Severity of Sexual Abuse and HIV Risk Characteristics: Implications for HIV Prevention with Youths in the Foster Care System

Diane E. Elze
George Warren Brown School of Social Work
Campus Box 1196
Washington University
St. Louis, MO 63130
314-935-8704
delze@gwbmail.wustl.edu
 
Wendy Auslander
George Warren Brown School of Social Work
Campus Box 1196
Washington University
St. Louis, MO 63130
 
Curtis McMillen
George Warren Brown School of Social Work
Campus Box 1196
Washington University
St. Louis, MO 63130
 
Tonya Edmond
George Warren Brown School of Social Work
Campus Box 1196
Washington University
St. Louis, MO 63130
 
Ron Thompson
George Warren Brown School of Social Work
Campus Box 1196
Washington University
St. Louis, MO 63130
Purpose:  Childhood sexual abuse may predispose adolescents to behaviors that increase their risk for HIV infection.  The purpose of this study was to determine whether the severity of sexual abuse was associated with HIV-related attitudes, intentions, self-efficacy, knowledge, and risk behaviors among adolescents involved in the foster care system.

Methods:  Structured interviews were completed with 168 adolescents, aged 15 to 19 years old, (mean age 16.3 years) who were in foster care.  Fifty-one percent of the youths were male and 62.3% were youths of color.  Thirty-five percent reported a history of sexual abuse; 21 youths reported forced touching with no forced intercourse; 38 reported forced intercourse, and 109 reported no sexual abuse.  Data were collected on youths’ attitudes for HIV prevention, intentions to engage in risk behaviors, HIV-related knowledge, self-efficacy and recent (during last 2 months) and lifetime HIV risk behaviors.

Results:  No differences were found between the sexually abused and the nonabused youths in HIV-related knowledge, self-efficacy, intentions and attitudes supportive of HIV prevention.  Despite characteristics supportive of prevention, sexually abused youths reported both recent and lifetime involvement in a greater number of risk behaviors than did the nonabused youths.  Youths who had experienced forced intercourse were less likely to use a condom during their last intercourse experience than the other youths.  Sexually abused youths were more likely to engage in sex while using alcohol or other drugs, and those that had experienced more severe abuse were significantly more likely than the others to report involvement in oral sex.

Implications for social work practice: The findings point to a critical need for HIV prevention programs to integrate an awareness of the reality of sexual abuse in the lives of adolescents in order to address sexually abused youths’ vulnerabilities to involvement in HIV risk behaviors.