Abstract
Men who have sex with men (MSM) are the group most at risk for HIV and represent the majority of new infections in the United States. Rates of childhood sexual abuse (CSA) among MSM have been estimated as high as 46 %. CSA is associated with increased risk of HIV and greater likelihood of HIV sexual risk behavior. The purpose of this study was to identify the relationships between CSA complexity indicators and mental health, substance use, sexually transmitted infections, and HIV sexual risk among MSM. MSM with CSA histories (n = 162) who were screened for an HIV prevention efficacy trial completed comprehensive psychosocial assessments. Five indicators of complex CSA experiences were created: CSA by family member, CSA with penetration, CSA with physical injury, CSA with intense fear, and first CSA in adolescence. Adjusted regression models were used to identify relationships between CSA complexity and outcomes. Participants reporting CSA by family member were at 2.6 odds of current alcohol use disorder (OR 2.64: CI 1.24–5.63), two times higher odds of substance use disorder (OR 2.1: CI 1.02–2.36), and 2.7 times higher odds of reporting an STI in the past year (OR 2.7: CI 1.04–7.1). CSA with penetration was associated with increased likelihood of current PTSD (OR 3.17: CI 1.56–6.43), recent HIV sexual risk behavior (OR 2.7: CI 1.16–6.36), and a greater number of casual sexual partners (p = 0.02). Both CSA with Physical Injury (OR 4.05: CI 1.9–8.7) and CSA with Intense Fear (OR 5.16: CI 2.5–10.7) were related to increased odds for current PTSD. First CSA in adolescence was related to increased odds of major depressive disorder. These findings suggest that CSA, with one or more complexities, creates patterns of vulnerabilities for MSM, including post-traumatic stress disorder, substance use, and sexual risk taking, and suggests the need for detailed assessment of CSA and the development of integrated HIV prevention programs that address mental health and substance use comorbidities.
Similar content being viewed by others
References
Ackerman, P. T., Newton, J. E. O., McPherson, W. B., Jones, J. G., & Dykman, R. A. (1998). Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both). Child Abuse and Neglect, 22(8), 759–774. doi:10.1016/S0145-2134(98)00062-3.
Arreola, S., Neilands, T., Pollack, L., Paul, J., & Catania, J. (2008). Childhood sexual experiences and adult health sequelae among gay and bisexual men: Defining childhood sexual abuse. Journal of Sex Research, 45(3), 246–252. doi:10.1080/00224490802204431.
Arriola, K. R. J., Louden, T., Doldren, M. A., & Fortenberry, R. M. (2005). A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child Abuse and Neglect, 29(6), 725–746. doi:10.1016/j.chiabu.2004.10.014.
Balsam, K. F., Lehavot, K., & Beadnell, B. (2011). Sexual revictimization and mental health: A comparison of lesbians, gay men, and heterosexual women. Journal of Interpersonal Violence, 26(9), 1798–1814. doi:10.1177/0886260510372946.
Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology, 73(3), 477–487. doi:10.1037/0022-006X.73.3.477.
Bartholow, B. N., Doll, L. S., Joy, D., Douglas, J. M., Bolan, G., Harrison, J. S., … McKirnan, D. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse and Neglect, 18(9), 747–761.
Bedoya, C. A., Mimiaga, M. J., Beauchamp, G., Donnell, D., Mayer, K. H., & Safren, S. A. (2012). Predictors of HIV transmission risk behavior and seroconversion among Latino men who have sex with men in Project EXPLORE. AIDS and Behavior, 16(3), 608–617. doi:10.1007/s10461-011-9911-4.
Bifulco, A., Brown, G. W., & Adler, Z. (1991). Early sexual abuse and clinical depression in adult life. British Journal of Psychiatry, 159, 115–122.
Brennan, D. J., Hellerstedt, W. L., Ross, M. W., & Welles, S. L. (2007). History of childhood sexual abuse and HIV risk behaviors in homosexual and bisexual men. American Journal of Public Health, 97(6), 1107–1112. doi:10.2105/AJPH.2005.071423.
Briere, J., & Runtz, M. (1990). Differential adult symptomatologies associated with three types of child abuse histories. Child Abuse and Neglect, 14, 357–364.
Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99(1), 66–77.
Carballo-Diéguez, A., Balan, I., Dolezal, C., & Mello, M. B. (2012). Recalled sexual experiences in childhood with older partners: A study of Brazilian men who have sex with men and male-to-female transgender persons. Archives of Sexual Behavior, 41, 363–376. doi:10.1007/s10508-011-9748-y.
Carballo-Diéguez, A., & Dolezal, C. (1995). Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men. Child Abuse and Neglect, 19(5), 595–605.
Casey, E. A., & Nurius, P. S. (2005). Trauma exposure and sexual revictimization risk: Comparisons across single, multiple incident, and multiple perpetrator victimizations. Violence Against Women, 11(4), 505–530. doi:10.1177/1077801204274339.
Chesney, M. A., Koblin, B. A., Barresi, P. J., Husnik, M. J., Husnik, M. J., Celum, C. L., Colfax. G., … EXPLORE Study Team (2003). An individually tailored intervention for HIV prevention: Baseline data from the EXPLORE Study. American Journal of Public Health, 93(6), 933–938.
Cloitre, M., & Rosenberg, A. (2006). Sexual revictimization. In V. M. Follette & J. I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma (2nd ed., pp. 321–361). New York, NY: Guilford Press.
Crepaz, N., Lyles, C. M., Wolitski, R. J., Passin, W. F., Rama, S. M., Herbst, J. H., … Stall, R. (2006). Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS, 20(2), 143–157. doi:10.1097/01.aids.0000196166.48518.a0.
Dallam, S. J., Gleaves, D. H., Cepeda-Benito, A., Silberg, J. L., Kraemer, H. C., & Spiegel, D. (2001). The effects of childhood sexual abuse: A critique of Rind, Tromovitch and Bauserman. Psychological Bulletin, 127, 715–733.
Des Jarlais, D. C., Paone, D., Milliken, J., Turner, C. F., Miller, H., Gribble, J., … Friedman, S. R. (1999). Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: A quasi-randomised trial. Lancet, 353(9165), 1657–1661.
Dyer, T. P., Shoptaw, S., Guadamuz, T. E., Plankey, M., Kao, U., Ostrow, D., … Stall, R. (2012). Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. Journal of Urban Health, 89(4), 697–708. doi:10.1007/s11524-012-9674-x.
El-Bassel, N., Gilbert, L., Vinocur, D., Chang, M., & Wu, E. (2011). Posttraumatic stress disorder and HIV risk among poor, inner-city women receiving care in an emergency department. American Journal of Public Health, 101(1), 120–127. doi:10.2105/AJPH.2009.181842.
Fargo, J. D. (2009). Pathways to adult sexual revictimization: Direct and indirect behavioral risk factors across the lifespan. Journal of Interpersonal Violence, 24(11), 1771–1791. doi:10.1177/0886260508325489.
Gidycz, C. A., Coble, C. N., Latham, L., & Layman, M. J. (1993). Sexual assault experience in adulthood and prior victimization experiences. Psychology of Women Quarterly, 17(2), 151–168. doi:10.1111/j.1471-6402.1993.tb00441.x.
Gold, S. D., Feinstein, B. A., Skidmore, W., & Marx, B. P. (2011). Childhood physical abuse, internalized homophobia, and experiential avoidance among lesbians and gay men. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 50–60. doi:10.1037/a0020487.
Heintz, A. J., & Melendez, R. M. (2006). Intimate partner violence and HIV/STD risk among lesbian, gay, bisexual, and transgender individuals. Journal of Interpersonal Violence, 21(2), 193–208. doi:10.1177/0886260505282104.
Ibañez, G. E., Purcell, D. W., Stall, R., Parsons, J. T., & Gómez, C. A. (2005). Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS, 19(Suppl. 1), S49–55.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.
Johnson, D. M., Pike, J. L., & Chard, K. M. (2001). Factors predicting PTSD, depression, and dissociative severity in female treatment-seeking childhood sexual abuse survivors. Child Abuse and Neglect, 25(1), 179–198. doi:10.1016/S0145-2134(00)00225-8.
