O4316: Lifetime Prevalence of Sexual & Physical Assault in LGBT Youth Living with Human Immunodeficiency Virus (HIV) and Association with Psychosocial Burden

Background: Youth living with HIV (YLWH) are especially susceptible to the detrimental cycle of sexual and physical assault (SA and PA). Few studies have highlighted the relationship between SA and PA with the exacerbation of HIV-related outcomes. In light of these considerations, our study aims to elucidate the lifetime prevalence of SA and PA among youth with acquired (A-HIV), with a focus on understanding the psychosocial burdens of A-HIV in LGBT youth to form targeted interventions of risk reduction.

Methods: This retrospective study conducted a comprehensive chart search encompassing all pediatric A-HIV patients under the care of the Horizon's Clinic in Detroit, MI, from 2018 to 2023. A total of 149 A-HIV were included. Lifetime accounts of assault (pre- and post-HIV diagnosis) were obtained with the key search terms "(sexual) abuse", "(sexual) assault", "rape", "molestation", "victim", "touch", "harm", "domestic violence", and "trauma". Patients were categorized by sexual preference stated during clinic encounters: male (heterosexual, bisexual, or homosexual), female (heterosexual or bisexual), or transgender female (bisexual or only preferring males). There were no transgender males in our search. Victims of assault were analyzed for substance use, suicidality (ideation requiring hospitalization or reported suicide attempt), and psychiatric diagnoses.

Results: Our retrospective analysis revealed 30.2% of our A-HIV cohort disclosed lifetime SA, encompassing a spectrum of traumatic experiences: molestation, abuse within foster care, and deliberate HIV contagion. Additionally, 16.1% of A-HIV patients reported lifetime PA, including incidents of interpersonal violence and victimization involving weaponry.

The devastating impact of these numbers was relayed in our analysis showcasing 86.67% of SA and 66.67% of PA in A-HIV patients involved LGBT youth. Homosexual males (MSM) and bisexual males were the most targeted, comprising 48.9% and 20% of total SA victims and 29.2% and 16.7% of total PA victims respectively. Nearly half of all MSM and transgender females reported concurrent lifetime SA and PA.

The most significant repercussions of these findings included suicidality in 42.9% of A-HIV MSM SA victims, ≥2 psychiatric comorbidities in >50% of all LGBT PA victims, and substance abuse (≥2 substances) rates between 80-100% in nearly all LGBT PA and SA victims.

Conclusion: YLWH represent a particularly vulnerable demographic susceptible to environments fostering the perpetuation of SA and PA in the context of A-HIV. Nearly 4 in every 10 YLWH in our clinic reported lifetime assault- the vast majority being LGBT youth with elevated rates of suicidality, psychiatric burden, and substance use. It is important to note that the true lifetime prevalence of assault in YLWH may be significantly higher than our predicted value given the reluctance of youth to disclose sensitive information.

As such, early intervention in YLWH may improve physical and psychological well-being while creating a foundation for healthier relationships.