UCSF study finds Gay/Bisexual men who were sexually abused

Men who have sex with men (MSM) who are victims of childhood sexual abuse are
more likely to engage in risky sexual behavior than other MSMs, say researchers
from UCSF’s Center for AIDS Prevention (CAPS).

The study, published in the April issue of Child Abuse & Neglect, found that
about one fifth (20.6%) of all MSMs experienced childhood sexual abuse—a rate
that is higher than prevalence estimates for the general male population. 
These men’s early sexual victimization experiences typically involved physical
force, penetrative sex, and were highly distressing. Researchers found that
greater severity of childhood abuse (more incidents) was associated with higher
rates of risky sexual behavior.  Findings were similar using two different
definitions of risky sexual behavior (unprotected anal intercourse with a
non-primary partner; unprotected anal intercourse with a male whose HIV status
was different from their own).  As further evidence of their greater sexual
risk-taking, those reporting childhood sexual abuse were more likely to be
HIV-positive (24% vs. 14%).

To understand better the linkages between childhood sexual abuse and current
sexual risk, the researchers examined other behaviors that are both associated
with sexual risk taking and with childhood sexual abuse.  The study found that
the men who had been victimized had higher rates of sex under the influence of
alcohol/drugs, “one-night stands,” and intimate partner violence, the
researchers said.  The current risk behavior of sexually abused men could be
related to these variables, which were also linked to other measures of
disturbed family functioning (e.g., childhood physical abuse, parental
substance abuse).

“These findings clearly indicate that there is a need to consider childhood
sexual abuse in developing and delivering HIV prevention interventions. 
Messages that emphasize the avoidance of ‘sex under the influence’ may not be
effective for those men whose use of substances may be a form of coping with
the disturbing aftermath of early sexual traumatization.  Work can be done to
identify prevention strategies that consider the after-effects of childhood
sexual abuse,” said lead author, Jay Paul, PhD, a specialist in the division of
medicine at UCSF’s Center for AIDS Prevention Studies.

“In addition, given the extent to which this is a problem among MSM, community
services should be reviewed to ensure that appropriate referrals are offered at
points where these men may contact mental health, substance abuse, social
services and medical services.  The multiple health-related negative
consequences of childhood sexual abuse emphasize the need to give this issue
appropriate attention,” said Paul.

The study analyzed data collected in the Urban Men’s Health Study, a telephone
sample of MSMs in San Francisco, New York, Chicago, and Los Angeles.  These
four cities were selected due to their importance as regional centers, being
the source of two thirds of U.S. MSM AIDS cases, and the estimated size and
concentration of their MSM population. This sample, conducted between November
1996 and February 1998, interviewed 2881 MSMs.  The interviews covered numerous
health issues; other findings (such as overall levels of risk behavior) have
been reported elsewhere.

Study co-investigators are Joseph Catania, PhD, assistant professor of medicine
with UCSF CAPS, Lance Pollack, PhD, specialist at UCSF CAPS, and Ron Stall,
PhD, MPH, Chief of the Behavioral Interventions Research Branch at the Division
of HIV/AIDS Prevention at the Centers for Disease Control.

The research was supported by grants from the National Institute of Mental
Health, the National Institute of Alcohol Abuse and Alcoholism, and the Centers
for Disease Control and Prevention’s Division of HIV/AIDS Prevention. Further
research to gain a clearer understanding of these issues has been funded by the
National Institute of Mental Health.