The Need for an Integrated Approach to Reducing Young People’s Risk of Homelessness and HIV in Pakistan
Keywords:Homelessness, HIV, Sexually transmitted infections, Youth
Background: Past research demonstrated a link between homelessness and the increased risk of HIV and other sexually transmitted infections (STIs). However, ways to reduce young people’s risk of homelessness and sexual health risks have not been adequately addressed. This paper, based on the first detailed sociological exploration into the lived experiences of homeless young people, argues for the adoption of a holistic and integrated approach to health promotion that goes beyond the health sector.
Methods: In-depth interviews were conducted with twenty-nine homeless young people, aged 16-25-year-old, from Rawalpindi, Pakistan.
Results: A combination of socio-structural and interpersonal forces shaped participants’ pathways to homelessness and their experiences of street life – notably regarding sex work – and produce contexts of competing risks where HIV/STIs prevention became a secondary concern. Participants had a reasonable knowledge regarding nature, transmission, prevention, and to some extent, treatment of HIV/STIs. Nevertheless, this knowledge did not help them much, as most of the participants used condoms inconsistently with clients and intimate partners. Financial considerations, fear of violence from clients, and social obligations in intimate partnerships contributed to participants inconsistent condom use, increasing their risk of HIV/STIs.
Conclusion: The results indicate the importance of the Ottawa Charter of health promotion, which suggests that conventional health promotion approaches are potentially suboptimal in shaping health behaviours supportive of good health. Notably, building healthy public policies, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services can help to improve young people’s socioeconomic status, which is inextricably linked with sexual health behaviour and status.
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