Gaps in Sexual Assault Health Care Among Homeless Young Adults

Introduction: Young adults experiencing homelessness are at increased risk for sexual assault. Receiving a post–sexual assault examination has important implications for HIV and unintended pregnancy prevention; yet, utilization is not well understood. In a population at elevated risk for HIV, unintended pregnancy, and sexual violence, identifying barriers and facilitators to post–sexual assault examination is imperative. Methods: As part of a large, multisite study to assess youth experiencing homelessness across 7 cities in the U.S, a cross-sectional survey was conducted between June 2016 and July 2017. Data were analyzed in 2019 to determine the prevalence and correlates of sexual violence and examine the correlates of post–sexual assault examination utilization. Results: Respondents (n=1,405), aged 18–26 years, were mainly youth of color (38% black, 17% Latinx) and identified as cisgender male (59%) and lesbian, gay, bisexual, or queer (29%). HIV risks were high: 23% of participants had engaged in trade sex, 32% had experienced sexual assault as a minor, and 39% had experienced sexual exploitation. Young adults reported high rates of sexual assault (22%) and forced sex (24%). Yet, only 29% of participants who were forced to have sex received a post–sexual assault examination. Latinx young adults were more likely than other races/ethnicities to receive post-assault care. Participants frequently said they did not get a post–sexual assault exam because they did not want to involve the legal system and did not think it was important. Conclusions: Interventions are needed to increase use of preventive care after experiencing sexual assault among young adults experiencing homelessness.