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.     

Child Sexual Abuse and Adult Mental Health,Sexual Risk Behaviors,and Drinking Patterns Among Latino Men Who Have Sex With Men

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals’ likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.     

Childhood sexual experiences and the perception of abuse among latino men who have sex with men

There is a lack of consensus on how to define childhood sexual abuse (CSA). In this study we explore the perceptions of CSA among men who had such experiences. One hundred Latino men (predominately gay) who had childhood sexual experiences with an older partner (CSEOP) were asked whether they considered their experiences sexual abuse (41 said no; 59 said yes). Those who felt abused were younger when the events happened and were more likely to have been physically forced, physically hurt, threatened, and emotionally hurt. Negative correlates of CSEOP in adulthood were also explored. Men who considered themselves the victims of CSA differed from those without CSEOP in having more alcohol use, unprotected anal sex, and male sex partners.     

Childhood sexual experiences and the perception of abuse among Latino men who have sex with men

There is a lack of consensus on how to define childhood sexual abuse (CSA). In this study we explore the perceptions of CSA among men who had such experiences. One hundred Latino men (predominately gay) who had childhood sexual experiences with an older partner (CSEOP) were asked whether they considered their experiences sexual abuse (41 said no; 59 said yes). Those who felt abused were younger when the events happened and were more likely to have been physically forced, physically hurt, threatened, and emotionally hurt. Negative correlates of CSEOP in adulthood were also explored. Men who considered themselves the victims of CSA differed from those without CSEOP in having more alcohol use, unprotected anal sex, and male sex partners.     

Sexual Risk-Taking among High-Risk Urban Women with and without Histories of Childhood Sexual Abuse: Mediating Effects of Contextual Factors

This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse histories. Childhood sexual abuse survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the childhood sexual abuse group. The mechanisms of risk are different for those with divergent childhood sexual abuse histories and thus interventions should be developed to educate women with a history of childhood sexual abuse about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use.     

Physical Abuse in Early Childhood and Transition to First Sexual Intercourse among Youth in Cape Town,South Africa

This study examined the relationship of physical abuse in early childhood and timing of first sexual intercourse among young South Africans aged 14 to 22 in Cape Town. Using the Cape Area Panel Survey and applying log-normal models, time ratios were estimated to show how rapidly or slowly youth experience first sexual intercourse. Results indicated that boys who experienced physical abuse in early childhood had faster timing to first sex. Boys and girls with violent school environments had faster timing to first sex. Race moderated the effects of physical abuse. Compared to Blacks, Coloreds who experienced higher levels of physical abuse in early childhood had faster timing to first sex. Youth with greater knowledge about HIV/AIDS and those with greater risk perception of contracting HIV/AIDS delayed first sex. On the basis of these findings, policy makers are encouraged to consider the early childhood experiences of youth when designing policies toward HIV/AIDS prevention in South Africa.     

Coerced Sexual Experiences Among Adolescent Substance Abusers: A Potential Pathway to Increased Vulnerability to HIV Exposure

This study describes the forced sexual experiences, serious internalizing problems, risky sexual behavior, and alcohol-related correlates of risky sexual behavior of 120 substance abusing adolescents and young adults (87 men, 33 women; mean age = 17.2 years) undergoing treatment. Prior coerced sexual experiences were associated with suicidal thoughts and attempts, higher levels of risky sexual behaviors, avoidance motives for drinking, and sexual decision-making conducive to risky sexual behavior. Sexual coercion was associated with patterns of sexual behavior and alcohol use that potentially increase vulnerability to HIV exposure. Social workers can play a number of significant roles in addressing ongoing psychological distress associated with sexual coercion among these predominantly female adolescents. Therefore, effective social work practice should enhance treatment effectiveness and reduce risk for a range of maladaptive outcomes including exposure to sexually transmitted diseases (STDs) and revictimization.     

