Policy and implementation context of an unconditional cash transfer program to address homelessness and improve HIV service uptake among marginalized youth in the United States

NIH RePORTER · NIH · K01 · $127,399 · view on reporter.nih.gov ↗

Abstract

Rates of homelessness among youth and young adults living in the United States have more than doubled in the last decade, and LGBTQ youth face a higher level of housing insecurity and an increased risk of homelessness compared with their non-LGBTQ peers. Stigma and discrimination based on sexual orientation or gender/identity expression contribute to the heightened levels of homelessness experienced by LGBTQ youth. Housing instability among LGBTQ youth can worsen existing risk factors for HIV and give rise to new environments that pose additional risks, including survival sex, physical and/or sexual abuse, and injection drug use. To add to this, unstable housing may challenge already suboptimal access to and engagement with healthcare services, including HIV prevention and treatment. Existing guidelines and strategic plans in the United States emphasize the importance of safe and affordable housing to HIV service utilization and outcomes, but innovative strategies that operate within the existing policy environment and effectively cater to the distinctive needs of young people are largely unavailable and understudied. While cash transfers are not novel among the array of existing social safety net interventions, their effective implementation has faced obstacles such as administrative complexities, conditions linked to work or behavior change, and a lack of adaptability to evolving needs. To address these complexities, we will first document the existing policy environment that influences housing and HIV, and second partner with Point Source Youth (PSY), an advocacy leader in the youth homelessness space, to refine and measure the implementation of monthly, unconditional cash disbursements to young LGBTQ people at or about to enter the homelessness system in Baltimore City. 60 young people will be provided with $25,000 each over two years to sustainably exit homelessness, find housing in alignment with apartment share arrangements, and more easily access HIV services. To guide this research, we will use two implementation science frameworks in conjunction: the Consolidated Framework for Implementation Research (CFIR) 2.0 and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM). The proposed strategy is grounded in insights from community-identified needs and barriers, consideration of implementation challenges at the individual and organizational levels, and an understanding of the ongoing evolution of the policy context. The specific aims of this study are as follows: Specific Aim 1 – Map existing municipal, state, and federal laws and policies that impact housing and HIV among young people and generate a policy index to quantify their breadth and depth, 2020-2025 Specific Aim 2 – Inform and tailor the implementation of an unconditional direct cash transfer intervention for LGBTQ youth based on stakeholder perspectives in Baltimore City Specific Aim 3 - Measure the implementation of a direct cash transfer intervention to addr...

Key facts

NIH application ID
11008144
Project number
1K01MD020002-01
Recipient
JOHNS HOPKINS UNIVERSITY
Principal Investigator
Amrita Rao
Activity code
K01
Funding institute
NIH
Fiscal year
2024
Award amount
$127,399
Award type
1
Project period
2024-08-07 → 2029-02-28