Teenage childhood sexual abuse (CSA) moderated the longitudinal associations between posttraumatic symptom clusters and HIV risk-related behaviors among young sexual and gender minorities assigned male at birth, with avoidance symptoms predicting more condomless sex partners among those with CSA histories.
Avoidance symptoms at Time 1 predicted fewer condomless sex partners at Time 2 across all CSA models in the overall sample.
Any history of teenage CSA moderated the relationship between avoidance symptoms and condomless sex partners, reversing the direction of the association.
Penetration-type teenage CSA showed a stronger moderating effect on the association between avoidance symptoms and condomless sex partners than any CSA exposure.
A total of 15 interaction effects were observed across CSA models and HIV risk behavior outcomes.
The study used structural equation models with Bayesian estimation to examine longitudinal associations in a sample of young sexual and gender minorities assigned male at birth.
Young sexual and gender minorities assigned male at birth experience significant sexual health disparities, and teenage CSA may have lasting effects on adulthood trauma response and HIV-related risk behaviors.
This research suggests that the relationship between trauma symptoms and risky sexual behaviors is more complex than previously understood, particularly for young gay, bisexual, and transgender people (assigned male at birth) who experienced sexual abuse as teenagers. In the general sample, people who had stronger avoidance symptoms — a common trauma response where people emotionally withdraw or avoid reminders of trauma — actually had fewer risky sexual partners over time. However, this protective pattern reversed entirely among those who had experienced teenage sexual abuse, especially penetration-type abuse: for them, higher avoidance symptoms were associated with more condomless sexual partners six months later. The study followed 487 young sexual and gender minority individuals in the Chicago area over six months as part of a larger ongoing study called RADAR. Researchers used sophisticated statistical methods to examine how different types of trauma symptoms (grouped into clusters) predicted HIV-related risk behaviors, and whether a history of childhood sexual abuse during the teenage years changed those relationships. They found 15 different interaction effects across various types of abuse history and risk behaviors, suggesting that the influence of trauma symptoms on sexual risk-taking is shaped in important ways by whether and how a person was sexually abused as a teenager. This research suggests that mental health and HIV prevention programs serving young LGBTQ+ people should screen for histories of childhood sexual abuse and tailor their approaches accordingly. The finding that avoidance symptoms can be associated with increased sexual risk among abuse survivors — possibly reflecting emotional numbing or dissociation during sexual encounters — points to the importance of trauma-informed care in HIV prevention efforts. Standard approaches that do not account for trauma history may miss important differences in how young people's mental health and sexual behavior are connected.
Hitch A, Sietins E, Mustanski B, Newcomb M. (2025). Posttraumatic Stress Symptoms and HIV Risk-Related Behaviors among Young Sexual and Gender Minorities Assigned Male at Birth: the Moderating Effects of Teenage Childhood Sexual Abuse.. AIDS and behavior. https://doi.org/10.1007/s10461-025-04661-7