Childhood Sexual Abuse Is Highly Associated With HIV Risk-Taking Behavior and Infection Among MSM in the EXPLORE Study.
Journal of Acquired Immune Deficiency Syndrome, 2009 Apr 13. [Epub ahead of print]
Mimiaga MJ, Noonan E, Donnell D, Safren SA, Koenen KC, Gortmaker S, Oʼcleirigh C, Chesney MA, Coates TJ, Koblin BA, Mayer KH.
From the *Departments of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA; daggerEpidemiology Unit, The Fenway Institute, Fenway Community Health, Boston, MA; double daggerStatistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA; section signDepartments of Society, Human Development and Health, and Epidemiology, Harvard School of Public Health, Boston, MA; ||Center for AIDS Prevention Studies, The University of California at San Francisco, San Francisco, CA; paragraph signThe University of California Los Angeles School of Medicine, Los Angeles, CA; #New York Blood Center, New York, NY; and **Departments of Infectious Diseases and Community Health, Miriam Hospital, Brown Medical School, Providence, RI.
Previous studies have found high rates of childhood sexual abuse (CSA) among US men who have sex with men (MSM). CSA history has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV acquisition and transmission. The present analysis is the first to examine the longitudinal association between CSA and HIV infection, unprotected anal sex, and serodiscordant unprotected anal sex, as well as mediators of these relationships among a large sample of HIV-uninfected MSM.
The EXPLORE Study was a behavioral intervention trial conducted in 6 US cities over 48 months with HIV infection as the primary efficacy outcome. Behavioral assessments were done every 6 months via confidential computerized assessments. Longitudinal regression models were constructed, adjusting for randomization arm, geographical location of study site, age at enrollment, education, and race/ethnicity.
Of the 4295 participants enrolled, 39.7% had a history of CSA. Participants with a history of CSA [adjusted hazards ratio = 1.30, 95% confidence interval (CI): 1.02 to 1.69] were at increased risk for HIV infection over study follow-up. A significant association was seen between history of CSA and unprotected anal sex (adjusted odds ratio = 1.24, 95% CI: 1.12 to 1.36) and serodiscordant unprotected anal sex (adjusted odds ratio = 1.30, 95% CI: 1.18 to 1.43). Among participants reporting CSA, the EXPLORE intervention had no effect in reducing HIV infection rates. Participants reporting CSA were significantly more likely to have symptoms of depression and use nonprescription drugs.
A predictive relationship between a history of CSA and subsequent HIV infection was observed among this large sample of HIV-uninfected MSM. Findings indicate that HIV-uninfected MSM with CSA histories are at greater risk for HIV infection, report higher rates of HIV sexual risk behavior, and may derive less benefit from prevention programs. Future HIV prevention interventions should address the specific mental health concerns of MSM with a history of CSA.