Homeless youths are likely to engage in risky sexual behavior such as unprotected sex, sex trading, and multiple partners. This behavior exposes them to sexually transmitted diseases and infections as well as early unwanted pregnancies. It also increases the vulnerability of engaging in risky sexual behavior. Homeless youth are more likely to abuse controlled substances including drugs and alcohol. Substance use is a risk factor for sexually transmitted illnesses such as Human Immunodeficiency Virus. It has a positive relationship with the sex trade, unprotected sex, and sharing of non-disinfected needles. Hence, homeless youth have a high risk of engaging in risky sexual behavior due to the uncontrolled environment.
Youths and Sexually Transmitted Diseases
Living conditions in the streets push homeless youth into risky activities that are sometimes inevitable. According to Asante, Meyer-Weitz, and Inge (2016), homeless youth are susceptible to various mental conditions, which contribute to sexual promiscuity and other risky behavior. Asante et al. (2016) argued that risky behavior among homeless youth focuses on survival strategies in the streets. Young people are more likely to engage in any activity for survival. Kennedy, Tucker, Green, Golinelli, and Ewing (2012) argued that homeless youth are at a higher risk of contracting sexually transmitted infections compared to the non-homeless group. Substance use, poor living conditions, and survival strategies increase the probability of homeless young people to engage in risky sexual activities. Kennedy et al. (2012) suggest that sharing of needles for injection of substances is likely to spread diseases. Though homeless youth may engage in safe sex and the context of substance use, the probability of indulging in risky sexual behavior is high.
Intervention measures for sexual promiscuity among homeless youth include increasing accessibility to condoms and education programs. However, being homeless is one of the risk factors for sexual promiscuity and substance use. The group lacks a central location where they can access services since most of them move from one town to another. They are most likely to be out of reach for the available intervention measures. As a result, the strategies are not valid because the possibility of reaching the target population is highly unlikely. According to Naranbhai, Abdool Karim, and Meyer-Weitz (2013), psychosocial and contextual factors that cause risky behavior also act as the main limitation for the implementation of various intervention measures. It is also difficult to communicate the purpose of the strategies as the youth may not welcome interventions due to ignorance. Holes shelters are temporary residences whose occupants changes frequently. Studies on the effectiveness of the intervention measures also produce ambiguous results. Hence, it is difficult to establish the best alternative for intervention.
Applying Ethical Decision Making and Critical Analysis to the Youth Homelessness
The primary professional responsibility of every nurse is to the people in need of care. Provision of care aims to promote the value of life and ensuring that caregivers respect people’s customs, rights, and beliefs. According to the International Council of Nurses (2012), the nurse bears the responsibility of the nursing practice. The use of such knowledge helps to grow the profession and serve the primary purpose of health care. Nurses also have an ethical responsibility to provide care to all individuals. While working with all members of the society, caregivers owe their patients duty of care, confidentiality, the accuracy of information, advocacy, integrity, and respect (Barman-Adhikari & Rice, 2011). Another important aspect is the act of compassion and responsiveness. Issues of homeless youth and sexual promiscuity touch on almost every aspect of ethical responsibility in nursing.
Homeless youth lack sufficient knowledge to understand the impacts of their risky behavior. Also, lack of expertise reduces the effectiveness of help-seeking behavior. Hence, homeless youth may fail to look for medical assistance for prevention and treatment because they are unaware of where to get such help. They also face numerous mental health problems that may deter their willingness to seek help. As a result, homeless youth fail to seek assistance and inhibit any possibility of accessing intervention measures. According to Barman-Adhikari and Rice (2011), homeless youth are reluctant to seek help through available traditional health facilities. According to Hudson et al. (2010), one of the factors that limit health seeking behavior among homeless youth is the lack of familiarity with accessing health. Thus, the lack of sufficient knowledge about alternative social and structural levels of assistance that are accessible to them inhibits access to care.
Additionally, homeless youth fear retribution and actions that members of society and health professionals may take if they seek assistance. The existing legal and social activities against homeless youth act as a barrier to finding health care. According to Hudson et al. (2010), homeless youth fail to seek health assistance due to fear of legal intervention or social service notification. Such fears inhibit homeless youth’s willingness to explore health leading to increased health risks and transfer of infectious and sexually transmitted diseases. According to Hudson et al. (2010), homeless youth face structural and social barriers to health. Structural barriers refer to system-related hindrances like limited clinic sites while social barriers refer to societal norms and beliefs such as uncaring professional. These factors limit health seeking behavior among homeless youth and decrease the effectiveness of intervention measures.
