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Street youth: Adaptation and survival in the AIDS decade
JOURNAL OF ADOLESCENT
G.
CAJETAN
HEALTH N91;32:511-514
L?JNA
This article discusses adaptational and survival strategies of homeless youth and describes how pilot research, begun in 1982 on these strategies in the western United States, led to additional research and activity focused upon the related international street youth probtem. The results of this research suggest that a critical relationship exists between survival strategies and the AIDS pandemic. The impact of this pandemic on street youth can be mitigated only by immediate a-d comprehensive yreventive actions at both national and international levels. WY WORDS:
youth Survival strategies HIV infection Street
AIDS
Street youths are engaged in a constant struggle for survival. Often exploited by adults because of their vulnerable situation and ignored by social service and health organizations oriented toward the homeless adult population, many street youths must obtain food, clothing, and shelter on a daily basis any way possible. Given this short-term orientation, more long-term considerations related to HIV infection and AIDS are often overlooked or denied. Research conducted in the western United States and Brazil supports the conclusion that street survival strategies, including sexual activity for money and drug use, put street youths in situations at consid-
Frm Mount Zion Hospital and Medical Center of the Universih! of Califwrzio, San Francisco, California. Address reprint requests to: G. C&an Luna, Researc!r Assokate and Coordinator, Mount Zion Hospital and Medical Cmter of the University of California, tin Francisco, 1600 Divisadp?o Street, San Francisco, CA 94120. Manuscript accept~l November 20, 1 QP,(r.
erable risk for disease and other health-related problems. These practices often take place when youths are aware of the potential risks. The ohcervations and recommendations in this article are the result of a series of interrelated studies. In 1982, an ethnographic pilot study on homeless youth was conducted in San Francisco, Los Angeles, and Seattle. With the approval of the Institutional Review Board at the University of California, San Francisco, structured and unstructured interviews were completed with a chain referral and clinic sample of 250 males and females between 15 and 19 years of age in both natural and clinical settings on the West Coast of the United States from 1982 to 1984 (1). Participant observations of the street scene occurred during the same 2-year period. Contact has been maintained with a subsample of 27 youths who have been interviewed in depth and followed over time (2) with particular attention to health-related beliefs and behaviors. In addition, structured interviews were conducted with 100 male “kept youths” 16-19 years of age on their health practices and behaviors. They were identified as a particularly difficult population to reach in regard to health-related services. In 1986, a small pilot study was developed to assess HIV infel-tion among teenagers. The study was conducted over a 4-month period and included both HIV testing and behavioral interviews. A particular effort was made to recruit street youth. Fifty sexually active teenagers, 16-19 years of age (19 males amd 31 females), were enrolled from the Adolescent Clinic ;t San Francisco General Hospital. Eleven were recently or currently homeless. Aware of demographic similarities between San Francisco and Rio de Janeiro, we began in 1988 crosscultural comparative research on street youth and AIDS in collaboration with the Adolescent Services
0 Society for Adolescent Medicine, 1991 P&shed by Eisevier Scieo;e Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
511
!a2
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
LUNA
Unit at the State University of Rio de Janeiro. Questionnaires were modified, translated into Portuguese, and administered to 103 street youths, or menines and minim de rua, in institutional settings.
