Street-involved youth in Canada

Prevention in Focus PiF 2012 Spring

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CATIE
PiF Street-involved youth

An estimated 150,000 youth are street-involved youth in Canada,1 but it is suspected that this number may actually be much higher.2 Certain youth are at greater risk of becoming street-involved, including Aboriginal youth; lesbian, gay, bi, trans and queer (LGBTQ) youth; youth in government care; and young males.2,3,4,5,6,7 Youth become street-involved for a multitude of reasons. The most common is conflict within the family; other reasons include wanting independence or to move to a larger city, being thrown out of the house and trouble with the law.2,5,8,9,10,11,12

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Street-involved youth can encounter many challenges in their day-to-day lives. They may experience stigma and discrimination, lack of access to health and social services, high levels of interaction with the criminal justice system, lack of access to jobs and education, family instability, and poor access to nutrition.2,12,13 Street-involved youth—particularly those that are LGBTQ—are also more vulnerable to sexual, physical and weapon-related assault, as well as robbery.8,14,15 Street-involved youth also have higher mortality rates: more than 11 times that of the general youth population.16

Despite these challenges, steet-involved youth often show great resiliency. They often have a strong sense of self-worth, feel secure in their beliefs, and are confident in their abilities.17 As well, they often have positive coping mechanisms that help them deal with the challenges they experience; these include having friends, time for personal reflection, interests and hobbies, and hope for the future.16,18,19

Rates of HIV, hepatitis C and STIs among street-involved youth

Street-involved youth are particularly impacted by HIV, hepatitis C and STIs, with HIV rates three times that of the Canadian adult population,5,20 and hepatitis C rates more than six times that of the general Canadian population.5,20 Furthermore, street-involved youth who inject drugs are four times more likely to have hepatitis C infection than street-involved youth who don’t inject.5 Finally, STIs rates can be up to 30 times higher among street-involved youth than among youth in the general population.5

Sexual activity

Research tells us that participating in high-risk sexual activity is an integral part of street life—activities that put them at risk for HIV and STI transmission. Street-involved youth are often sexually active, engage in sex at an earlier age, and have multiple sex partners. They report low rates of condom use and some also engage in sex work.3,21,22

Street-involved youth are more likely to engage in sexual activities that can put them at risk for HIV and other STIs:

  • 90-96% have engaged in sexual activities2,5
  • street-involved youth have an average of 17 sexual partners in their lifetime2,5
  • 14 is the average age at first sexual encounter23,24
  • 47-74% do not consistently use condoms2,5
  • 12-32% have participated in sex work5,24,25,26,27

Substance use

Many street-involved youth use drugs. Youth may turn to drugs to help them deal with the difficult realities they face on the street.12,13 Among those who use drugs, many engage in injection drug use and share needles, injecting equipment and crack pipes—all of which put them at risk for HIV and/or hepatitis C.

Research tells us that street-involved youth often use drugs and participate in activities that put them at risk for HIV and hepatitis C:

  • 95% have used drugs in their lifetime5
  • 21-54% have injected drugs2,5,26,28,29,30
  • 25-75% of those who inject do not always use clean needles and equipment2,5,26,29,31
  • 54% have shared crack pipes2

Older youth are more likely to inject drugs, perhaps because this becomes more normalized the longer a young person lives on the street.32Youth who consider injection drug use unacceptable prior to becoming street-involved may change their minds as they repeatedly witness others use injection drugs. While younger youth are less likely to take up injection drug use, those who do are more likely to participate in risky behaviours such as sharing needles.32

An innovative intervention

Eva’s Initiatives, a Toronto-based agency that provides services to street-involved youth, has addressed the need for youth to reconnect with their families before youth become entrenched in street life. By doing so, the agency hopes to prevent the engagement in high-risk behaviours that street life promotes and sustains. To this end, Eva’s has created its award-winning Family Reconnect program, which works with young people aged 16 to 24 who are already, or are at risk of becoming, street-involved and their families. Young people who have recently left their family home or who have had recent contact with their family are seen as soon as possible to help facilitate reconnection. Through the program, young people and their families (however the young person defines family*) are offered supportive counselling as well as referrals to other supports in the community. The focus of this counselling varies with each family and often encompasses areas such as grief and loss, living well with mental illness, anger management, life skills, dealing with family conflict and communication breakdown.

