A history of childhood sexual abuse was common and appeared to be linked to risky behavior during adulthood among a sample of HIV-infected men who have sex with men and who participated in safer-sex seminars in 2005–2006.1 Close to half of the men in the sample reported having been abused as children; most of this group, or about a third of the entire sample, said that the abuse had occurred with some frequency. The frequency of abuse was positively associated with men’s reported number of recent sexual contacts and recent acts of unprotected anal intercourse. Men reporting a history of abuse were more likely than others to be black or Latino.
To be eligible for participation in the seminars, which were conducted in six major cities with high rates of HIV infection, men had to be HIV-positive, be at least 18 years old and say that they had had unprotected anal sex with a man at least once in the previous year. The analyses are based on the 593 participants who completed a self-administered baseline questionnaire and answered the questions about childhood sexual abuse. In bivariate analyses, researchers compared men who reported a history of abuse with those who did not; in multivariate analyses, they explored the relationships between abuse and selected sexual behaviors.
Forty-seven percent of the men said that at least once during childhood or adolescence, an older man or woman had forced them to have unwanted sexual activity; 15% reported that abuse had occurred once or rarely, 17% that it had happened sometimes and 15% that it had occurred often. Some 58% of those who had experienced abuse reported that the perpetrator was a man, 14% had been victimized by a woman and 28% had been abused by both.
In terms of demographic characteristics, men who had been abused and men who had not differed chiefly with regard to race and ethnicity: The proportions who were Latino and black were significantly greater among men with a history of abuse (28% and 47%, respectively) than among those reporting no childhood abuse (18% and 43%); 20% of men reporting abuse were white, compared with 32% of men not reporting abuse. Education also differed by group: Forty-three percent of men who had been abused, but only 34% of others, had no more than a high school education. Age differences were significant but small; employment status and income were comparable in the two groups.
The two groups registered sharp differences on measures assessing mental health and substance use. Men reporting abuse were significantly more likely than others to score at the high end of scales measuring compulsive sexual behavior (40% vs. 26%), negative feelings about their homosexuality (41% vs. 25%), and depression and anxiety (39% vs. 24%); they also were more likely than men not reporting abuse to give their level of comfort with sex a low rating (63% vs. 52%). Reports of problems with drugs, either currently or in the past, were more common among men who said they had been abused than among others (41% vs. 28%); the same was true of problems with alcohol (33% vs. 28%). About half of each group reported having used alcohol during anal sex during the last 90 days, but a higher proportion of men reporting abuse than of others said that they had used methamphetamines at least some of the time during anal sex (19% vs. 14%).
Reports of sexual orientation and sexual risk measures also varied by abuse status. The proportion of participants who said that they were gay or they were attracted to men was significantly lower among those who had been abused (77%) than among those who had not (84%). Consistent with those reports, abused men were less likely than others to say that their most recent partners in the past three months were exclusively or mostly men (84% vs. 93%). The two groups were similar in the proportions who said that they had had any intercourse, anal intercourse and unsafe anal intercourse (i.e., unprotected receptive or insertive anal sex with a partner who was HIV-negative or whose HIV status was unknown) during the previous three months. However, the median numbers of total acts of intercourse and total acts of anal intercourse (safe or unsafe) were larger among men reporting childhood abuse (24 and 15, respectively) than among those not reporting this experience (18 and 12). Men in the abuse group had received their HIV diagnosis somewhat longer ago than others (median, 12 vs. 11 years), but rates of STD diagnosis or treatment in the last three months did not differ between the groups.
Multivariate analyses showed a history of childhood abuse to be significantly related to sexual activity and unsafe sexual activity. Men who had been abused reported more sexual contacts in the past three months than others (rate ratio, 1.2 if abuse had occurred once or rarely, 1.3 if it had been occasional and 1.3 if it had been frequent). They also reported more acts of anal intercourse (1.2 for onetime or infrequent abuse, 1.4 for frequent abuse) and of unsafe anal intercourse (2.0 for occasional and 1.5 for frequent abuse).
While acknowledging that their sample is limited geographically and by participants’ risk profiles, the researchers nonetheless conclude that their findings "provide compelling evidence for an association of childhood sexual abuse with frequencies of sexual behavior." They advocate for "community-level programs aimed at reducing rates of childhood sexual abuse or mitigating the long-term effects of abuse in [men who have sex with men]," and they particularly point to the need for heightened awareness of childhood sexual abuse in minority communities.—D. Hollander
1. Welles SL et al., History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men, American Journal of Public Health, 2009, 99(6):1079–1086.