Choosing not to use a condom can mean an extra meal or shelter for LGBT youth, according to a survey of young people in New York City who exchange sex for money to pay for basic needs – a practice also known as “survival sex”.

The health habits of 283 LGBT youth in New York City who who become involved in the commercial sex market to meet “basic survival needs” were published in a study released on Thursday by the nonprofit Urban Institute.

“A common theme we had through a lot of the conversations was ‘I’m doing this because I have no other choice’ and ‘this is the only way I can get by,’” said Meredith Dank, the study’s lead author.

Of those surveyed, 99% said they use protection against sexually transmitted infection and pregnancy, though only 63% said they used protection all the time.

The others said they would not use condoms because they trusted their regular clients, were coerced or forced to not use them, or did not see a need for them when having sex with a partner or friend with benefits.

A 21-year-old gay male said he used condoms “all the time” because he is not having sex for pleasure, but for money. “Like, I don’t know where these people go, where they are coming from ... I don’t know what they are doing,” he said.

But a 19-year-old bisexual male said he tried to use his “best judgment” on whether protection is necessary.

“A condom is for your protection and for my protection. You don’t know what I have, I don’t know what you have, you don’t know what you have, and I don’t know what I have,” he said. “But sometimes I still got to do it, I need the money, and some dudes throw in extra money for it, so I go with it, and just about a month, literally, I think a month ago, I found out that I was HIV positive, yeah, so.”

He was one of 29% who said they had a current or previous sexually transmitted infection (STI). Of that group, 21% said they were HIV positive.

There were some encouraging numbers, however, including that 97% of those surveyed said they had seen a doctor in the past six months. Medical providers are usually the first line of defense for homeless youth, which the study authors said put clinicians in a position to develop a trusted relationship and help them with non-medical needs.

The new research is the final report from a three-year-long study focused on the city’s young LGBT population, who are at a disproportionately greater risk for negative health outcomes compared to heterosexual youth. The previous studies looked more broadly at the experiences and needs of those youths and their experience with the criminal justice and child welfare system.

But, Dank noted, a key portion of young adults is left behind because of the structure of these services. In New York City, programs geared toward youth offer services to people up to age 24, but funding is typically specific for programs directed towards people aged 16 to 21.

Dank said the gap is a problem for young people who are seeking shelter and other services in an effort to become stable. She said if they cannot access these services simply because of their age, “then we are doing a huge disservice to the young people and are putting them back into an incredibly vulnerable position, even if they have made further ground to get out of engaging in survival sex”.

The report also indicated that city services are benefitting this population, with 93% of those surveyed saying they visited such organizations. Of those 260 people, 99% accepted help.

The study authors offered 14 recommendations on how to expand and improve services for LGBT youth, including creating a centralized database for youth service referrals, creating more medical vans that bring services directly to communities and raising awareness of HIV prevention drugs.

Dank said: “I think this is a hard issue to find the right solution for other than offering young people employment so they don’t have to put themselves in a situation that makes them vulnerable to this.”