For a time, classes in sexual health were offered at the center as part of a research project conducted by Dr. Lynn Rew, the Denton & Louise Cooley and Family Centennial Professor in Nursing at The University of Texas at Austin. She wanted to see what impact education about sexual health would have on the young people. The lessons included how to examine themselves for breast and testicular cancer, how to speak up to make sure a sex partner wears a condom and how to get help if something goes wrong. “We were trying to affect how they thought about themselves as sexually healthy people and also for them to engage in more of what I would call health-promoting sexual behavior and less risk-taking behavior,” Rew said. There are 500,000 to two million homeless young people in the United States, according to government reports. Little academic research has been done on them and even less about their sexual health.
The National Institutes of Health backed Rew’s study with $1.4 million. Sexual activity by homeless young people might be the riskiest behavior of an already risky lifestyle. In some cases, they’ve left home because of sex-related problems such as abuse or their parents’ rejection of their sexual orientation. On the street, they may engage in survival sex—trading sex for money, food or a place to stay. “The reason they are vulnerable to HIV and other sexually transmitted diseases is that they tend to have multiple sex partners. They tend not to use condoms or any other kind of birth control. They don’t have access to health care,” Rew said. Adolescence also is a time when most of us establish our identities. That’s a harder process for homeless young people, who live without the usual things that confer identity: family, home and school. “Identifying oneself as a mature sexual person is another major task of adolescents,” Rew said. “So, we want them to create that identity in a positive way rather than in a way that they’re getting a reputation for, which is being promiscuous, and prostitution because they don’t know any other way to make a living or to make an identity for themselves. Who wants that for adolescents?” Rew devised a three-part study. First, she would test young people who volunteered to participate about what they knew. Then she would offer them a multi-week course on sexual health education (intervention in the language of the study). Finally, she would test them again to see how much their scores changed from the first test. Another group, the control group, would take the tests, but not participate in the classes. Because many homeless young people have learning disabilities, Rew and her colleagues designed classes with different approaches to help them learn and digest the material. Each one-hour session was divided into four or five topics and each topic was taught in a different format. “When we taught assertive communication, we would have them role-play different scenarios of speaking assertively versus aggressively to another person,” Rew said. “When we spoke about STDs, we showed them full-color pictures of what symptoms might look like on their bodies.” There was also hands-on training. “When we taught them correct application and removal of condoms, we had simulations so they could practice,” she said. “Similarly, when we taught the women breast self-examination and the males testicular self-examination, we had life-size simulations to give them actual experience.” The transitory nature of homelessness made it difficult to run the test according to the protocols Rew set. Some of the young people in the control group wanted to be in the intervention group. The people that ran the center urged Rew to let them in. “As a scientist you say, ‘You can’t do that, science doesn’t allow for that,’” Rew said. She contacted the NIH, which OKed the change. “They were saying do whatever you have to do to get this off the ground,” she said. The study has 572 participants: 287 were in the control group, 196 were in the group that received the classes and 89 were in both control and intervention. The results showed improvements in men’s and women’s understanding of self-examination for testicular and breast cancer. And women seemed to get more of the risks involved in dangerous sex, particularly those concerning the future. But, disappointingly for Rew, there was not as much of an increase of knowledge as she expected. “We didn’t see a lot of improvement over time in either group, like we had hoped we would,” she said. “We did see some improvement in their knowledge about AIDS. But, they were, actually, at a pretty good knowledge level to begin with.” The Journal of Health Psychology has accepted a paper about the study. For Rew, a lot of dealing with homeless teens is connecting with them. Seen on the street, wearing Army surplus clothing and their hair in dreadlocks, they may seem intimidating to passers-by. But not to Rew, and, she said, they should not appear that way to anyone else. “They’re made out of skin and bones, just like we are and they have the same emotions that we have. Why should we treat them differently?” she said. “And, since they don’t have people that care about them, then we should when we get the opportunity.” She said that just introducing yourself and saying hi will make the day of a homeless young person. Rew related a conversation she had with a man who followed her advice when he saw homeless young people on the street. “I just stuck out my hand and they were just as nice as they could be,” he told her. “And I said, well, sure. They’re just kids. They want to have adults in their lives.” Tim
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