198. Adolescent Lives Matter: Social Well-Being of Sexual And Gender Minority Adolescents At-Risk For And Living With HIV

Abstract

Young Black and Latinx gay and bisexual cisgender males (YGLGBM) and transwomen (TW) are key populations that carry a high burden of HIV. Potential drivers of elevated HIV risk include unstable housing, substance use and social pressures within relationships (forced anal sex without a condom). Less is known about whether perceived and actual financial well-being may be associated with HIV status. We sought to examine the association of HIV status with substance use, housing and social factors (exchanging sex, forced anal sex without a condom, and perceived financial well-being) in a sample of Black and Latinx YBLGBM/TW living in Baltimore, MD; Washington, DC; and Philadelphia, PA. YBLGBM/TW 15-24 years old living in Baltimore; Washington, DC; and Philadelphia were recruited via social media, outreach, respondent-driven sampling, and local clinics sites. Eligible participants were recruited to complete rapid HIV-1 testing and an electronic 45-minute survey that included questions on sociodemographics (age, education, housing); self-reported financial well-being (measured by receipt of food assistance) and perceived financial well-being; substance use; and sexual risk (exchange sex, forced anal sex without a condom). Chi-squared and Fisher’s exact tests were used to examine bivariate relationships associated with HIV status and Poisson regression was used to build a model of factors associated with HIV status. Data were analyzed using STATA 14®. Mean age of the sample was 21.2 (2.40 SD) and 93% were Black/African-American. Most (84%) were cisgender males, who identified as gay (66%) or bisexual (22%). Nearly one-quarter (23%) described exchanging sex for money, a place to stay or food in the last 12 months (21%). While 11% reported being forced to engage in anal sex without a condom. Substance use was common in the sample with 75% reporting alcohol and marijuana use and 41% reporting tobacco use. In bivariate analysis, HIV negative participants were younger, more likely to have a high school diploma and a cell phone; and less likely to: report tobacco, marijuana, and alcohol use; have a regular place to stay; engage in exchange sex; or have been forced not to use a condom during anal sex. There were no differences between groups with regard to financial well-being, gender identity or sexual orientation. In the final model, HIV negative participants were 16% less likely to report tobacco use and 18% less likely to report having been forced not use a condom during anal sex. This work suggests that YBLGBM/TW living in Baltimore; Washington, DC; and Philadelphia are vulnerable to substance use and unstable housing which may predispose some to exchange or survival sex. Youth living with HIV had higher rates of social instability and experiencing having been forced not to use a condom during anal sex, both of which may have contributed to HIV acquisition. In order to effectively prevent HIV acquisition in YBLGBM/TW more interventions will be needed that address the unstable housing, high substance use and the social factors that impact one's ability to negotiate condom use during anal sex.