Street Youth
in Two
Cultures
in the studies conducted in the United States it was evident that personal and immediate survival dominated the lives of street youths. Normal adolescent development was disrupted by early separation from family and often forced traumatic initiation into sexual activity. Money became a necessity. A wide spectrum of available and chosen survival strategies existed along with the accompanying adaptation to existing lifestyles and subcultural groups. Some youths sold small goods or used clothing, but most of them panhandled, dealt drugs, or stole, especially in areas frequented by tourists, such as Ghiradelli Square, the Wharf, Haight, and North Beach in San Francisco; on Hollywood, Santa Monica, and Sunset Boulevards in Los Angeles; and around the Pike Place Market in Seattle. Similar to what is reported by others in this issue (Deisher, Litchfield, and Hope; Yates et al.), equally large numbers were involved in sexual activity for money, either habitually or episodically, to q?urvive. Street youths adopted the social roles and identities essential to their survival. The graffiti of these youths were a particularly significant and unobtrusive form of communication Statements such as “We sold our love here” and “Welcome to my Nightmare” were common and particularly poignant (3). The health problems of male “‘kept youths” were particularly troubling. “Kept youths” defined as those youth who had previously been on the street and were now supported in part or in full by nonrelated ad&s, were often involved in organized prostitution and pornography. They were invisible to s\ost health care providers until thrown out by ‘*sugar daddies.” Once again they were forced to survive on the streets, only later to appear at dropin clinics or public health centers (4). Male kept youths were clearly at risk for sexually transmitted diseases (STD); 28 of 52 who spoke of their sexual behaviors reported that they did not use condoms during sexual activity. Andy is a typical example of a street youth at risk. In interviews he described how he had been thrown out of his Floridahome in 1985 at the age of 14 years because he had been involved in sexual activity with anotfier boy. In the turmoil that follsved he told his
parents he thought he was gay. His father, a policeman, immediately told him to leave home and “disowned” him. By $86, Andy had hustled and bummed in San Francisco, Los Angeles, and HOUSton. He had been kept by a number of older men. He had also had a variety of STD, overdosed twice, and been stabbed on three occasions while hustling or dealing drugs. He was proud to display the resulting scars intermixed with tattoos. By late 1986, Andy was avoiding the “meat rack” on Polk Street, and was living in a cardboard box in Golden Gate Park with another youth who had similarly been ejected from his Albuquerque home. In 1986,SO youth were tested for HIV at San Francisco General Hospital. Andy was the. one youth in the sample who tested positive. He left San Francisco to avoid an arrest warrant before receiving the I-llV test results. Later we learned from another street youth that Andy had died of AIDS-related complications in a county hospital in Florida in March 1989, at age 19. A week earlier he had been living on the street. By 1987, the health community realized that street youth were at high-risk for HIV infection because of their street activities. Clinical cases of AIDS began to appear among street youth still in th‘ck teens or former street 4 7th in their tidriy twenties in urban centers throughout the United States (5). Studies of street youth and HIV infection continue to reveal the increasing incidence of AIDS in this population. While street youth are very difficult to track, HIV studies in diverse environments have obtained similar results. In 1988, 10.5% of street youths in New York’s Covenant House Medical Clinic tested HIV positive (6). In a large serological study conducted on HIV and street youth, Carvelho found 32 youths were infected in the state institution for street youth in Rio de Janeiro (78). Seven hundred minors, or 35% of the abandoned Brazilian youths in FUNABEM (Fundacao National do Bern-Estar do Menor) and FEEM (Fundacao Estadual de Educacao ao Menor), were also reported infected (9). A recent study in downtown Rio de Janeiro found 68.6% of males (age 11-23 years) engaged in sexual activity for money were infected (10). Meninos and naeninasde ma in Rio de Janeiro are similar to street youth in San Francisco. Since leaving his Pernambuco home at the age of 12 years, Carlos, now 16, has lived on the streets of Rio de Janeiro. To make life easier on his parents, Carloslefta family of seveu brothers and sisters and a physically abusive, intermittentlyemployed father. Nevertheless, when possible, he rides the roof of
November1991
the tmin home every few months to visit hia family. Carloz regularly visits his uncle who lives in Rio. Carlos sells small tourist goods on Copacabana Beach during the day and has a side business selling cocaine to interested tourists at night. He considers himself “sexual” when asked his sexual orientation. When he needs money he “can get it easy” from the tourists at the outdoor cafes in front of the Galeria Alaska in Copacabana or in Cinelandia. He has sex with men if they pay him “enough.” He engages in both insertive and receptive oral and anal sex. He has engaged in unprotected sex with many men. Most refused to pay if he used a condom. He is used to this practice; “You do what you have to do to survive.” His girlfriend who has also lived on the street, now lives with her aunt. Carlos and his girlfriend have had sexual relations on numerous occasions. She is unaware of how Carlos earns money. He would be ashamed if his family or girlfriend knew. He does not us2 a condom when he has sex with his girlfriend; he believes that if he d;d, shy tb~:rrZ think he had ATE. I& dues not worry about AIDS or death. If he was infected, it would not matter anyway. “I live on the street, I don’t really have anyone. I die every day. I’m not afraid of death, I’m afraid of life.” Like San Francisco’s street youth, meninos de IUQ are subjected to a variety of physical violence and sexual abuse from family members, law enforcement officials, drug dealers and addicts, mentally disturbed homeless adults, service providers, and especially by tourists. Similarly, most of them are also abused within their own street peer groups. Sex for money and glue or solvent inhalation are common practices among youth in the Copacabana, Cinelandia, and train station areas in central Rio. According to service providers in Brazil, low selfesteem is the most serious problem of these youth, with no family, jobs or potential jobs, and little if any education. In interviews, most stated that they felt that they had no control over what would happen in their lives. In addition to obtaining money, there are several reasons for high-risk sexual activity (such as unprotected receptive anal sex) among street youth including, for adolescent males, homosexual or bisexual experimentation and sexual intercourse as a rite of passage in pervasively male-oriented culture;. or as a reflection of dominant-submissive-aggressive behavior. For adolescent street females, especially in Brazil, anal intercourse is often employed as a means of birth control. However, it is important to
STREET SURVIVAL IN AIDS DECADE
513
emphasize that male and female street youth studied i.n the United States and Brazil, given their precarious life situations and previous deprivations, often perceive high-risk sexual activity as a different or exciting way to express or receive some semblance of affection.
