Sexually Transmitted Infections in Canadian Street Youth

Findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003

March 2006

PDF version 27 Pages - 1.38 MB

Cat. No. HP5-14/2006 ISBN 0-662-49063-0

Table of Contents

Executive Summary

1. Introduction
   1.1 Purpose
2. Method
   2.1 Analysis
   

   2.1.1 Analysis Terms

   2.2 Laboratory Methods
   2.3 Limitations
3. Demographic Profile of E-SYS Participants
4. Prevalence
   4.1 Chlamydia
   4.2 Gonorrhoea
   4.3 Syphilis
   4.4 Hepatitis B
   4.5 Herpes Simplex Infection (Genital Herpes)
   4.6 Hepatitis C
   4.7 HIV
   4.8 HTLV
5. Sexual Behaviours and STIs
   5.1 Sexual Activity
   5.2 Condom Use
   5.3 Sexual Partners
   5.4 High-Risk Partners
   5.5 Unwanted Sex
   5.6 Sex Trade
   5.7 Obligatory Sex
   5.8 Previous STIs
   5.9 Self-Perceived Risk and STIs
6. Substance Use and STIs
7. Implications
8. Conclusion
9. References

List of Tables
Table 1	Demographic profile of street youth recruited for E-SYS.
Table 2	Prevalence rates of chlamydia, gonorrhoea and infectious syphilis among street youth and in the general youth population in 1999, 2001 and 2003
Table 3	Sexual behaviours and self-perceived risk among street youth in 2003

List of Figures
Figure 1	Chlamydia prevalence among street youth in 1999, 2001 and 2003
Figure 2	Gonorrhoea prevalence among street youth in 1999, 2001 and 2003
Figure 3	Proportion of street youth who had been exposed to hepatitis B in 1999, 2001 and 2003
Figure 4	Proportion of street youth susceptible (no immunity) to hepatitis B in 1999, 2001 and 2003
Figure 5	Prevalence rates of HSV-1, HSV-2 (mono-infections), and HSV-1 and 2 co-infection among street youth in 2001 and 2003
Figure 6	Prevalence rates of hepatitis C infection among street youth in 1999, 2001 and 2003
Figure 7	Rate of hepatitis C infection among IDU street youth in 1999, 2001 and 2003
Figure 8	Average number of times street youth had sex per week by partner type in 2003
Figure 9	Proportion of street youth who reported not using condoms for protection at their last sexual encounter by gender of partner in 2001 and 2003
Figure 10	Proportion of street youth in 1999, 2001, and 2003 with a history of sex trade involvement who reported not using condoms for protection at last sexual encounter with a client partner
Figure 11	Average lifetime number of sexual partners among street youth by gender in 1999, 2001 and 2003
Figure 12	Lifetime number of partners by sexual relationship in 1999, 2001 and 2003

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Executive Summary

Street youth endure considerable hardship, including the uncertainty and danger of life on the streets. They exist in an economically and socially marginalized position because of their age, homeless status and lack of education and job skills¹. Street youth may be more preoccupied with meeting their basic daily needs than with health risks. Their lifestyle may also predispose them to engage in high-risk behaviours¹ such as unprotected sex, sex with high-risk partners and sex with multiple partners - behaviours that increase their risk of contracting and transmitting sexually transmitted infections (STIs) and blood-borne infections. This report is based on Enhanced Surveillance of Canadian Street Youth (E-SYS),² a multi-centre sentinel surveillance system that monitors rates of STIs and blood-borne pathogens, behaviours and risk determinants in Canada's street youth population. Key findings from 1999, 2001 and 2003 are presented below.

Key Findings

• Street youth are a sexually active population, with more than 95% reporting previous engagement in sexual activities.
• On average, street youth report having had no fewer than 17 sexual partners in their lifetime.
• A high proportion of street youth report not having used condoms with their regular or client partners during their most recent episode of sexual intercourse.
• Approximately one-quarter of street youth report having traded sex at some point in their lives.
• Rates of chlamydia and gonorrhoea in street youth are more than ten times those in the general youth population.
• Street youth do not seem to modify their sexual behaviours following the diagnosis of an STI.
• Hepatitis B immunity level is gradually increasing among street youth; however, the proportion of street youth with no immunity remains high.

Rates of STIs and blood-borne infections have been shown to be much higher among street youth than in the general youth population. As shown in this report, street youth do not take adequate measures to protect themselves from STIs. Even after being told they have an STI, some youth are still choosing not to use protection, while some discontinue using protection after a period of time.

Sufficient resources need to be allocated to provide outreach services such as STI prevention, screening and treatment to street youth, and such services need to be made accessible through community-based programs. Harm reduction approaches such as consistent and correct condom use, later initiation of sexual activities and reduction in the number of sexual partners need to be advocated among street youth.

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1. Beech BM, Myers L, Beech DJ, et al. Human Immunodeficiency Syndrome and Hepatitis B and C Infections among Homeless Adolescents. Seminars in Pediatric Infectious Diseases. 2003;14(1):12-19.
2. Public Health Agency of Canada. Enhanced Surveillance of Street Youth in Canada. Ottawa; 2006.