Kalichman, S. C., Gore-Felton, C., Benotsch, E., Cage, M., & Rompa, D. (2004). Trauma symptoms, sexual behaviors, and substance abuse: Correlates of childhood sexual abuse and HIV risks among men who have sex with men. Journal of Child Sexual Abuse, 13(1), 1–15. doi:10.1300/J070v13n01_01.
Kaltman, S., Krupnick, J., Stockton, P., Hooper, L., & Green, B. L. (2005). Psychological impact of types of sexual trauma among college women. Journal of Traumatic Stress, 18(5), 547–555. doi:10.1002/jts.20063.
Kaysen, D., Rosen, G., Bowman, M., & Resick, P. A. (2010). Duration of exposure and the dose-response model of PTSD. Journal of Interpersonal Violence, 25(1), 63–74. doi:10.1177/0886260508329131.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113(1), 164–180. doi:10.1037/0033-2909.113.1.164.
Kilpatrick, A. C. (1992). Long-range effects of child and adolescent sexual experiences. Hillsdale, NJ: Lawrence Erlbaum Associates.
Koblin, B. A., Husnik, M. J., Colfax, G., Huang, Y., Madison, M., Mayer, K., … Buchbinder, S. (2006). Risk factors for HIV infection among men who have sex with men. AIDS, 20(5), 731–739. doi:10.1097/01.aids.0000216374.61442.55.
Kurtz, S. P., Buttram, M. E., Surratt, H. L., & Stall, R. D. (2012). Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Education and Prevention, 24(3), 193–205.
Lalor, K., & McElvaney, R. (2010). Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. Trauma Violence and Abuse, 11(4), 159–177. doi:10.1177/1524838010378299.
Lenderking, W. R., Wold, C., Mayer, K. H., Goldstein, R., Losina, E., & Seage, G. R, 3rd. (1997). Childhood sexual abuse among homosexual men. Prevalence and association with unsafe sex. Journal of General Internal Medicine, 12(4), 250–253.
Leserman, J., Li, Z., Drossman, D. A., & Hu, Y. J. (1998). Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: The impact on subsequent health care visits. Psychological Medicine, 28(2), 417–425.
Leserman, J., Li, Z., Drossman, D. A., Toomey, T. C., Nachman, G., & Glogau, L. (1997). Impact of sexual and physical abuse dimensions on health status: Development of an abuse severity measure. Psychosomatic Medicine, 59(2), 152–160.
Lesserman, J., Ironson, G., & O’Cleirigh, C. (2006). Preliminary results of a randomized controlled trial of an emotional disclosure intervention in patients with HIV. Presented at the Annual Meeting of the International Society of Behavioral Medicine, Bangkok, Thailand.
Lim, H., Guadamuz, T., Kao, U., Plankey, M., Ostrow, D., Shoptaw, S., & Stall, R. (2010). Childhood sexual abuse, gay-related victimization, HIV infection and syndemic productions among men who have sex with men (MSM): Findings from the Multicenter AIDS Cohort Study (MACS). Presented at the XVIII International AIDS Conference, Vienna, Austria.
Lloyd, S., & Operario, D. (2012). HIV risk among men who have sex with men who have experienced childhood sexual abuse: Systematic review and meta-analysis. AIDS Education and Prevention, 24, 228–241.
Loeb, T. B., Gaines, T., Wyatt, G. E., Zhang, M., & Liu, H. (2011). Associations between child sexual abuse and negative sexual experiences and revictimization among women: Does measuring severity matter? Child Abuse and Neglect, 35(11), 946–955. doi:10.1016/j.chiabu.2011.06.003.
Maniglio, R. (2010). Child sexual abuse in the etiology of depression: A systematic review of reviews. Depression and Anxiety, 27(7), 631–642. doi:10.1002/da.20687.
McKibben, J. B., Bresnick, M. G., Wiechman-Askay, S. A., & Fauerbach J. A. (2008). Acute stress disorder and posttraumatic stress disorder: A prospective study of prevalence, course, and predictors in a sample with major burn injuries. Journal of Burn Care & Research, 29, 22–35. doi:10.1097/BCR.0b013e31815f59c4.