Discussion viewed cross-culturally
and globally, the adaptational and survival strategies of street youth in the western United States and meninos de ruu in &O de Janeiro are similar in nature and often identical in character to those of the estimated 100 million street youth of the world (11). Social inequalities and prevailing familial disruptions are common in all countries. Street youth remain at the fringes of society, the casualties of larger inherent social problems. Whether due to the death of parents, war, poverty, famine, disease, abandonment, or abuse, the social and health problems of the world’s street youth are proround. It is easy to understand why street youth everywhere (including those studied in the western United States and Brazil) have difficulty perceiving the threat of AIDS, the consequences, and the need for precautions given other more pressing survival factors. In response, there are a number of programs addressing the street youth and AIDS problem in different countries and on the international level, The Society for Adolescent Medicine, UNICEF, and the Pan American and the World Health organizations are directly concerned with the related and endemic health problems, prevention, and education of street youth (12). On June 25, 1990, these organizations, along with other govemment;tl and nongovernmental organizations, cosponsored the first international conference (held in San Francisco) focused solely on AIDS and street youth. These organizations will also cosponsor the Segundo Encontro International de Meninos-Meninas de Rua in Rio de Janeiro, Brazil, September 3-5, 1992, which will address larger health related issues. The AIDS pandemic gives special impetus to immediate and comprehensive preventive actions (13). Those who provide health care services to street youth throughout the nation must create an informational exchange network. In addition, scientists must continue to undertake both national and international collaborative research initiatives. Given the current urgency of the local, national, an@ international AIDS problem, long--term housing for street youth must be available on a large-scale
514
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
LUNA
basis, with accompanying and coordinated health care and social services. There must be special services for those who are HIV infected, including treatment, follow-up, and case management. However, segregation and isolation must be resisted. Streetbased AIDS education and outreach should target not only street adolescents involved in sex for money, but concentrate on those nonhomeless peers who nevertheless are actively involved in the street scene. Particular attention, including research, prevention, and education, must also be directed to the customers of these teenagers, especially tourists. In addition, durable and appropriately sized condoins must be available at no cost to street youth. Adultsized condoms are not always available or appropriate (14). Professionals must develop, encourage, and support interventions and programs that promote selfesteem, not dependency, in street youth. Being off the street physically does not eliminate the psychological and financial needs that often drive some youth to perceive the street as the only alternative. Finally, as the new decade unfolds, social and health interventions must be developed to empower street youth themselves. Programs should be designed to assist by organizing these youth to advocate for their own rights, respectfully identifying their skills, resiliency and resourcefulness, and treating them deserve.
with the compassion
and dignity
References 1. Luna GC, Brown RC, Eisenstein E. The significance of the
2.
7.
8.
9.
10.
11.
they 12.
The author acknowledges the support of the Center for AIDS Prevention Studies, the Universitywide AIDS Research Programs, and the University Re+earch Expeditions Program at the University of California, Berkeley. The author acknowledges the collaboration of Drs. Joan I. Ablon,Richard C. Brown, D. Nicollete Collins, and Evelyn Eisenstein, and the assistance of Robson F. Pinto and Raimundo Paulito.
13. 14.