Nurses have an ethical responsibility to provide care to needy homeless youth. Homeless youth is one of the groups in the society that are in urgent need of medical information and assistance. Most of them are unable to access traditional healthcare facilities due to the fears mentioned above. To ensure that the group can access healthcare, nurses and other healthcare professional should come up with ways to improve healthcare provision. According to Naranbhai et al. (2013), it is difficult to establish the effectiveness of current intervention measures. Hence, the caregivers should move from traditional to modern approach of providing care. Nurses have the responsibility to develop better and more realistic intervention measures. The most realistic intervention measures are evidence-based treatment strategies. However, evidence-based intervention measures require lots of research to establish the needs of the patients and the impact of the intervention measures.
There is limited knowledge of the factors and conditions that would determine the effectiveness of intervention measures. Hence, nurses also have an ethical responsibility to expand the body of knowledge concerning homeless youth. One of the limitations to intervention measures for homeless youth is the lack of understanding of the real issues that the group experiences (Hudson et al., 2011). Existing intervention measures such as social service notification and legal intervention only increase medical risks for homeless youth. Some homeless youth are runaways from their homes as a result of home problems and disagreements with their parents (Hudson et al., 2010). Thus, most are often unwilling to return home. Most intervention approaches used involve returning the youth to their parents. Hence, for homeless youth, seeking health assistance is a risk factor as they are forced to return to areas that escaped. As a result, intervention measures such as social service agency notification generate a form of fear among the youth and push them away from health facilities. Therefore, there is a gap of knowledge between the intervention measures and the real situation affecting homeless youth. Nurses and other medical professionals have an ethical responsibility to fill the gap of knowledge through research.
Also, nurses owe homeless youth, like any other patient, the duty of confidentiality. As discussed above, homeless youth fear the current intervention measures that aim at reuniting them with their families. Actions such as social service notifications only cause fear among homeless youth (Hudson et al., 2011). Hence, nurses need to refrain from taking such actions. To encourage homeless youth to seek medical assistance, nurses and other medical professionals need to exercise the duty of confidentiality. Nurses also need to protect young people from scrutiny from law enforcement. Nurses need to preserve their relationship with homeless youth by accepting their unwillingness to return home. Protecting homeless youth confidential information, medical professionals can develop a lasting relationship with young people and encourage health-seeking behavior (Adhikari & Rice, 2011). Such means can help to eliminate barriers to health-seeking behavior and increase familiarity with health care resources.
Plan of Action and Conclusion
An ethical plan will involve knowledge gathering and the development of an evidence-based intervention for homeless youth. The new intervention strategy must stress confidentiality and knowledge provision for homeless youth. It must also encourage continuous knowledge gathering and establishment of positive relationships with homeless youth. Doing so will help the young population to seek medical assistance and provide knowledge about risky behaviors. Besides, youths also need training on the strategies to be established for them to embrace changes quickly. The intervention method must also include training the youth about prevention measures and better survival strategies like job seeking. During the training, the facilitators can place monetary awards to those who will show significant change after the program. This move will be a way of motivating them to take the program seriously. Hence, the intervention method should be psychological and psychosocial friendly to encourage the youth to refrain from risky behavior. However, to achieve the above strategies, nurses and other professionals must engage in knowledge gathering and research.
It is clear that homeless youths are likely to engage in risky behavior such as unprotected sex and trade due to uncontrolled environment. Thus, they are susceptible to sexually transmitted diseases such as HIV/AIDs and unwanted pregnancies. They also have high chances of indulging in substance abuse. Unfortunately, the intervention measures that have been established seem ineffective due to various reasons. Lack of permanent shelters reduces the practicability of these approaches as most youths move from one town to another in search of food and other necessities. Besides, research shows that homeless youth refrain from conventional means of healthcare provision since most of them are not friendly. Many of them are not aware of the existing strategies. Others are not willing to go through the new approaches due to fear of facing the law. Hence, the new intervention method must avoid reporting of homeless youth to social service agencies and other legal systems.
Asante, K. O., Meyer-Weitz, A., & Petersen, I. (2016, June). Mental health and health risk behaviors of homeless adolescents and youth: A mixed methods study. In the Child & Youth Care Forum (Vol. 45, No. 3, pp. 433-449). Springer US.
Barman-Adhikari, A., & Rice, E. (2011). Sexual health information seeking online among runaway and homeless youth. Journal of the Society for Social Work and Research, 2(2), 88-103.
Hudson, A. L., Nyamathi, A., Greengold, B., Slagle, A., Koniak-Griffin, D., Khalilifard, F., & Getzoff, D. (2010). Health-seeking challenges among homeless youth. Nursing Research, 59(3), 212-8.
Kennedy, D. P., Tucker, J. S., Green, H. D., Golinelli, D., & Ewing, B. (2012). Unprotected sex of homeless youth: Results from a multilevel dyadic analysis of individual, social network, and relationship factors. AIDS and Behavior, 16(7), 2015-32.
Naranbhai, V., Abdool Karim, Q., & Meyer-Weitz, A. (2011). Interventions to modify sexual risk behaviors for preventing HIV in homeless youth. The Cochrane Database of Systematic Reviews, (1), CD007501. doi:10.1002/14651858.CD007501.pub2