Program coordinators work with young people and their families towards various outcomes. For some of the youth, returning home may not be an option, but increased communication and a better rapport can encourage family members to support the youth as they establish their own lives. For others, relationships improve so much with their families that they elect to return home. Sometimes, the program is not successful at opening up the lines of communication; nonetheless, the counselling process has proven to be effective in assisting them to move forward in their lives and develop as healthy young people.

The Family Reconnect Program did wonders for us … After struggling through the years of my troubled youth, my family and I couldn’t be closer, if not geographically at least in every other way. My parents are here for me and I am here for them. It’s been 10 months living on my own and finally I feel some stability.

―Bre-Ann

Initially, we sought the advice of a specific Counselor [at the Family Reconnect Program]…for our son who was struggling with many issues, including no life focus, a volatile temperament, and disrespect for our family values… The Counselor offered us support at a time when we did not know where else to turn. Our son was provided with a safe place to stay, in addition to professional assessments and in-house counseling. All the while, my husband and I continued to receive guidance that included strategies on how we could cope within our lives and on how we could help our son help himself. Most importantly, we were provided with an empathetic sounding board and we were never judged.

―anonymous

If you are interested in finding out more about the Family Reconnect Program, visit Eva’s Reconnect Toolkit. 

Moving upstream                                      

Programs such as Family Reconnect underline the need to move upstream and work with families, to prevent youth from becoming street-involved whenever possible. This program also highlights the growing understanding that there may be pivotal moments for some young people, where intervention could prevent them from transitioning to a life on the street. And as they reconnect with family and avoid life on the street, these youth become less likely to engage in behaviours that place them at risk for HIV, hepatitis C and STIs.

* Family could mean a community of origin, a cousin, grandparent, family friend, guardian, sibling, biological or non-biological parent(s). This definition is up to the young person to discern.

 

