Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.     

Factors that predict how women label their own childhood sexual abuse

Despite the psychological impact of child sexual abuse, many victims do not acknowledge that their experiences were "abuse". This study sought to identify factors that predict how women label their own experiences of childhood sexual abuse. This cross-sectional study was conducted in a family medicine clinic with adult female patients. Subjects completed structured interviews about their childhood environment and their sexual abuse history. Logistic regression analysis showed that labeling of abuse was dependent upon intercourse (beta = 7.43, p = .006), the frequency of abuse by the first perpetrator (beta = 5.08, p = .024), and paternal overprotection (beta = 6.69, p = .010). Findings suggest that the severity of abusive acts is most important and an over-protective father may enhance the victim's acknowledgment that sexual touching is abusive.     

Partnering with parents to prevent childhood sexual abuse

Although research demonstrates that child‐focused sexual abuse prevention programmes can teach children personal safety knowledge and skills, childhood sexual abuse (CSA) prevention programmes that involve parents have a number of distinct advantages. The more knowledge parents have about CSA, the greater likelihood they can create safer environments for their children and thus prevent the occurrence of sexual exploitation. Research has demonstrated that parents lack crucial information about CSA and can benefit from even brief educational efforts. This paper will identify potential barriers to participation and offer practical suggestions for enhancing both recruitment and retention rates. Recommendations for parent education programmes are offered, including improving parents' confidence and skills in educating their children about CSA, providing them with parent‐friendly materials to use and developing Internet applications. Copyright © 2010 John Wiley & Sons, Ltd.     

Remembering and forgetting childhood sexual abuse

Twelve white middle-class women who had been severely sexually abused as children by a family member were asked to provide a narrative of their abuse and discuss their subsequent remembering and forgetting of these experiences. Most claimed they had undergone periods during which they had not recalled their abuse, but also claimed that they had never forgotten their experiences at another point during the interview. Nine of the women had actively tried to forget the abusive experiences, although 8 still experienced recurrent and often relentless intrusive memories. Our findings suggest that women with continuous memories may have longer and more coherent narratives than women without continuous memories. Implications of these findings for understanding the phenomenology of memory experiences and the concept of "recovered" memories of childhood sexual abuse are discussed.     

Unwanted sexual experiences and sexual risks in gay and bisexual men: Associations among revictimization,substance use,and psychiatric symptoms

The data set of 2,182 gay/bisexual men's month‐long sexual diaries collected by the United Kingdom Socio‐sexual Investigations of Gay Men and Aids (Project SIGMA) was used to analyse the extent to which acts of anal intercourse (AI) are distributed among gay men, using the Lorenz/Gini methodology for measuring concentration. Most individuals (60%) who engage in AI do so only once or twice a month, but there is a long tail of those who do it much more. In terms of the amount of AI acts, one tenth of the individuals are performing half of the acts of AI. The Gini coefficient of concentration is high (0.55). Factors most affecting rates and concentration of risk behaviour include relationship status, HIV sero‐status and concordant/discordant partner status.     

Contempt and defensiveness in couple relationships related to childhood sexual abuse histories for self and partner

This study examined the relationship between a history of childhood sexual abuse (CSA) for one or both members of a romantic couple and perceptions of contempt and defensiveness for self and partner. Data from the Relationship Evaluation (RELATE) were analyzed for 10,061 couples. The findings suggest that when either or both partner(s) has a history of CSA, contempt and defensiveness in the couple relationship are greater than when neither reports a history of CSA. Furthermore, the males' experience of CSA had a greater impact on their perceptions of self and partner's contempt and defensiveness than females' experience of CSA. Explanations of gender differences are offered and implications for future research and practice are suggested.     

Neurodevelopmental biology associated with childhood sexual abuse

Child maltreatment appears to be the single most preventable cause of mental illness and behavioral dysfunction in the United States. Few published studies examine the developmental and the psychobiological consequences of sexual abuse. There are multiple mechanisms through which sexual abuse can cause post-traumatic stress disorder, activate biological stress response systems, and contribute to adverse brain development. This article will critically review the psychiatric problems associated with maltreatment and the emerging biologic stress system research with a special emphasis on what is known about victimization by sexual abuse.     

The role of sexual behavior in the identification process of gay and bisexual males

This study examined the role of same‐sex sexual behavior in the identification and coming‐out process among three cohorts of gay and bisexual males. The sequence through which the males identified their same‐sex attractions was coded as either sex‐centered (labeling of sexual identity after first same‐sex sexual encounter) or identity‐centered (labeling of sexual identity before engaging in sex with males). The project tested whether developmental sequence was a significant predictor of later adjustment to sexual identity and relationship involvement. Findings demonstrate that the proportion of sex‐centered males decreased as a function of age cohort. Moreover, sex‐centered males reported higher levels of homophobia toward other males, more lifetime sexual partners, and more heterosexual sexual and romantic relationships. Thus, the route males take to identify and label their sexual identity is a good predictor of future adjustment and relationship involvement.     