AIDS pandemic for homeless youth. Proceedings of the Fifth International Conference on AIDS, Montreal, June 1989. Luna GC. HIV infection and street youth. Proceedings of the Second International AIDS Symposium for Health Professionals, Vancouver, British Columbia, November 1988. Luna GC. Welcome to my nightmare: The graffiti of homeless youth. Society Magazine 1987;24:73-8. Luna GC. HIV and homeless youth. Focus: A Review of AIDS Research 1987;2:10. Hein K. AIDS in adolescents: A rationale for concern. NY State J Med 1987;290-5. St&of R, Novick LF, Kennedy J, et al. Seroprevalence of adolescents at a homeless facility. American Public Health Association Conference, Boston, November 1988. Vasconcellos-Carvalho CJ, Castro-Menezes LF. Estudio epidemiologico de HIV em menores encaminhados ao Hospital Central da FUNABEM/RJ. Rio de Janeiro, Brazil: Ministerio da Previdencia e Assistencia SociaYMPASIFUNABEM, June 1988. JomaQ ;la FUNABEM. FUNABEM esta a parelhada para lutar contra a AIDS. Rio de Janeiro, Brazil: Coordinadoria de Comunicacao Social 1988;.1:5. Ministerio da Saude. As faces da AIDS: A AIDS no Bras% Rio de Janeiro, Brazil: II Teleconferencia Pan-Americana Sobre AIDS, December 12, 1988. Long0 P, Pereira R, Vasconcellos LE, et al. Pegacao program: Information and prevention for male prostitutes in Rio de Janeiro, Brazil. Proceedings of the Sixth International Conference on AIDS, San Francisco, June 1990. CHILDHOPE. Our Child Our Hope, 1989. Guatemala: CHILDHOPE: The International Movement on Behalf of Street Children, 1989;1:4. World Health Organization. AIDS Health Promotion Exchange, 1989. Amsterdam: World Health Organization Global Programme on AIDS Health Promotior. Unit, no. 2; 1989. Luna GC, Sondheimer DL. HIV and AIDS among street youth. Children with AIDS 19!30;2:2. Luna, GC, Brown RC, Eisenstein E, Justin R. Condom use, misuse, and nonuse among homeless youth. Proceedings of the Sixth International Conference on AIDS, San Francisco, June 1990,
G.
CAJETAN
HEALTH N91;32:511-514
L?JNA
This article discusses adaptational and survival strategies of homeless youth and describes how pilot research, begun in 1982 on these strategies in the western United States, led to additional research and activity focused upon the related international street youth probtem. The results of this research suggest that a critical relationship exists between survival strategies and the AIDS pandemic. The impact of this pandemic on street youth can be mitigated only by immediate a-d comprehensive yreventive actions at both national and international levels. WY WORDS:
youth Survival strategies HIV infection Street
AIDS
Street youths are engaged in a constant struggle for survival. Often exploited by adults because of their vulnerable situation and ignored by social service and health organizations oriented toward the homeless adult population, many street youths must obtain food, clothing, and shelter on a daily basis any way possible. Given this short-term orientation, more long-term considerations related to HIV infection and AIDS are often overlooked or denied. Research conducted in the western United States and Brazil supports the conclusion that street survival strategies, including sexual activity for money and drug use, put street youths in situations at consid-
Frm Mount Zion Hospital and Medical Center of the Universih! of Califwrzio, San Francisco, California. Address reprint requests to: G. C&an Luna, Researc!r Assokate and Coordinator, Mount Zion Hospital and Medical Cmter of the University of California, tin Francisco, 1600 Divisadp?o Street, San Francisco, CA 94120. Manuscript accept~l November 20, 1 QP,(r.