Exploring and Adapting a Conceptual Model of Sexual Positioning Practices and Sexual Risk Among HIV-Negative Black Men Who Have Sex With Men

Estimates show a 50% lifetime human immunodeficiency virus (HIV) risk among Black men who have sex with men (BMSM) in the United States(U.S.). Studying the dynamics of sexual positioning practices among BMSM could provide insights into the disparities observed among U.S. groups of men who have sex with men (MSM). This study explored sexual positioning dynamics among HIV-negative BMSM and how they aligned with a theoretical model of sexual positioning and HIV/sexually transmitted infection (STI) risk among MSM. In-depth qualitative interviews were conducted with 29 HIV-negative BMSM between ages 25 and 35 in Los Angeles. Comments related to sexual behaviors were reviewed for relevance regarding oral or anal sexual positioning practices. Data presented represent the range of themes related to decision making regarding sexual positioning. Personal preference, partner attraction, HIV avoidance, and feeling obligated to practice partner preferences influenced sexual positioning. Drug use also affected decision making and was sometimes preferred in order to practice receptive anal intercourse. These variables build on the conceptual model of sexual positioning practices and sexual risk, and add understanding to the relationship between preferences, practices, and risk management. Future research on risk among HIV-negative BMSM should quantify the relative impact of personal preferences, partner attraction, partner type, compromise, and substance use on sexual positioning practices and risk.     

A Developmentally Relevant Approach to Classifying Nonconsensual Sexual Experiences in the Study of Women’s Sexual Well-Being

In this article we propose a sexual developmental approach to classifying the onset of nonconsensual sexual experiences (NSEs) that differs from the traditional age cutoff approach. Online measures of sexual self-schemas, sexual response, and sexual functioning were administered to 797 women with and without NSE histories. Women were grouped based on when their NSEs first occurred in reference to their age of menarche and age of their first consensual sexual experience (i.e., premenarche onset, postmenarche preconsensual onset, postconsensual onset, and no NSEs). Between-group analyses assessed differences in sexual well-being and structural equation modeling (SEM) assessed measurement invariance across the four groups. Women with NSE onset postmenarche but before their first consensual sexual experience reported significantly more conservative-embarrassed sexual self-schemas than did women with no NSEs. Women with NSE onset postmenarche and post–first consensual sex had significantly less sexual satisfaction than did women with no NSE histories. The other groups did not significantly differ from each other. The model demonstrated partial indicator-level metric noninvariance, suggesting that the various indicators of sexuality contributed differentially to the overall sexual well-being across these groups of women. The results support the use of the developmentally informed approach to classifying NSEs when assessing female sexual well-being.     

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.     

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.     

Human immunodeficiency virus (HIV) seropositive homeless men: Behavioral and social characteristics

Homeless persons living in U.S. innercities are at risk for human immunodeficiency virus (HIV) infection, but few studies have examined the continued risk behaviors of HIV infected homeless men. We investigated the sexual behavior of 32 homeless men who had tested HIV seropositive. Twenty-five percent of HIV positive men reported a history of injection drug use, 34% had sex with men, over 40% had participated in commercial sex, and 59% had been treated for a non-HIV sexually transmitted disease. HIV seropositive men also reported recent sexual behavior, with 62% having sex in the previous month and 50% currently sexually active. Condom use was inconsistent among seropositive men; 44% of vaginal and 50% of anal intercourse occasions in the preceding three months did not involve condoms, and 28% of HIV seropositive men did not use a condom during their most recent sexual encounter. Substance use was frequently associated with unprotected sexual behavior among HIV seropositive men. Finally, measures of life satisfaction showed that HIV seropositive men were most satisfied with their relationships, mental health, and spiritual well being. These data suggest a need for intensive behavioral interventions tailored for homeless HIV infected men and we recommend that existing substance use treatment and holistic care be incorporated into behavioral interventions for HIV infected men.     

Predictors of HIV Sexual Risk Behavior Among Men Who Have Sex with Men,Men Who Have Sex with Men and Women,and Transgender Women

ABSTRACT

Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.     

The Impact of Childhood Sexual Abuse on Later Sexual Victimization among Runaway Youth

Path analysis was used to investigate the impact of childhood sexual abuse on later sexual victimization among 372 homeless and runaway youth in Seattle. Young people were interviewed directly on the streets and in shelters by outreach workers in youth service agencies. High rates of both childhood sexual abuse and street sexual victimization were reported, with females experiencing much greater rates compared with their male counterparts. Early sexual abuse in the home increased the likelihood of later sexual victimization on the streets indirectly by increasing the amount of time at risk, deviant peer affiliations, participating in deviant subsistence strategies, and engaging in survival sex. These findings suggest that exposure to dysfunctional and disorganized homes place youth on trajectories for early independence. Subsequently, street life and participation in high‐risk behaviors increases their probability of sexual victimization.     

