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Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood

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Abstract

Childhood sexual abuse (CSA) is associated with HIV sexual risk behavior. Although many psychosocial correlates of sexual risk among HIV-positive persons have been identified, studies predicting continued risk among HIV-positive adults with histories of CSA are limited. This cross-sectional study identified variables predictive of sexual transmission risk behavior among an ethnically diverse sample of 256 HIV-positive adults (women and men who have sex with men; MSM) with CSA histories. Participants were assessed for trauma symptoms, shame related to HIV and sexual trauma, substance use, coping style, and sexual risk behavior. Logistic regression analyses were conducted to identify variables predictive of unprotected sexual behavior in the past 4 months. Unprotected sex was significantly associated with substance use and trauma-related behavioral difficulties among women and men, and less spiritual coping among men. Unprotected sex with HIV negative or serostatus unknown partners was significantly associated with greater trauma-related behavioral difficulties, more HIV-related shame, and fewer active coping strategies. Thus, trauma symptoms, shame, coping style, and substance use were significantly associated with sexual risk behavior among HIV-positive adults with histories of CSA, with models of prediction differing by gender and partner serostatus. HIV prevention intervention for persons with HIV and CSA histories should address trauma-related behavioral difficulties and enhance coping skills to reduce sexual transmission risk behavior.

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Acknowledgements

This research was supported by grants RO1-MH62965 (awarded to Kathleen J. Sikkema, Ph.D.), P30-MH62294 (Center for Interdisciplinary Research on AIDS; CIRA), and T32-MH20031 from the National Institute of Mental Health. The authors gratefully acknowledge our community collaboration with the Callen-Lorde Community Health Center in New York City and Sharon Neufeld for assistance with this manuscript.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA

    Kathleen J. Sikkema & Arlene Kochman

  2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Kathleen J. Sikkema, Nathan B. Hansen & Ashley M. Fox

  3. Department of Psychology, Yale University, New Haven, CT, USA

    Kathleen J. Sikkema & Christina S. Meade

  4. Duke University School of Nursing, Duke University Medical Center (DUMC 3322), 307 Trent Drive, Durham, NC, 27710, USA

    Kathleen J. Sikkema

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  1. Kathleen J. Sikkema
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Correspondence to Kathleen J. Sikkema.

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Sikkema, K.J., Hansen, N.B., Meade, C.S. et al. Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood. Arch Sex Behav 38, 121–134 (2009). https://doi.org/10.1007/s10508-007-9238-4

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