A comparison of risk factors for sexual victimization among gay, lesbian, bisexual, and heterosexual homeless young adults

Although high rates of sexual victimization have been reported among homeless youth, less is known about whether the risk factors vary for gay, lesbian, and bisexual youth compared to heterosexual youth. Based on a sample of 172 homeless young adults ages 19 to 26, results revealed that depressive symptoms, prostitution, and having friends who traded sex were significantly associated with higher levels of sexual victimization. Gay, lesbian, and bisexual young adults experienced more sexual victimization compared to heterosexual young adults. A test for interactions revealed that the effect of sexual orientation on sexual victimization was moderated by trading sex and having friends who traded sex. Finally, there is support for partial mediation of the effects of sexual abuse, neglect, and depressive symptoms on sexual victimization through other risk factors.     

Practical ways psychotherapy can support physical healthcare experiences for male survivors of childhood sexual abuse

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2009), which is intended to help healthcare providers from all disciplines understand the effect of child sexual abuse on some survivors' abilities to access and benefit from health care. This paper discusses what psychotherapists can learn from the healthcare experiences of the male survivors who participated in this project. It also offers practical suggestions for supporting male clients who experience difficulty seeking treatment for physical health concerns.     

Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada

Some studies suggest lesbian, gay, and bisexual (LGB) teens are at higher risk than peers for violence at home, in school, and in the community. That can bring them into the child welfare system or services for runaway and homeless teens. This study compared self-reported experiences of sexual and physical abuse based on sexual orientation and gender in seven population-based surveys of youth. The authors used c2 and age-adjusted odds of abuse to compare bisexual to heterosexual, mostly heterosexual, and gay and lesbian students. They also provide case studies to illustrate the experiences of such youth.     

Time to ask and tell: Voices of older gay and bisexual male veterans regarding community services

ABSTRACT

This participatory action study involved lesbian, gay, bisexual, transgender, and queer (LGBTQ) veterans in determining community-based service needs for health and wellness, illuminating perspectives of older LGBTQ veterans regarding community services. This study explored veterans' perceptions of being LGBTQ later in life. The study included data from interviews with gay and bisexual male veterans ages 51 to 87. Participants valued engagement as part of community. Their recommendations for action included communal meals, transportation, housing, and the coming-out process. Community services facilitated community engagement to support health and wellness for LGBTQ older veterans. The authors used participatory action research (PAR), a method of systematic inquiry integrating the perspective of persons living the experience, to organize the study. Further PAR is recommended to implement community services to meeting health and wellness needs of participants.     

Preventing childhood sexual abuse: an ecological approach

Childhood sexual abuse is a significant public health problem that negatively affects victims, families, organizations, and society. This special issue presents innovative approaches designed to prevent the sexual exploitation of youth. Using both an ecological approach and the Spectrum of Prevention ( Parks, Davis & Cohen, 2010 ), the articles collected for this special issue highlight cutting-edge prevention approaches educating children, parents, professionals, organizations, and the general public.     

Parents’ awareness of lesbian,gay, and bisexual youths’ sexual orientation

This study used a sample of 293 lesbian, gay, and bisexual youth to examine factors that differentiated youth whose parents knew of their sexual orientation from youth whose parents did not know. Earlier awareness and disclosure of same‐gender attractions, greater childhood gender atypicality, and less internalized homophobia were characteristic of youth whose parents were aware of youths’ sexual orientation. Youth with aware parents reported more past verbal victimization on the basis of sexual orientation from parents, yet more current family support and less fear of future parental victimization on the basis of their sexual orientation.     

Community reactions to campaigns addressing crystal methamphetamine use among gay and bisexual men in New York City

Crystal methamphetamine (aka "crystal meth") use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed.     

Healing from childhood sexual abuse: a theoretical model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.     

Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.     

Experiences of disclosure of childhood sexual abuse and psychopathology

Reported child sexual abuse is associated with the development of anorexia and bulimia nervosa overall, but the mediating factors that determine whether such abuse is relevant in individual cases are not adequately understood. This study considers the importance of the experience of initial disclosure as a mediator in a case series of eating-disordered women. The extent of psychopathology (particularly the frequency of vomiting and the presence of the symptoms of borderline personality disorder) was associated with the nature of the perceived response to an attempted disclosure. A perceived lack of response or a negative, hostile response was associated with specific patterns of symptomatology. Further research is suggested to extend these conclusions, and the clinical implications of these findings are discussed.