Risk Bases in Childhood and Adolescence Among HIV-Negative Young Adult Gay and Bisexual Male Barebackers

ABSTRACT

We sought to consider the phenomenon of intentional unprotected intercourse, known colloquially as barebacking, with regard to identities that gay men develop as barebackers and the developmental bases that may predispose some men to this identity. As part of a larger study, we analyzed the life history interviews of 12 diverse HIV-negative men in early adulthood, using thematic coding procedures to identify events, conditions, and emotional states in childhood and adolescence that might help to explain why uninfected young men might place themselves at risk for HIV seroconversion. These analyses elicited various risk bases in childhood and adolescence, including early sexual experiences, pronounced experimentation with and abuse of drugs and alcohol, feelings of loneliness, a lack of love relationships despite sexual activity, and early experiences of loss. These findings suggest a complex interplay between emotional factors and life events, which may help to explain these men as sexual risk takers.     

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.     

Assessing the Prevalence of Unwanted Childhood Sexual Experiences

A survey of 345 college men and women avoided the conceptual and definitional of past studies of sexual victimization bv using an explicit checklist to ask respondents which of a variety of overt sexual behaviors they had experienced before the age of 16 when they did not want to. Forty-five percent of the group reported bothersome incidents, and a fifth of them, both males and females, had engaged in unwanted oral, anal, or vaginal sex. When they occurred, these severe experiences occurred both more frequently and for longer periods than did less severe experiences. The checklist procedure may be an optimal method for eliciting self-report of early, aversive sexual experiences, which may be considerably more prevalent than is commonly believed.     

Sexual Risk Behaviors and Perceptions of Men Who Go to Gay Sex Parties in New York City: Comparisons Between Three HIV Groups

Men who have sex with men (MSM) who attend group-sex events often engage in risky sexual behaviors that contribute to the high human immunodeficiency virus (HIV) incidence among this population. We conducted an online survey with 211 New York City MSM who attended sex parties in the prior year and asked them to describe their behaviors and perceptions of risk. We compared responses from HIV-positive-undetectable men (n = 36), HIV-negative men on pre-exposure prophylaxis (PrEP; n = 62), and HIV-negative men never on PrEP (n = 113). In bivariate analyses, undetectable and on-PrEP men had been to more sex parties in the prior six months, had more anal sex partners there, and had higher rates of sexually transmitted infection (STI) diagnoses than men never on PrEP. Although less than the other groups, 43% of the presumably HIV-negative men never on PrEP reported condomless anal sex at a party in the prior six months. About half of participants agreed that, at sex parties, they made assumptions about others’ HIV status, that they sometimes took more risks than intended, and that the atmosphere of these events was conducive to risk taking. Most disagreed that there was discussion of HIV status at sex parties. Implications for sexual health interventions are discussed.     

Briefly Noted

Researchers have found that mirtazapine, in addition to counseling for substance use, reduced methamphetamine use and some HIV risk behaviors in cisgender men and transgender women who have sex with men. Mirtazapine, an antidepressant also known as Remeron, showed benefits after treatment ended, even if patients didn't always take their medication or took less than they were supposed to. The study follows a previous study of mirtazapine finding reductions in methamphetamine use and sexual risk behaviors among men who have sex with men. “Effects of mirtazapine for methamphetamine use disorder among cisgender men and transgender women who have sex with men: A placebo‐controlled randomized clinical trial” was published in JAMA Psychiatry online last week by Phillip Coffin, M.D. and colleagues. The RCT took place over a course of 24 weeks from 2013 to 2017 in San Francisco. Main outcomes measured were urine tests for methamphetamine and sexual risk behaviors, with sleep, methamphetamine craving, dependence severity, and adverse events also assessed. Sexual risk behaviors included number of sexual partners, and frequency of condomless anal sex. Participants assigned to mirtazapine also had reductions in depressive symptoms.