The sexual health stories of young people experiencing homelessness

© 2014 Dr. Dorothy (Dot) WrightResearch has shown that young people experiencing homelessness have poorer health than their housed peers. Despite this, little is known about the health, sexual health, sexual relationships and access to health care of young people experiencing homelessness in Australia or about how they navigate the health system. This thesis describes an in-depth qualitative study of young Australians and their pathways into and experience of homelessness, their sexual relationships and their understanding of general and sexual health, including their practice of access to health care. In the literature review I describe what is known of the reasons for and the theoretical frameworks for researching the health risks, sexual health and health care access of young homeless people. My body of research clarifies young homeless people’s understanding of health behaviours, health knowledge (including sexual health) and how they use the knowledge to utilise health care access. Between 22 December 2008 and 20 November 2009 I interviewed 24 young people aged 16–23 staying in temporary, secure and supervised accommodation, known as youth refuges, in suburban Melbourne. The young people were recruited and interviewed at the refuges. Interviews were semi-structured and digitally recorded. Following transcription, I conducted thematic analysis of the interview data to generate an understanding of their experiences. The data highlighted the diverse experience of and varied reasons for homelessness. The participants were either forced out of home or made independent or mutual decisions to leave. Their understanding of health and sexual health, their sexual relationships and how and when they negotiated access to health care were also diverse. Some found negotiating sexual relationships easier once they had left home. Multiple factors mediated their use of health care services, including the immediacy of their need, their accommodation status, an understanding of managing health, knowledge of health issues and availability of a suitable service. In relation to health care access, young people tended to prioritise the things (e.g. vaccinations, sexual health screens, and antenatal care) that led to them feeling ‘healthy’, whatever that meant to them. Health meant different things to young men and young women, men tended to emphasise fitness, while women tended to emphasise body size. The findings suggest provision of and access to sex education for this group varied in acceptability and value. My study showed that lack of secure accommodation and family support compromised the young people’s social needs, access to health care, relationships and opportunities to establish the healthy lifestyles important for long-term wellbeing. Homelessness reduced their ability to begin and maintain sexual relationships and access ongoing health care with a regular health care provider. Women faced additional challenges creating healthy, safe sexual relationships. Furthermore, my research contributes to the field of health and youth homelessness by better describing the diverse homeless population and offering practical implications of ways to improve the health of these young people. Few researchers have compared gendered experiences of homelessness, and most of the few existing studies involve people older than 25 years. My research of the sexual health of young Australian homeless is novel in that it uses the voices of young males and females experiencing homelessness while being housed in temporary youth refuge accommodation. It contributes to the field of health and youth homelessness with its identification of practical ways to improve the health of these young people. Additionally, the results highlight that health professionals need further training to understand the circumstances, diverse backgrounds and health needs of young people experiencing homelessness. The findings also emphasise the importance of young homeless people’s access to free health services