (87.1)  1
Yes  44 (27.0)  42 (12.9)  2.5 (1.6, 4.0)
Anal sex with any females
No  146 (89.6)  318 (97.8)  1
Yes  17 (10.4)  7 (2.2)  5.3 (2.1, 13.0)
Vaginal sex with females
None or protected  136 (83.4)  302 (92.9)  1
Unprotected  27 (16.6)  23 (7.1)  2.6 (1.4, 4.7)
Anal sex with females
None or protected  155 (95.1)  321 (98.8)  1
Unprotected 8 (4.9) 4 (1.2) 4.1 (1.1, 19.0)
Sex with HIV-infected or AIDS person
No/Don’t know  141 (90.4)  282 (95.3)  1
Yes  15 (9.6)  14 (4.7) 2.1 (1.0, 4.6)
HIV PREVALENCE AND RISK BEHAVIORS AMONG URBAN RUNAWAY YMSM 335
of sexual identity, may be more effective. In aIDition, MSM of color may be less
likely to self-identify as gay or bisexual.
30,31
The multisite study of YMSM indi-cated that the prevalence of HIV infection was highest among closeted black
MSM compared with all other racial groups.
32
Consequently, these runaways,
regardless of their perceived sexual orie ntation, engaged in  risky behaviors such
as having sex with both men and women and could serve as a bridge for HIV
and STD transmission.
Multivariate analysis indicated that runaways were almost two times as likely
to have a history of sexual abuse. Sexual abuse has been linked not only to home-lessness but also to increased promis cuity and HIV risk-taking behaviors.
33,34
Youth
who run away from home often engage in risky behaviors that place them at high
risk for HIV infection. However, in our study, we found that over half (65%) of the
runaways who tested positive  for HIV did not perceive themselves to be at risk of
infection. Various risk behaviors were seen among runaways; they were more likely
to have had multiple male or female partners, use noninjection and injection drugs,
or use needles for self-tattooing or body piercing. A study of male and female
runaways from New York City indicated that the use of noninjection drugs was
associated with an increased number of sexual partners and decreased condom use,
thereby placing youth at incr eased risk for HIV infection.
10
These findings highlight
the need for drug prevention and treatmen t and psychosocial services that specifi-cally target youth.
Findings in this report are subject to at least three limitations. First, this is a
venue-based survey of YMSM in Miami. Therefore, our findings are not generaliz-able to all street and homeless youth in a given area. Nevertheless, our data repre-sent a minimum estimate of association between risky sexual and drug use
behaviors and a history of running away from home. Second, because high-risk
behaviors and illegal drug practices were self-reported, validity of responses could
be affected by under-reporting or over-reporting. Third, participants were asked at
the time of the study whether they had a history of running away from home or had
been removed from their parents’ or guardians’ home. The nature of cross-sectional
surveys prevents us from making temporal inferences on the causation between the
history of running away from home and HIV risk behaviors.
CONCLUSIONS
Overall, this study demonstrated the hi gh prevalence of HIV infection and risk
behaviors among YMSM who had a history of running away. Despite a decline in
the prevalence of HIV infection among men who have sex with men (MSM) since
the mid-80s, the HIV epidemic among MSM continues, especially among black and
Hispanic MSM.
35–37
Recent studies have identified the resurgence of STDs and HIV
among MSM.
38,39
Unfortunately, with the advance of new therapies, there is a sense
of complacency among some MSM that the HIV/AIDS epidemic  will soon be com-ing to an end.
40
Our study illustrated that runawa ys continue to engage in risky
behaviors such as male-to-male sex that pl ace them at high risk for HIV infection.
Gay-sensitive HIV instruction appears to be innovative and beneficial among gay,
lesbian, and bisexual adolescents who attend schools.
41
It may be advantageous to
adapt a similar approach for out-of-school settings. Our findings emphasize the
urgent need for prevention programs that target not only street youth and those
living in homeless shelters but also high-risk youth with a history of running away
from home, regardless  of their HIV status.
336 LALOTA ET AL.
ACKNOWLEDGEMENT
We greatly appreciate the efforts and commitment of the young men who enrolled in
the survey and the YMS study team in Miami. Special appreciation goes to the project
coordinators, John Kiriacon and Al Bay,  PhD; Care Resource, Inc. (formerly known
as Health Crisis Network, Inc.) for c onducting the study; James M. Schultz, PhD, at
the University of Miami for providing epidemiologic consultation; Eduardo Valverde,
MPH, at the Miami-Dade County Health Department for providing technical over-sight and assistance; and the laboratory and data management staff. Thanks also go
to Spencer Lieb, MPH, for reviewing and editing the manuscript. This study was
funded by the Centers for Disease Control and Prevention (CFDA 93-944).
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