Sexual and Reproductive Health and Wellness in Autistic and Neurodiverse Communities

Background and purpose: In the US, approximately 1.5 million children have been formally diagnosed with autism. Parallel figures about the national prevalence of autistic adults are nonexistent due to lacking public health surveillance measures, though it was recently estimated that 1 in 45 adults, ages 18-84, are likely autistic. Certainly, as prevalence in children increases due to growing awareness and changes in diagnostic criteria, the number of children entering adulthood will increase in addition to information about their care needs and strategies to meet them.

Autism is a lifelong neurological and developmental disability that is characterized by challenges with social communication and interaction, as well as restricted or repetitive behaviors or interests. Autistic people can have ways of learning, conversing, moving, or paying attention that are informed by their diagnoses; however, autism is a "spectrum" in that it is experienced and presents differently for every autistic person. Public perception may imply autism is only a childhood concern; however, autism is lifelong, and many autistic people require support into and throughout adulthood including in the domain of sexual and reproductive health.

Sexually transmitted infections (STIs) are prevalent in the general population, and autistic individuals and their peers with intellectual (ID) and developmental disabilities (DD) may be at increased risk due to gaps in sexual health education, increased vulnerability to sexual abuse and victimization, and disparities in access to primary care. Contrary to widespread belief, autistic individuals engage in sexual behavior and experience sexual attraction similar to their same-age peers without autism. This study aims to identify the prevalence of STIs and HIV among a national sample of Medicaid-enrolled autistic individuals to identify opportunities for intervention.

Methods: We utilized the 2016 national Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files to extract data for Medicaid-enrolled individuals with autism, ID, or both, aged 14-50. The study assessed the prevalence of chlamydia, gonorrhea, syphilis, and HIV. Diagnostic classifications were identified using validated algorithms from the Chronic Condition Warehouse, and descriptive statistics were calculated to compare the characteristics of individuals within these groups.

Results: Our findings indicate significant disparities in STI and HIV rates among autistic individuals, particularly notable in the 22-30 age group and among Black enrollees. The prevalence was slightly higher among adults with ID compared to those with autism alone or both autism and ID. The rates of chlamydia (75.7% vs. 24.3%) and gonorrhea (69.3% vs. 30.7%) were higher among females, while rates of syphilis (60.3% vs. 39.7%) and HIV (57.1% vs. 42.9%) were higher among males.

Conclusions/implications: Results emphasize urgent gaps in addressing the sexual health needs of autistic individuals and promoting their overall well-being. Policymakers must advocate for targeted interventions to improve sexual health education and access to healthcare services, emphasizing the development of policies that cater specifically to the needs of this population. Social workers should consider specialized training and increased funding for programs that address these disparities, ensuring that preventive measures and treatments are accessible to all members of the community, especially those from marginalized backgrounds.