erable risk for disease and other health-related problems. These practices often take place when youths are aware of the potential risks. The ohcervations and recommendations in this article are the result of a series of interrelated studies. In 1982, an ethnographic pilot study on homeless youth was conducted in San Francisco, Los Angeles, and Seattle. With the approval of the Institutional Review Board at the University of California, San Francisco, structured and unstructured interviews were completed with a chain referral and clinic sample of 250 males and females between 15 and 19 years of age in both natural and clinical settings on the West Coast of the United States from 1982 to 1984 (1). Participant observations of the street scene occurred during the same 2-year period. Contact has been maintained with a subsample of 27 youths who have been interviewed in depth and followed over time (2) with particular attention to health-related beliefs and behaviors. In addition, structured interviews were conducted with 100 male “kept youths” 16-19 years of age on their health practices and behaviors. They were identified as a particularly difficult population to reach in regard to health-related services. In 1986, a small pilot study was developed to assess HIV infel-tion among teenagers. The study was conducted over a 4-month period and included both HIV testing and behavioral interviews. A particular effort was made to recruit street youth. Fifty sexually active teenagers, 16-19 years of age (19 males amd 31 females), were enrolled from the Adolescent Clinic ;t San Francisco General Hospital. Eleven were recently or currently homeless. Aware of demographic similarities between San Francisco and Rio de Janeiro, we began in 1988 crosscultural comparative research on street youth and AIDS in collaboration with the Adolescent Services
0 Society for Adolescent Medicine, 1991 P&shed by Eisevier Scieo;e Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
511
!a2
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
LUNA
Unit at the State University of Rio de Janeiro. Questionnaires were modified, translated into Portuguese, and administered to 103 street youths, or menines and minim de rua, in institutional settings.
Street Youth
in Two
Cultures
in the studies conducted in the United States it was evident that personal and immediate survival dominated the lives of street youths. Normal adolescent development was disrupted by early separation from family and often forced traumatic initiation into sexual activity. Money became a necessity. A wide spectrum of available and chosen survival strategies existed along with the accompanying adaptation to existing lifestyles and subcultural groups. Some youths sold small goods or used clothing, but most of them panhandled, dealt drugs, or stole, especially in areas frequented by tourists, such as Ghiradelli Square, the Wharf, Haight, and North Beach in San Francisco; on Hollywood, Santa Monica, and Sunset Boulevards in Los Angeles; and around the Pike Place Market in Seattle. Similar to what is reported by others in this issue (Deisher, Litchfield, and Hope; Yates et al.), equally large numbers were involved in sexual activity for money, either habitually or episodically, to q?urvive. Street youths adopted the social roles and identities essential to their survival. The graffiti of these youths were a particularly significant and unobtrusive form of communication Statements such as “We sold our love here” and “Welcome to my Nightmare” were common and particularly poignant (3). The health problems of male “‘kept youths” were particularly troubling. “Kept youths” defined as those youth who had previously been on the street and were now supported in part or in full by nonrelated ad&s, were often involved in organized prostitution and pornography. They were invisible to s\ost health care providers until thrown out by ‘*sugar daddies.” Once again they were forced to survive on the streets, only later to appear at dropin clinics or public health centers (4). Male kept youths were clearly at risk for sexually transmitted diseases (STD); 28 of 52 who spoke of their sexual behaviors reported that they did not use condoms during sexual activity. Andy is a typical example of a street youth at risk. In interviews he described how he had been thrown out of his Floridahome in 1985 at the age of 14 years because he had been involved in sexual activity with anotfier boy. In the turmoil that follsved he told his
