Childhood Sexual Abuse Is Highly Associated With HIV Risk-Taking Behavior and Infection Among MSM in the EXPLORE Study

Abstract

Background Previous studies have found high rates of childhood sexual abuse (CSA) among US men who have sex with men (MSM). CSA history has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV acquisition and transmission. The present analysis is the first to examine the longitudinal association between CSA and HIV infection, unprotected anal sex, and serodiscordant unprotected anal sex, as well as mediators of these relationships among a large sample of HIV-uninfected MSM. Methods The EXPLORE Study was a behavioral intervention trial conducted in 6 US cities over 48 months with HIV infection as the primary efficacy outcome. Behavioral assessments were done every 6 months via confidential computerized assessments. Longitudinal regression models were constructed, adjusting for randomization arm, geographical location of study site, age at enrollment, education, and race/ethnicity. Results Of the 4295 participants enrolled, 39.7% had a history of CSA. Participants with a history of CSA [adjusted hazards ratio = 1.30, 95% confidence interval (CI): 1.02 to 1.69] were at increased risk for HIV infection over study follow-up. A significant association was seen between history of CSA and unprotected anal sex (adjusted odds ratio = 1.24, 95% CI: 1.12 to 1.36) and serodiscordant unprotected anal sex (adjusted odds ratio = 1.30, 95% CI: 1.18 to 1.43). Among participants reporting CSA, the EXPLORE intervention had no effect in reducing HIV infection rates. Participants reporting CSA were significantly more likely to have symptoms of depression and use nonprescription drugs. Conclusions A predictive relationship between a history of CSA and subsequent HIV infection was observed among this large sample of HIV-uninfected MSM. Findings indicate that HIV-uninfected MSM with CSA histories are at greater risk for HIV infection, report higher rates of HIV sexual risk behavior, and may derive less benefit from prevention programs. Future HIV prevention interventions should address the specific mental health concerns of MSM with a history of CSA.

Exploring Determinants of Unprotected Sexual Behaviours Favouring HIV Transmission among Men who Have Sex with Men in Yogyakarta, Indonesia

“…Individuals' engagement in risky sexual behaviours or UAI has been incriminated as the main contributor to the spread of the epidemic among them (Mumtaz, Hilmi, McFarland, Kaplan, & Akala, 2011;Mustanski, Newcomb, Du-Bois, Garcia, & Grov, 2011). Consistent with the results of several previous studies (El-Sayed, IA, & El-Gueniedy, 2008;Mimiaga et al, 2009;Morineau, et al, 2011;Poon, et al, 2013), the current study confirms that having multiple casual sex partners was one of the behavioural determinants strongly associated with HIV-risk sexual practice among the participants. Likewise, enjoyment associated with group sex practices and their preference to experience sexual sensation without condoms, coupled with the unavailability of condoms at time when such practices happened, were enablers to MSM engagement in UAI.…”

Disparities in Mental Well-being between Non-Minority and Sexual Minority Male Youth in Bangkok, Thailand: Quantitative Findings from a Mixed Method Study

“…The higher tendency of sexual minority adolescents being sexually coerced raises concern over the higher risks for HIV and other STDs, as condoms are reportedly used less than half the time when sexual coercion occurs (Guadamuz et al, 2011;Manopaiboon et al, 2003). In addition, as many studies have shown, sexual coercion during adolescence is significantly associated with subsequent HIV risk-taking behaviors (Bensley, Van Eenwyk & Simmons, 2000;Brennan, Hellerstedt, Ross & Welles, 2007;Holmes & Slap, 1998;Mimiaga et al, 2009;O'Leary, Purcell, Remien & Gomez, 2003;Senn, Carey, Vanable, Coury-Doniger & Urban, 2006) According to Meyer (2003), such experiences of victimization and sexual coercion are distal minority stressors which can negatively impact mental well-being. In this study, we found a significant association between victimizations/sexual coercion and adverse mental well-being measures.…”

Risk Patterns Preceding Diagnosis Among Newly HIV-Diagnosed Men Who Have Sex with Men in New York City

“…Alternatively, MSM, particularly those who test often, may be aware of their risk but are unable to change their behavior for multiple syndemic psychosocial reasons, 57 including substance use difficulties, 32 mental health problems, 58 and the psychological sequelae of childhood sexual abuse, 59 and may thus utilize more frequent testing as a means of selfmonitoring. Depression was a significant burden for a large subset of this sample of MSM.…”