One in 10 young adults aged 18 to 25 and one in 30 adolescents aged 13 to 17 experienced homelessness over the course of a year. On any given night in the United States, 1.7 to 2.5 million youth under age 25 were homeless. The tumultuous experiences of daily life on the streets were incredibly difficult for youth experiencing homelessness (YEH). While surviving the dangers of the streets and meeting one’s basic needs for food and shelter, youth faced enormous difficulties in maintaining their health and well-being. Congregate living settings such as shelters, halfway houses, encampments, and street dwelling, as well as the lack of access to basic hygiene facilities and supplies, increased the risk of virus transmission and their potential for being exposed to COVID-19.

While many cities had imposed stay-at-home orders to prevent COVID-19 transmission, those without shelter had largely been left on the streets and without access to resources due to shelter closures and shutdowns of drop-in and food distribution centers. It was unclear how and where YEH had moved during quarantines and lockdowns. It was also unclear what impact lockdowns and infection mitigation efforts may have had on YEH’s mental health. YEH already experienced a mortality rate that was 5–10 times higher than that of the general population. COVID-19 infection might have further increased morbidity and mortality. Many YEH also had chronic mental and physical conditions, engaged in risky behaviors (e.g., drug use, condomless sex), and faced extreme challenges in accessing health care.

To address these gaps, the team conducted a mixed-methods study utilizing the existing cohort of YEH from an ongoing longitudinal study (R01NR017837). The study initially had 68 YEH and recruited 200 additional YEH over the next 12 months. Additional COVID-19 related measures were collected at 3-month intervals for 1 year on the 268 participants. Qualitative interviews were conducted with 40 youth to learn what YEH knew about COVID-19 and preventive measures and how it affected their daily life and health. The interviews inquired about COVID-19 knowledge, knowledge of and adherence to preventive measures, symptoms, testing, ability to acquire basic needs, impact on social supports, access to healthcare including HIV care, substance use patterns, and mental and emotional health. Finally, the prevalence rate was assessed by conducting COVID-19 antibody testing among the sample of 268 YEH.