parents he thought he was gay. His father, a policeman, immediately told him to leave home and “disowned” him. By $86, Andy had hustled and bummed in San Francisco, Los Angeles, and HOUSton. He had been kept by a number of older men. He had also had a variety of STD, overdosed twice, and been stabbed on three occasions while hustling or dealing drugs. He was proud to display the resulting scars intermixed with tattoos. By late 1986, Andy was avoiding the “meat rack” on Polk Street, and was living in a cardboard box in Golden Gate Park with another youth who had similarly been ejected from his Albuquerque home. In 1986,SO youth were tested for HIV at San Francisco General Hospital. Andy was the. one youth in the sample who tested positive. He left San Francisco to avoid an arrest warrant before receiving the I-llV test results. Later we learned from another street youth that Andy had died of AIDS-related complications in a county hospital in Florida in March 1989, at age 19. A week earlier he had been living on the street. By 1987, the health community realized that street youth were at high-risk for HIV infection because of their street activities. Clinical cases of AIDS began to appear among street youth still in th‘ck teens or former street 4 7th in their tidriy twenties in urban centers throughout the United States (5). Studies of street youth and HIV infection continue to reveal the increasing incidence of AIDS in this population. While street youth are very difficult to track, HIV studies in diverse environments have obtained similar results. In 1988, 10.5% of street youths in New York’s Covenant House Medical Clinic tested HIV positive (6). In a large serological study conducted on HIV and street youth, Carvelho found 32 youths were infected in the state institution for street youth in Rio de Janeiro (78). Seven hundred minors, or 35% of the abandoned Brazilian youths in FUNABEM (Fundacao National do Bern-Estar do Menor) and FEEM (Fundacao Estadual de Educacao ao Menor), were also reported infected (9). A recent study in downtown Rio de Janeiro found 68.6% of males (age 11-23 years) engaged in sexual activity for money were infected (10). Meninos and naeninasde ma in Rio de Janeiro are similar to street youth in San Francisco. Since leaving his Pernambuco home at the age of 12 years, Carlos, now 16, has lived on the streets of Rio de Janeiro. To make life easier on his parents, Carloslefta family of seveu brothers and sisters and a physically abusive, intermittentlyemployed father. Nevertheless, when possible, he rides the roof of
November1991
the tmin home every few months to visit hia family. Carloz regularly visits his uncle who lives in Rio. Carlos sells small tourist goods on Copacabana Beach during the day and has a side business selling cocaine to interested tourists at night. He considers himself “sexual” when asked his sexual orientation. When he needs money he “can get it easy” from the tourists at the outdoor cafes in front of the Galeria Alaska in Copacabana or in Cinelandia. He has sex with men if they pay him “enough.” He engages in both insertive and receptive oral and anal sex. He has engaged in unprotected sex with many men. Most refused to pay if he used a condom. He is used to this practice; “You do what you have to do to survive.” His girlfriend who has also lived on the street, now lives with her aunt. Carlos and his girlfriend have had sexual relations on numerous occasions. She is unaware of how Carlos earns money. He would be ashamed if his family or girlfriend knew. He does not us2 a condom when he has sex with his girlfriend; he believes that if he d;d, shy tb~:rrZ think he had ATE. I& dues not worry about AIDS or death. If he was infected, it would not matter anyway. “I live on the street, I don’t really have anyone. I die every day. I’m not afraid of death, I’m afraid of life.” Like San Francisco’s street youth, meninos de IUQ are subjected to a variety of physical violence and sexual abuse from family members, law enforcement officials, drug dealers and addicts, mentally disturbed homeless adults, service providers, and especially by tourists. Similarly, most of them are also abused within their own street peer groups. Sex for money and glue or solvent inhalation are common practices among youth in the Copacabana, Cinelandia, and train station areas in central Rio. According to service providers in Brazil, low selfesteem is the most serious problem of these youth, with no family, jobs or potential jobs, and little if any education. In interviews, most stated that they felt that they had no control over what would happen in their lives. In addition to obtaining money, there are several reasons for high-risk sexual activity (such as unprotected receptive anal sex) among street youth including, for adolescent males, homosexual or bisexual experimentation and sexual intercourse as a rite of passage in pervasively male-oriented culture;. or as a reflection of dominant-submissive-aggressive behavior. For adolescent street females, especially in Brazil, anal intercourse is often employed as a means of birth control. However, it is important to
STREET SURVIVAL IN AIDS DECADE
513
emphasize that male and female street youth studied i.n the United States and Brazil, given their precarious life situations and previous deprivations, often perceive high-risk sexual activity as a different or exciting way to express or receive some semblance of affection.