Merrill, L. L., Guimond, J. M., Thomsen, C. J., & Milner, J. S. (2003). Child sexual abuse and number of sexual partners in young women: The role of abuse severity, coping style, and sexual functioning. Journal of Consulting and Clinical Psychology, 71(6), 987–996. doi:10.1037/0022-006X.71.6.987.
Merrill, G. S., & Wolfe, V. A. (2000). Battered gay men: An exploration of abuse, help seeking, and why they stay. Journal of Homosexuality, 39(2), 1–30. doi:10.1300/J082v39n02_01.
Metzger, D. S., Koblin, B., Turner, C., Navaline, H., Valenti, F., Holte, S., … Seage, G. R. (2000). Randomized controlled trial of audio computer-assisted self-interviewing: Utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. American Journal of Epidemiology, 152(2), 99–106.
Millstein, S. G. (1987). Acceptability and reliability of sensitive information collected via computer interview. Educational and Psychological Measurement, 47(2), 523–533. doi:10.1177/0013164487472028.
Mimiaga, M. J., Noonan, E., Donnell, D., Safren, S. A., Koenen, K. C., Gortmaker, S., … Mayer, K. H. (2009). Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study. Journal of Acquired Immune Deficiency Syndromes, 51(3), 340–348. doi:10.1097/QAI.0b013e3181a24b38.
Mimiaga, M. J., O’Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, … Mayer, K. H. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 68, 329–336.
Mustanski, B., Garofalo, R., Herrick, A., & Donenberg, G. (2007). Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Annals of Behavioral Medicine, 34(1), 37–45.
Mustanski, B. S., Newcomb, M. E., Du Bois, S. N., Garcia, S. C., & Grov, C. (2011). HIV in young men who have sex with men: A review of epidemiology, risk and protective factors, and interventions. Journal of Sex Research, 48(2–3), 218–253. doi:10.1080/00224499.2011.558645.
Navaline, H. A., Snider, E. C., Petro, C. J., Tobin, D., Metzger, D., Alterman, A. I., & Woody, G. E. (1994). Preparations for AIDS vaccine trials. An automated version of the Risk Assessment Battery (RAB): Enhancing the assessment of risk behaviors. AIDS Research and Human Retroviruses, 10(Suppl. 2), S281–283.
Neumann, D. A., Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment, 1(1), 6–16. doi:10.1177/1077559596001001002.
Nieves-Rosa, L. E., Carballo-Dieguez, A., & Dolezal, C. (2000). Domestic abuse and HIV-risk behavior in Latin American men who have sex with men in New York City. Journal of Gay and Lesbian Social Services, 11(1), 77–90. doi:10.1300/J041v11n01_04.
O’Cleirigh, C., Newcomb, M. E., Mayer, K. H., Skeer, M., Traeger, L., & Safren, S. A. (2013). Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: A longitudinal analysis of data from six sites involved in a “prevention for positives” study. AIDS and Behavior, 17(5), 1764–1769. doi:10.1007/s10461-013-0462-8.
O’Cleirigh, C., Safren, S. A., & Mayer, K. H. (2012). The pervasive effects of childhood sexual abuse: Challenges for improving HIV prevention and treatment interventions. Journal of Acquired Immune Deficiency Syndromes, 59(4), 331–334. doi:10.1097/QAI.0b013e31824aed80.
O’Cleirigh, C., Tan, J. Y., Raminani, S. R., Reilly, L. C., Otto, M. W., et al. (2011). Medication adherence outcomes are mediated by treatment-related changes in depression among people with HIV in treatment for opiate dependence. Presented at the 6th International Conference on HIV Treatment and Prevention Adherence.
O’Leary, A., Purcell, D., Remien, R. H., & Gomez, C. (2003). Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care, 15(1), 17–26. doi:10.1080/0954012021000039725.
O’Reilly, J. M., Hubbard, M. L., Lessler, J. T., Biemer, P. P., & Turner, C. F. (1994). Audio and video computer-assessed self-interviewing: Preliminary tests of new technologies for data collection. Journal of Official Statistics, 10(2), 197–214.
Ondersma, S. J., Chaffin, M., Berliner, L., Cordon, I., & Goodman, G. S. (1998). Sex with children is abuse: Comment on Rind, Tromovitch, and Bauserman (1998). Psychological Bulletin, 127, 707–714.
Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102(1), 156–162. doi:10.2105/AJPH.2011.300284.
Paul, J. P., Catania, J., Pollack, L., & Stall, R. (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study. Child Abuse and Neglect, 25(4), 557–584.
Reisner, S. L., Mimiaga, M. J., Safren, S. A., & Mayer, K. H. (2009). Stressful or traumatic life events, post-traumatic stress disorder (PTSD) symptoms, and HIV sexual risk taking among men who have sex with men. AIDS Care, 21(12), 1481–1489. doi:10.1080/09540120902893258.
Relf, M. V. (2001a). Battering and HIV in men who have sex with men: A critique and synthesis of the literature. Journal of the Association of Nurses in AIDS Care, 12(3), 41–48.
Relf, M. V. (2001b). Childhood sexual abuse in men who have sex with men: The current state of the science. Journal of the Association of Nurses in AIDS Care, 12(5), 20–29.
Relf, M. V., Huang, B., Campbell, J., & Catania, J. (2004). Gay identity, interpersonal violence, and HIV risk behaviors: An empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men. Journal of the Association of Nurses in AIDS Care, 15(2), 14–26. doi:10.1177/1055329003261965.
Rind, B., Tromovitch, P., & Bauserman, R. (1998). A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin, 124, 22–53.
Safren, S. A., Reisner, S. L., Herrick, A., Mimiaga, M. J., & Stall, R. (2010). Mental health and HIV risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 55(Suppl. 2), S74–S77. doi:10.1097/QAI.0b013e3181fbc939.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl. 20), 22–33. quiz 34–57.
Skeer, M. R., Mimiaga, M. J., Mayer, K. H., O’Cleirigh, C., Covahey, C., & Safren, S. A. (2012). Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS and Behavior, 16(3), 676–689. doi:10.1007/s10461-011-9880-7.
Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). User’s guide for the structured clinical interview for DSM-IV Axis I disorders SCID-I: Clinician Version. Washington, DC: American Psychiatric Publishers.
Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., … Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93(6), 939–942.
Stanley, J. L., Bartholomew, K., & Oram, D. (2004). Gay and bisexual men’s age-discrepant childhood sexual experiences. Journal of Sex Research, 41, 381–389. doi:10.1080/00224490409552245.
Suvak, M. K., Brogan, L. A., & Shipherd, J. C. (2012). Predictors of sexual functioning in a sample of U.S. Marines: An 11-year follow-up study. International Journal of Sexual Health, 24(1), 26–44. doi:10.1080/19317611.2011.640387.
Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science, 280(5365), 867–873.
Valentine, S. E., & Pantalone, D. W. (2013). Correlates of perceptual and behavioral definitions of abuse in HIV-positive sexual minority men. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 417–425.
Van Bruggen, L. K., Runtz, M. G., & Kadlec, H. (2006). Sexual revictimization: The role of sexual self-esteem and dysfunctional sexual behaviors. Child Maltreatment, 11(2), 131–145. doi:10.1177/1077559505285780.
Wilson, F. R., Genco, K. T., & Yager, G. G. (1985). Assessing the equivalence of paper-and-pencil vs. computerized tests: Demonstration of a promising methodology. Computers in Human Behavior, 1(3–4), 265–275. doi:10.1016/0747-5632(85)90017-2.
Zink, T., Klesges, L., Stevens, S., & Decker, P. (2009). The development of a sexual abuse severity score: Characteristics of childhood sexual abuse associated with trauma symptomatology, somatization, and alcohol abuse. Journal of Interpersonal Violence, 24(3), 537–546. doi:10.1177/0886260508317198.
Acknowledgments
This study was supported by a Grant from the NIMH (R01 MH095624) PI: O’Cleirigh; Author time (Safren) was supported, in part, by Grant 5K24MH094214.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boroughs, M.S., Valentine, S.E., Ironson, G.H. et al. Complexity of Childhood Sexual Abuse: Predictors of Current Post-Traumatic Stress Disorder, Mood Disorders, Substance Use, and Sexual Risk Behavior Among Adult Men Who Have Sex with Men. Arch Sex Behav 44, 1891–1902 (2015). https://doi.org/10.1007/s10508-015-0546-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-015-0546-9