Adverse childhood experiences and risk of living with HIV among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) people: a cross-sectional study
The Lancet Regional Health Western Pacific
Authors: Jingli Yang, Lei Liu, Junren Wang, Yueyao Xu, Peipei Zhao, Yumeng Wang, Peipei Du, Joseph D Tucker, Stefan Baral, Elvin H Geng, Xiaodong Wang, Huan Song & Dan Wu
This study examined the relationship between adverse childhood experiences (ACEs) and HIV among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) people in China. While ACEs and HIV are independently recognized as important public health concerns, limited research has examined their intersection among LGBTQ+ populations. The study aimed to characterize patterns of ACEs, assess their association with living with HIV, and identify potentially modifiable factors underlying this relationship.
Researchers analyzed baseline data from the TREASURE cohort, an ongoing study of LGBTQ+ health in Chengdu, China. The analysis included 8,384 participants aged 16 years and older who completed an online survey between August 2023 and March 2025. Participants reported their experiences of 10 types of childhood adversity, including physical, emotional, and sexual abuse and household dysfunction. Researchers used cluster analysis to identify patterns of ACE exposure and logistic regression to examine associations with living with HIV. Mediation analyses assessed whether psychosocial factors, including substance use and mental health problems, contributed to the observed associations.
Overall, 63.5% of participants reported at least one ACE, with physical abuse (34.4%) and emotional abuse (34.1%) being the most frequently reported. Approximately 80% of ACE exposures occurred in clusters, demonstrating that childhood adversity often involves multiple, co-occurring experiences. Participants reporting any ACE had 38% higher odds of living with HIV compared with those reporting no ACEs (adjusted odds ratio [aOR] 1.38; 95% CI, 1.14–1.66). The association was particularly evident among participants assigned male at birth, cisgender gay men, and queer/questioning individuals.
Mediation analyses suggested that substance use and mental health problems may partially explain the relationship between specific ACEs and HIV. Because the study was cross-sectional and relied partly on self-reported HIV status and convenience sampling from a single city, causal relationships cannot be established and findings may not generalize to all LGBTQ+ populations in China. Nevertheless, the findings highlight the importance of integrating trauma-informed care, mental health support, and substance-use interventions into LGBTQ+-competent HIV prevention and sexual health services.