Discussion viewed cross-culturally
and globally, the adaptational and survival strategies of street youth in the western United States and meninos de ruu in &O de Janeiro are similar in nature and often identical in character to those of the estimated 100 million street youth of the world (11). Social inequalities and prevailing familial disruptions are common in all countries. Street youth remain at the fringes of society, the casualties of larger inherent social problems. Whether due to the death of parents, war, poverty, famine, disease, abandonment, or abuse, the social and health problems of the world’s street youth are proround. It is easy to understand why street youth everywhere (including those studied in the western United States and Brazil) have difficulty perceiving the threat of AIDS, the consequences, and the need for precautions given other more pressing survival factors. In response, there are a number of programs addressing the street youth and AIDS problem in different countries and on the international level, The Society for Adolescent Medicine, UNICEF, and the Pan American and the World Health organizations are directly concerned with the related and endemic health problems, prevention, and education of street youth (12). On June 25, 1990, these organizations, along with other govemment;tl and nongovernmental organizations, cosponsored the first international conference (held in San Francisco) focused solely on AIDS and street youth. These organizations will also cosponsor the Segundo Encontro International de Meninos-Meninas de Rua in Rio de Janeiro, Brazil, September 3-5, 1992, which will address larger health related issues. The AIDS pandemic gives special impetus to immediate and comprehensive preventive actions (13). Those who provide health care services to street youth throughout the nation must create an informational exchange network. In addition, scientists must continue to undertake both national and international collaborative research initiatives. Given the current urgency of the local, national, an@ international AIDS problem, long--term housing for street youth must be available on a large-scale
514
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
LUNA
basis, with accompanying and coordinated health care and social services. There must be special services for those who are HIV infected, including treatment, follow-up, and case management. However, segregation and isolation must be resisted. Streetbased AIDS education and outreach should target not only street adolescents involved in sex for money, but concentrate on those nonhomeless peers who nevertheless are actively involved in the street scene. Particular attention, including research, prevention, and education, must also be directed to the customers of these teenagers, especially tourists. In addition, durable and appropriately sized condoins must be available at no cost to street youth. Adultsized condoms are not always available or appropriate (14). Professionals must develop, encourage, and support interventions and programs that promote selfesteem, not dependency, in street youth. Being off the street physically does not eliminate the psychological and financial needs that often drive some youth to perceive the street as the only alternative. Finally, as the new decade unfolds, social and health interventions must be developed to empower street youth themselves. Programs should be designed to assist by organizing these youth to advocate for their own rights, respectfully identifying their skills, resiliency and resourcefulness, and treating them deserve.
with the compassion
and dignity
References 1. Luna GC, Brown RC, Eisenstein E. The significance of the
2.
7.
8.
9.
10.
11.
they 12.
The author acknowledges the support of the Center for AIDS Prevention Studies, the Universitywide AIDS Research Programs, and the University Re+earch Expeditions Program at the University of California, Berkeley. The author acknowledges the collaboration of Drs. Joan I. Ablon,Richard C. Brown, D. Nicollete Collins, and Evelyn Eisenstein, and the assistance of Robson F. Pinto and Raimundo Paulito.
13. 14.
AIDS pandemic for homeless youth. Proceedings of the Fifth International Conference on AIDS, Montreal, June 1989. Luna GC. HIV infection and street youth. Proceedings of the Second International AIDS Symposium for Health Professionals, Vancouver, British Columbia, November 1988. Luna GC. Welcome to my nightmare: The graffiti of homeless youth. Society Magazine 1987;24:73-8. Luna GC. HIV and homeless youth. Focus: A Review of AIDS Research 1987;2:10. Hein K. AIDS in adolescents: A rationale for concern. NY State J Med 1987;290-5. St&of R, Novick LF, Kennedy J, et al. Seroprevalence of adolescents at a homeless facility. American Public Health Association Conference, Boston, November 1988. Vasconcellos-Carvalho CJ, Castro-Menezes LF. Estudio epidemiologico de HIV em menores encaminhados ao Hospital Central da FUNABEM/RJ. Rio de Janeiro, Brazil: Ministerio da Previdencia e Assistencia SociaYMPASIFUNABEM, June 1988. JomaQ ;la FUNABEM. FUNABEM esta a parelhada para lutar contra a AIDS. Rio de Janeiro, Brazil: Coordinadoria de Comunicacao Social 1988;.1:5. Ministerio da Saude. As faces da AIDS: A AIDS no Bras% Rio de Janeiro, Brazil: II Teleconferencia Pan-Americana Sobre AIDS, December 12, 1988. Long0 P, Pereira R, Vasconcellos LE, et al. Pegacao program: Information and prevention for male prostitutes in Rio de Janeiro, Brazil. Proceedings of the Sixth International Conference on AIDS, San Francisco, June 1990. CHILDHOPE. Our Child Our Hope, 1989. Guatemala: CHILDHOPE: The International Movement on Behalf of Street Children, 1989;1:4. World Health Organization. AIDS Health Promotion Exchange, 1989. Amsterdam: World Health Organization Global Programme on AIDS Health Promotior. Unit, no. 2; 1989. Luna GC, Sondheimer DL. HIV and AIDS among street youth. Children with AIDS 19!30;2:2. Luna, GC, Brown RC, Eisenstein E, Justin R. Condom use, misuse, and nonuse among homeless youth. Proceedings of the Sixth International Conference on AIDS, San Francisco, June 1990,