References

  1. DeMatteo D, Major C, Block B et al. Toronto street youth and HIV/AIDS: prevalence, demographics, and risks. Journal of Adolescent Health. 1999 Nov;25(5):358-66.
  2. a. b. c. d. e. f. g. h. i. j. Worthington C, MacLaurin B, Huffey N et al. Calgary youth, health and the street—final report. Calgary: University of Calgary: 2008.
  3. a. b. Kelly K, Caputo T. Health and street/homeless youth. Journal of Health Psychology. 2007 Sep;12:726-36.
  4. Miller CL, Strathdee SA, Spittal PM et al. Elevated rates of HIV infection among young Aboriginal injection drug users in a Canadian setting. Harm Reduction Journal. 2006;(3):3.
  5. a. b. c. d. e. f. g. h. i. j. k. l. m. Public Health Agency of Canada [Internet]. Street youth in Canada: findings from enhanced surveillance of Canadian street youth, 1999-2003. Ottawa: Public Health Agency of Canada; 2006 [cited 2012 Jan 31]. Available from: www.phac-aspc.gc.ca/std-mts/reports_06/pdf/street_youth_e.pdf.
  6. McCreary Centre Society [Internet]. Moving upstream: Aboriginal marginalized and street-involved youth in B.C. Vancouver: McCreary Centre Society; 2008 [cited 2012 Jan 31]. Available from: http://www.mcs.bc.ca/pdf/Moving_Upstream.pdf.
  7. Higgitt N, Wingert S, Ristock J et al. Voices from the margins: experiences of street-involved youth in Winnipeg [Internet]. Winnipeg: Winnipeg Inner-city Research Alliance; 2003 Sep [cited 2012 Jan 31]. Available from: http://ius.uwinnipeg.ca/pdf/Street-kidsReportfinalSeptember903.pdf.
  8. a. b. Cauce, A. M., Tyler, K. A., & Whitbeck, L. B. Maltreatment and victimization in homeless adolescents: out of the frying pan and into the fire. The Prevention Researcher. 2004;11:12-14.
  9. Chen X, Tyler KA, Whitbeck LB et al. Early sexual abuse, street adversity, and drug use among female homeless and runaway adolescents in the Midwest. Journal of Drug Issues. 2004 Jan 1;34(1), 1-21.
  10. Hyde J. From home to street: understanding young people's transitions into homelessness. Journal of Adolescence. 2005 Apr;28:171-83.
  11. McLean L. Seeking sanctuary: an exploration of the realities of youth homelessness in Calgary—2005. Calgary: Broadview Applied Research Group; 2005.
  12. a. b. c. Tyler KA, Johnson KA. Pathways in and out of substance use among homeless—emerging adults. Journal of Adolescent Research. 2006 Mar;21(2):133-57.
  13. a. b. Barnaby L, Penn R, Erickson PG. (2010). Drugs, homelessness & health: homeless youth speak out about harm Reduction. The Shout Clinic Harm Reduction Report. Toronto: Wellesley Institute: 2010.
  14. Gaetz S. Safe streets for whom? Homeless youth, social exclusion, and criminal victimization. Canadian Journal of Criminology and Criminal Justice. 2004;46(4):423-55.
  15. Whitbeck LB, Chen X, Hoyt DR et al. Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. Journal Of Sex Research. 2004 Nov;41(4):329-42.
  16. a. b. Boivin J, Roy E, Haley N et al. The health of street youth: a Canadian perspective. Canadian Journal of Public Health. 2005;96(6):432-37.
  17. Kidd SA. Street youth: coping and interventions. Child and Adolescent Social Work Journal. 2003;20(4):235-61.
  18. Johnson KD, Whitbeck LB, Hoyt DR. Predictors of social network composition among homeless and runaway adolescents. Journal of Adolescence. 2005 Apr;28:231-48.
  19. Milburn NG, Rotheram-Borus MJ, Batterham P et al. Predictors of close family relationships over one year among homeless young people. Journal of Adolescence. 2005 Apr;28:263-79.
  20. a. b. CATIE (Canadian AIDS Treatment Information Exchange) [Internet]. HIV in Canada: trends and issues that affect HIV prevention, care, treatment and support. CATIE; 2010 [cited 2012 Jan 31].
  21. Fast D, Small W, Wood E et al. Coming 'down here': young people's reflections on becoming entrenched in a local drug scene. Social Science & Medicine. 2009 Aug 21;69(8):1204-10.
  22. Linton AB, Singh MD, Turbow D et al. (2009). Street youth in Toronto, Canada: An investigation of demographic predictors of HIV status among street youth who access preventive health and social services. Journal of HIV/AIDS & Social Services. 2009;8(4):375-96.
  23. Johnson TP, Aschkenasy JR, Herbers MR et al. Self-reported risk factors for AIDS among homeless youth. AIDS Education and Prevention. 1996 Aug;8(4):308-22.
  24. a. b. Weber AE, Boivin J, Blaise L et al. HIV risk profile and prostitution among female street youths. Journal of Urban Health. 2002 Dec;79(4):525-35.
  25. Weber AE, Boivin J, Blaise L et al. Predictors of initiation into prostitution among female street youths. Journal of Urban Health. 2004 Dec;81(4):584-95.
  26. a. b. c. Clatts M, Rees-Davis W, Sotheran JL et al. (1998). Correlates and distribution of HIV risk behaviors among homeless youth in New York City: Implications for prevention and policy. Child Welfare. 1998;77(2):195-207.
  27. Haley N, Roy E, Leclerc P et al. HIV risk profile of male street youth involved in survival sex. Sexually Transmitted Infections. 2004;80(6):526-30.
  28. Leach MP, Wolitski RJ, Goldbaum GM et al. HIV risk and sources of information among urban street youth. Psychology, Health & Medicine. 1997;2(2):119-134.
  29. a. b. Roy, E, Haley, N, Leclerc, P, et al. Drug injection among street youth: the first time. Addiction. 2002 Aug;97(8):1003-10.
  30. Roy E, Lemire N, Haley N et al. Injection drug use among street youth: a dynamic process. Canadian Journal of Public Health. 1998;89(4):239-40.
  31. Gleghorn AA, Marx R, Vittinghoff E et al. Association between drug use patterns and HIV risks among homeless, runaway, and street youth in northern California. Drug and Alcohol Dependence. 1998 Aug 1;51(3):219-27.
  32. a. b. Public Health Agency of Canada [Internet]. Canadian street youth and substance use. Ottawa: Public Health Agency of Canada; 2007 [cited 2012 Jan 31]. Available at: www.phac-aspc.gc.ca/sti-its-surv-epi/report07/index-eng.php.
  33. Eva’s Initiatives. Family stories: A collection of stories written by and about the youth and families involved with the Family Reconnect Program. Available at: http://reconnecttoolkit.evasinitiatives.com/frp-program-model/family-stories

 

About the author(s)

Cris (Cristine) Renna is currently the Youth Project Coordinator at CATIE. Cris holds an MA in Women and Gender Studies from the University of Toronto, and a BA (Honors) in Women’s Studies and International Development Studies from Queen’s University. Cris has worked in community development in the area of sexual health and LGBTQ health for nearly 10 years. Prior to joining CATIE, Cris worked as an educator in a community-based AIDS service organization.