Polyvictimization and High-Risk Sexual Behaviors Among Youth Involved with Child Welfare: Implications for HIV Prevention

Background and Purpose: Rates of new HIV diagnoses among youth living in the United States (US) has decreased overall. However, these rates vary for different groups of youth. Although much is known about HIV risk among youth in the general US population, the same is not true for youth involved with the child welfare system (CWS). This is worrisome, considering the vast breadth of research identifying CWS-involved youth as highly vulnerable to adverse childhood experiences, including child maltreatment which has been linked to increased risk of future HIV infection. Thus, understanding the association between polyvictimization (i.e., cumulative victimization) and high-risk sexual behavior is of utmost importance for informing HIV prevention research and intervention. We sought to answer the following questions: (1) What are the national estimated rates of high-risk sexual behavior among CWS-involved youth? (2) Are higher levels of polyvictimization associated with increased likelihood of high-risk sexual behaviors?

Method: This analysis used data from the second round of the National Survey of Child and Adolescent Well-Being (NSCAW II). The sample included 876 youth aged 11 years or older. Using an ecological framework, polyvictimization was measured based on the number of ecological domains of violence exposure: (1) child maltreatment (i.e., microsystem exposure), (2) exposure to family violence (i.e., mesosystem exposure), and (3) living in a violent neighborhood (i.e., exosystem exposure). Domains were totaled to produce a score ranging from 1 to 3 domains of violence exposure. Youth’s high-risk sexual behavior was measured using three NSCAW II specific questions regarding (1) number of consensual sexual partners, (2) age of first consensual intercourse, and (3) condom use during most recent consensual sexual intercourse (y/n).  We conducted regression analyses to examine the relationship between polyvictimization and each high-risk sexual behavior. NSCAW II weights were applied to all analyses to ensure the sample was nationally representative.

Results:  Approximately 30% (n=281) of youth reported being sexually active. Among these youth, most reported having 1 (30.59%) or 3-5 (29.88%) sexual partners and 36.63% reported condomless sex. The average age of first sexual experience was 12.98 (SE=0.17).

Controlling for sociodemographics associated with HIV, we found that youth with two victimization domains were more likely to have higher numbers of sexual partners than youth with one victimization domain (B =0.38, 95% CI = [0.14, 0.63]).  Additionally, among sexually active youth, youth with two (B = -1.03, 95% CI = [-1.98, -0.08]) or three (B = -2.28, 95% CI = [-3.36, -1.19]) victimization domains were more likely to have their first sexual experience at a younger age than youth with one victimization domain. There was no significant association between polyvictimization and reports of condomless sex among sexually active youth.

Conclusions and Implications: Findings suggest many youth involved with CWS report high-risk sexual behaviors at a young age, and polyvictimization is a significant determinant of these behaviors. Factors placing CWS-involved youth at risk of HIV may differ from that of the general youth population. HIV prevention efforts targeting youth involved with CWS should incorporate trauma-informed approaches addressing issues of polyvictimization.